Overweight by default

We’ve spent a good chunk of the last year looking at how our approach to behaviour change can play a role in the profound problem of obesity.

We all know what this problem looks like by now. Over a quarter of adults in the UK are classified as obese and 2 out of 3 are overweight. This is having dramatic effects on the health of our nation. Between 2000/1 and 2010/11 the number of admissions to the NHS with a primary diagnosis of obesity increased 1,000%. The picture is very similar in the USA and many other nations are catching up fast – or already there.

What we see from our work – and what is becoming better evidenced and articulated all the time by others – is that there are strong underlying forces in mainstream culture that line up to make everyday life almost inevitably unhealthy.

Someone much cleverer than us – Professor Martin Wiseman of the World Cancer Research Fund – has been saying for some time that “from television advertising to the pricing of food, our society works in a way that discourages people from adopting healthy habits.”

However, only very few approaches to behaviour change in this area assess or acknowlede these fundamental forces, so most solutions can only ever play around with the superficial layers of the problem.

You don’t have to look any further than the source of some of the above stats for some clues as to what we mean by this. The NHS’s Statistics on Obesity, Physical Activity and Diet report is thorough, clear and accurate, but the way that it links its conclusions together is very revealing.

Its main summary of findings start with these key stats:

1. 26% of adults are classified as obese
2. 20% of people take walks of at least 20 minutes “less than once a year or never”
3. 74% of adults don’t consume five or more portions of fruit and vegetables a day

Reading through these, you’re naturally lead to feel that this selection of facts covers both cause and effect: we are overweight because we don’t live active lives or eat fruit and vegetables. Moreover, amongst current efforts to change behaviours, a vast amount of prevention resources are poured into increasing awareness of the benefits of regular exercise and more fruit and veg.

And why not? This is obviously very good advice – most of us should be doing more of those things.

But, assuming a strong link between obesity and these behaviours can lead debate and policy in the wrong direction.

Take the first link made, between high levels of obesity and the fact that 1 in 5 people take walks of 20 minutes “less that once a year or never.” These behaviours are not healthy in any way, of course, but is there a strong link to weight gain?

The kinds of carbohydrate rich foods we are surrounded by would be ridiculously difficult to burn off with low level activity like walking. A large Dominos pizza with, say, cheese and pepperoni on it, has over 2,700 calories, which would take over 13 hours of walking to burn off. 13 hours! Even just one slice would take over 90 minutes of walking.

Calorie dense foods like Dominos pizza are everywhere and they are sanctioned and signed-off as appropriate by brands we trust and governments that we believe are protecting us from the worst excesses of those brands. They are almost inescapable in fact. When you pay for a paper at WH Smith, you’re often offered a half price half kilo of Cadbury’s chocolate (2,500 calories, 12.5 hours of walking). When you left the Olympic Stadium during the 2012 Games, having watched elite athletes perform, you were met with the two largest McDonalds in Europe  (Big Mac meal – 1350 calories, just under 7 hours of walking) and almost exclusive sales of Coke (500ml bottle – 53g of sugar, holy crap). None of these decisions, which are culturally and practically the default decisions of daily life, can be offset by low level exercise like regular walking. (Just so you know, the calories in that Dominos pizza would take 4.5 hours of average paced swimming or running to burn off).

On the second link made – that obesity is strongly connected to fruit and vegetable intake – we’re again met with a problem. Let’s focus on fruit, the Goldenballs of healthy eating for all. Fruit has all sorts of vitamins, minerals, fibre and, vitally, a diverse mixtures of phytonutrients. Everyone should eat fruit, obviously, and the sugar in fresh fruit – fructose – comes in natural, moderate quantities.

But, the word “fruit” is attached to millions of products which all want to bathe in the reflected glory of nature’s well balanced offering and the NHS’s trustworthy recommendations. This is where the fact that fructose is the most lipogenic carbohydrate (meaning that it has a tendency to get converted to fat more than any other carbohydrate) has serious consequences. From fruit smoothies, often with over 10g of fructose sugar in them, to the endless range of high-fructose corn syrup products sold as “containing fruit”, we accumulate dangerous levels of sugar intake very easily, which is directly linked to an increased risk of metabolic syndrome and with higher levels of Type 2 diabetes and obesity.

These two points clearly meet in the middle: the dominant forces designing our daily food landscape do not care about whether we are fat and unhealthy. They care about providing food that is quick and cheap to prepare and quick and cheap to eat. They care about continuing to do this by ticking enough boxes marked “healthy” and sponsoring sport.

This isn’t a rant against these companies – what they are doing is completely predictable. They are responding to the incentives and regulations provided by government and aiming to make as much money as possible within this structure. That’s what they are there to do. Let’s not pretend otherwise and whinge about their role in society. Let’s also not pretend that “self-regulation” of this industry can possibly stem the tidal wave of obesity that is crippling our society.

But, there are others with a different remit: government, NGOs, non-profits and other social organisations that prioritise a healthy society. These stakeholders have to be cleverer and more profound in their approach. The occasional 5-a-day campaign and Change for Life billboard or instructions to add salads to take-away menus and keep kids out of chicken and chip shops are all operating on the fringes of the problem. Often, they are even counter-productive by making healthy behaviours “alternative” and therefore irrelevant to mainstream audiences.

Its not easy, but we have to get right in there are start filling society with behavioural norms that around eating that aren’t unhealthy. There should be projects and pilots going on all over the place that test how we can create menus and products that mainstream consumers can love (i.e. not overtly healthy food) and which contain behaviours with neutral or positive health outcomes.

This isn’t about undermining personal responsibility, it’s about giving it a fighting chance. Eating the right amount of calories every week is far, far too difficult at the moment – it involves ignoring billions of pounds of advertising, analysing claims of “healthy” products, turning down cheap, tasty, readily available food all around us and denying great value offers.

The idea of perfectly rational human cognition is long gone and, just as ad agencies know that you can sell 53g of fizzy sugar with famous footballers, we know that consuming this stuff “in moderation” is incredibly difficult.

Healthy habits shouldn’t be represented by such difficult decisions and lots of forces and influences within society have an acceptable remit to do something about that. We hope to chip in.

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