How do we change what people eat? Susan Jebb, professor of diet and population health, gives food for thought in the annual Oxford London Lecture.

The big fat questionBy Richard Lofthouse


Britain’s dreadfully expanding waistline loomed large at this year’s Oxford London Lecture, jostling for room with the big fat question of how to change what people eat. Titled Knowledge, Nudge and Nanny: Opportunities to Improve the Nation’s Diet, the lecture was given this week at Westminster’s Church House Conference Centre by Susan Jebb, professor of diet and population health at the Nuffield Department of Primary Care Health Sciences.

Apologising for stating the bleedin’ obvious, she began by reminding us that nutrient-rich leafy greens and fruit had been shown to be good for schoolchildren, and their polar opposites — heavily fatty and sugary sweets and snacks — were not. She reminded a packed auditorium that barely 2.5 per cent of health research budget links to food and diet. In other words, what we all know to be true still needs to be demonstrated through excellent research, but there is surprisingly little of it.

The big fat question

Later on, following a panel discussion, I felt sorry for Professor Jebb and her colleagues (pictured left to right: chair and Times columnist Alice Thomson, Professor Jebb, Tesco director of corporate responsibility Joshua Hardie, and Lord Krebs, who chairs the House of Lords science and tech committee). While they beat themselves up over the quality of the research, it’s obvious that no one is listening at all. The powers that determine what the nation eats are drenched in their own fatty substances, especially the money-making incentive. There is a food industry, a booze industry, a retail industry, a catering trade and a weight-loss industry. The sweetest profit margins often come from the foods most attractive to consumers — precisely the foods that are the least healthy. As consumers we are all selectively complicit.

We learned that stacking bottles of beer or bars of chocolate on the end of a supermarket aisle directly increases sales. Psychology matters. We also learned that banning multi-buy promotions for alcohol in Scotland had zero impact on quantities purchased.

Where politicians take a view, it is mired in sensibilities about not wanting to be seen as representatives of the ‘nanny state’. Above all, and zoning in on the inherently difficult nature of being a diet researcher, Jebb (pictured below with outgoing Vice-Chancellor Andrew Hamilton at the lecture) spoke about the ‘fundamental attribution error’ of assuming that because people know something is bad for them they won’t eat it. If someone brings a box of doughnuts to a work meeting, everyone will eat one. If the meeting hadn’t taken place, no one would have eaten one.

The takeaway of the talk (pun intended) can be boiled down to the following points. First, the NHS’s future as a ‘free service at the point of use’ rests heavily on tackling diabetes, because it already sucks up £14 billion a year, two thirds of that on the preventable ‘Type II’ variety. If we keep going as we are, this could torpedo the whole enterprise a few years down the line.

The big fat question

Second, research shows that intervention works (this is when someone is told they are at risk or exhibit very early signs of diabetes, and are helped to make lifestyle adjustments). On average they lose 4kgs over one year, but this results in a 58 per cent reduction in fully blown cases of diabetes down the line.

Third, general practitioners (it was shocking news to me) do not ever tell patients that they are overweight. In other words, the entire health system is built on treating ailments, not preventing them. Fourth, this culture of non-prevention is what has to change. Fifth, we need to regulate bad food the same way we regulate tobacco. Sixth, the industry needs to turn its back on ‘supersizing’ (and to a very limited degree has done so).

The big fat question

Seventh, there is a strong correlation (surprise!) between social deprivation, fast food availability, and obesity. Eighth, taxation works and is present in seven countries, but it is controversial and no one quite agrees on how effective it is. Ninth, British hospitals are absolutely shocking for setting a bad example, being full of fast food outlets and vending machines dispensing crisps and chocolate, promoting an ‘obesogenic’ environment in the one place where you would least expect it. Tenth, there is a need for global coordination.

So there we have it. In some ways the talk and the subsequent discussion were painfully, awkwardly English — as awkward as the title itself (a noun and two verbs?). Why do we persist in using words like nanny, when no one has one any more?

Luckily the straight-talking Scot Barbara Young, Baroness Young of Old Scone and chief executive of charity Diabetes UK, was having none of it and said the s*** word when joking about how we all gloat at other people’s groceries at the checkout, particularly if we have leeks and they only have Walkers crisps. It was a rare moment of levity in a somewhat dry evening with no solutions but terrible financial implications for Great Britain PLC. Words that were not mentioned once the whole evening included ‘sport’, ‘exercise’ and ‘fitness’. No one joked about Young’s life peerage and whether she was having cream and jam on it.

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Top and preview images © Lisa S. via Shutterstock. London lecture images © Oxford University Images / John Cairns.


By Dr Dick Morris

A well presented summary of a host of sensible, but difficult-to-implement ideas. Marred, sadly, by a throwaway line of lazy racism - "alcohol in Scotland had zero impact on quantities purchased (possibly a glimpse into national character, I thought)". As a Scot only by adoption (since retirement), I would still expect to be rightly pilloried for using comparable language about the English, or even more so in reference to other racial groups. One of the sadder aspects of the recent referendum is the way in which such casual racism about Scots and Scotland seems to have become acceptable. Yet, as the author notes, we tiptoe around any such comments in reference to those who are obese. Strange world.
[WEB EDITOR'S NOTE: The comment has been removed, and we thank Dr Morris for this reminder that tongue-in-cheek humour may inadvertently cause offence.]

By debbie sharp

GPs do not ever tell patients they are overweight. This is a shocking untruth. GPs spend a significant amount of time addressing lifestyle issues - diet, smoking, alcohol - whether directly related to the reason for consultation or not. Engaging patients in this dialogue is rarely easy but despite the singular lack of support from government policy with regard to the industries that 'feed' these behaviours we routinely offer patients help and advice. And we will continue to do so.

By John Valentine

Point 3 is absolute nonsense. GPs spend a huge amount of time on preventive work, checking blood pressure, smoking status and weight or "body mass index". They certainly tell people they are overweight - although it has been known for complaints to be made by patients who are told that they or their children are overweight. The problem is that telling people they are overweight is not very helpful - changing lifestyle seems to be very difficult for most. Successful interventions to reduce the risk of diabetes rightly focus on lifestyle measures but are very labour intensive and thus expensive.

By Richard Stickland

I would like to see an article which clearly explains which food should not be eaten if one wishes to reduce one's waist line, and which foods are recommended, without using expressions such as "fast food", "high calories", "bad food", etc., which are not understood by many, including myself.

By Julia S

Type 2 diabetes is not always preventable - or at least, if it is, we do not yet know all the ways in which it can be prevented. I have relatives with it who are skinny, and do everything they are told to do by doctors. Unfortunately it's in our family's genetic make-up.