Fixing our broken food health system

Nada Khan is an Exeter-based GP and an NIHR Academic Clinical Lecturer in General Practice at the University of Exeter. She is also an Associate Editor at the BJGP.

Food systems are the complex networks incorporating food production to consumption, and all of the associated economic, environmental, and health outcomes. But, is our food system broken?  A recent House of Lords committee certainly thinks so. The recently published report, ‘Recipe for health: a plan to fix our broken food health system’ examines the wider food industry and how it impacts on our diet and obesity levels in the UK.¹ Their report challenges whether the UK food system currently meets our health and nutritional needs in the context of increasing obesity rates. Mirroring a change in language akin to the climate emergency, the report moves away from using the term ‘epidemic’ when describing the obesity crisis, instead calling it a ‘public health emergency’.  But why, after decades of successive different policy initiatives to ‘fix’ the food system are obesity rates still increasing in the UK?  

The obesity crisis

I’ve written previously about the obesity epidemic and the need to look towards wider societal solutions. One of the failures of current policy initiatives is the focus on individual responsibility rather than public interventions that involve long-term, system wide change. Policy approaches that rely on individual agency are less likely to be effective in influencing behaviour change and haven’t slowed down the increases in obesity prevalence.² Take, for example, a recent Cochrane review looking at how food and menu calorie labelling influenced people’s choices on what to eat, and found only very small effects in calorie reduction.³

Despite the modest effects of these approaches, the Soil Association noted in their evidence to the House of Lords committee that the food industry had successfully lobbied for government strategies favouring individual responsibility over state intervention. And on the flip-side of individual level interventions, structural policies that eliminate or restrict choice are often criticised for their ‘nanny-statism’ and include policies like banning advertising for all high fat, salt or sugar foods, or banning high fat, salt or sugar food price promotions. In theory, these approaches mean that people are less exposed to and potentially then less likely to choose unhealthy options, but again, results are mixed and generally modest.² In our obesogenic environment, and given the complexities and barriers to implementation any approaches need to tackle a wide range of fronts from individual behaviour change through to wider population interventions.²  This kind of system-wide approach to escape the junk food cycle, reduce diet-related inequality, make better use of our land and to create a long-term shift in our food culture was presented in the 2021 National Food Strategy, but as we will see, there is a national failure to implement change when it comes to our food system.⁴

An obesogenic environment influenced by industry

The House of Lords report puts the blame for rising obesity squarely at the feet of the food industry, stating that marketing of unhealthy food products has created an ‘obesogenic’ food environment.  The report goes on to contend that the food industry, as a powerful lobbying group, has used a variety of sophisticated strategies to influence not just the government, but academic research. As an example, some of those providing evidence to this report argued that the current Scientific Advisory Committee on Nutrition is not free of industry influence given the inclusion of members with a financial interest linked to food corporations. To illuminate how different lobbying groups might influence government strategy, the report calls for a code of conduct for ministerial meetings with food businesses, with full transparency on meeting minutes. And what about academic affiliations with the food industry – should academics work together with the food industry on research around the food system and obesity?  There may be opportunities for partnerships to work together to find solutions and combine shared information and expertise.  Industrial influence on research, however, risks impacting the research agenda, with funding prioritised to research that aligns with commercial interests.  Tread carefully and be transparent.

Repeated failures to implement policy recommendations

The last big House of Lords report on this topic was the Food, Poverty, Health and Environment Committee ‘Hungry for change’ report, which was published in 2020 and proposed several recommendations which were not acted upon.⁵  This current ‘Recipe for Health’ report references two significant developments since the publication of the Hungry for Change report – the National Food Strategy which was published in 2021 and ongoing debates around how ultra-processed foods impact on obesity levels.⁴  The National Food Strategy suggested steps towards shifting how we think about food within our cultural ethos, along with a significant cash injection to create a better food system.  The offset for this investment, according to the report team, would be greater economic gains from a healthier society.  But, just like the ‘Hungry for change’ report, most recommendations from the National Food Strategy were not implemented, leading to the resignation of the then food tsar Henry Dimbleby in protest.  What’s the point of repeated reports that come to the same general conclusions? The only conclusion, that I can take from this is that the political will to act for long-term change or hold the food industry to account is lacking.

Almost 700 different policies have been proposed by different governments over the past 30 years to tackle obesity, yet the obesity crisis continues to escalate. A review identified that a third of all obesity policies failed to demonstrate that their implementation was viable, so it seemed as if they were doomed to fail before they even started.  Given the UK has seen hundreds of policies with no improvements in the food system alongside a worsening of the obesity crisis, we need a long-term, structured evaluation of previous failed policy initiatives to understand what went wrong.²  For instance, the majority of policies fail to build in specific obesity reduction targets, which may contribute to general feeling of ambiguity around what different initiatives are actually trying to achieve.

I’m not going to go into depth here around ultra-processed foods (UPFs), the second area of development since the original Hungry for Change report.  This current House of Lords report did include a focus on UPFs and included evidence from Dr Chris van Tulleken, author of ‘Ultra Processed People’.  I’m not going to touch on that here, but would guide you towards BJGP Life articles by Dr Chris Newman looking more closely at healthy eating and a review of van Tulleken’s book here if you’re interested in reading more. I’d suggest a third significant development which is the potential impact of obesity treatments. Despite the increasing popularity of GLP-1 agonists, this House of Lords committee wasn’t able to look specifically at this area given time constraints (including the fact that the committee had to dissolve and then be reappointed during the last general election) and would be well considered in the context of the wider food system rather than as a ‘silver bullet’ solution to rising obesity rates.⁶

Towards reasonable goals for our food system

The central recommendation from this House of Lords report is that the UK government urgently needs to adopt an overarching food strategy to address the failings of the current, broken food system. This does again seem like well-trodden ground, considering that the comprehensive recommendations from the last National Food Strategy haven’t been enacted. And in a nod to previous implementation failures, the House of Lords committee suggests that the Government needs to act on recommendations from the previous ‘Hungry for Change’ report.  The report makes further recommendations around increased regulation of the food industry to increase industry accountability for the obesity ‘emergency’. If this committee is right, and our food system is broken, it seems that potential solutions have been repeatedly laid out, but haven’t, or can’t be implemented effectively within the current environment of food industry lobbying and influence. What broke our food system is the lack of will to act on what we know, and what we need to do to make a change.

References

1. Recipe for health: a plan to fix our broken food system. House of Lords Food, Diet and Obesity Committee; 2024.
2. Theis DRZ, White M. Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992-2020. Milbank Q. 2021;99(1):126-70.
3. Clarke N, Pechey E, Shemilt I, Pilling M, Roberts NW, Marteau TM, et al. Calorie (energy) labelling for changing selection and consumption of food or alcohol. Cochrane Database Syst Rev. 2025;1(1):CD014845.
4. Chapter 16: National Food Strategy Independent Review 2021.
5. Hungry for Change: Food, Poverty, Health and the Environment Committee report. Select Committee on Food, Poverty Health and the Environment; 2021.
6. ‘Weight loss drugs have the potential to improve lives but should not be seen as a silver bullet’ says College Chair: Royal College of General Practitioners 2024 [Available from: https://www.rcgp.org.uk/news/nice-tirzepatide-guidelines-response.

Featured Photo by Christopher Williams on Unsplash