Decades of obesity policies destined to fail, say researchers
Jesus College PhD student Dolly Theis (2018), and Martin White at the Centre for Diet and Activity Research (CEDAR), have published a critical study of 30 years of UK Government attempts to tackle obesity.
In research published in The Milbank Quarterly, they conclude that Government obesity policies in England over the past three decades have largely failed. They highlight problems with implementation, lack of learning from past successes or failures, and a reliance on trying to persuade individuals to change their behaviour rather than tackling unhealthy environments.
These findings may explain why, after decades of Government obesity policies, obesity levels in England have not fallen and substantial inequalities persist.
Theis and White analysed 14 Government-led obesity strategies from 1992-2020, to determine whether they were fit for purpose. They evaluated 689 policies in terms of strategic focus, content, basis in theory and evidence, and implementation viability.
Twelve of the fourteen strategies contained obesity reduction targets. However, only five of these were specific numerical targets, rather than statements like ‘aim to reduce obesity’.
“Overall we might give them 4 out of 10: could do much better.” Dolly Theis
Theis said, “In almost 30 years, successive UK Governments have proposed hundreds of wide-ranging policies to tackle obesity. These are yet to have an impact on levels of obesity or reduce inequality. Many policies were flawed from the outset, and proposed in ways that made them difficult to implement. What’s more, there’s been a consistent failure to learn from past mistakes. Governments are more likely to publish another strategy containing the same, recycled policies than to implement policies already proposed. Overall we might give them 4 out of 10: could do much better.”
Theis and White identified seven criteria for effective implementation. Only 8% of policies fulfilled all seven criteria, while the largest proportion of policies (29%) did not fulfil any of the criteria. Less than a quarter (24%) included a monitoring or evaluation plan, just 19% cited any supporting scientific evidence, and less than one in ten (9%) included projected costs or an allocated budget.
“No matter how well-intended and evidence-informed a policy is, if it’s proposed without a clear plan or targets it makes implementation difficult,” added Theis. “What is the purpose of proposing policies at all if they are unlikely to be implemented?”
Evidence suggests that policymaking is changing. Though the current Government favours a less interventionist approach, recent strategies have contained some fiscal and regulatory policies. These include banning price promotions of unhealthy products, banning unhealthy food advertisements and the Soft Drinks Industry Levy. This may be because the Government has come under increasing pressure, and recognises that previous approaches have not been effective. Additionally, interventionist approaches are increasingly acceptable to the public, and evidence to support regulatory approaches is mounting.
Most strategies explicitly recognised the need to reduce health inequality, including one strategy fully focused on this. Yet only 19% of policies proposed measures which were likely to be effective in reducing inequalities.
The researchers found little attempt to evaluate strategies, or build on their successes and failures. As a result, many proposed policies were similar or identical over multiple years, often with no reference to their use in a previous strategy. Only one strategy (Saving Lives, 1999) commissioned a formal independent evaluation of the previous government’s strategy.
“Until recently, there seems to have been an aversion to conducting high quality, independent evaluations, perhaps because they risk demonstrating failure as well as success,” added White. “But this limits governments’ ability to learn lessons from past policies. The often short timescales for putting together a strategy or implementing policies may compound this.”
“Governments need to ensure that policy proposals can be successfully implemented, with built-in evaluation plans and time frames. Important progress has been made with commissioning evaluations in the last three years. However, policies should be framed in ways that make them readily implementable. We must move away from interventions that rely on individuals changing their diet and activity, and towards policies that change the environments that encourage people to overeat and to be sedentary.”
Theis has also written a article on the findings for research website The Conversation.
The NIHR School for Public Health Research funded the research. The British Heart Foundation, Cancer Research UK, Economic & Social Research Council, Medical Research Council, and Wellcome Trust provided additional support.
This is an abridged version of an article originally published by the University of Cambridge. It is reproduced under a Creative Commons Attribution 4.0 International License.