A few days ago, the Food Foundation tweeted a disturbing clip showing how – if current trends continue – one in four children born in 2022 will suffer overweight or obesity by the time they start school. By the time this cohort reaches age 65, only 18% would have a healthy weight.
Yesterday, Nesta – the UK’s innovation agency for social good – launched a report: The future of food: opportunities to improve health through reformulationat an event in London that I attended.
Nesta set out to uncover the food categories that could be reformulated to reduce excess calorie consumption, and to figure barriers and opportunities to doing so.
Calorie-density of foods was considered to be the big challenge. If this could be reduced by reformulation of a select group of commonly-consumed foods that were amenable to reformulation, then, in theory, the consumer would consume fewer calories every day, without noticing it and without looking for more calories elsewhere.
Their model suggests we would consume 38 kcals less per person per day, on average.
To halve obesity by 2030, we would, on average, needs to consume 216 kcals less per day – so this would get us around 17% of the way to that goal.
The report recommends government-mandated calorie-reduction targets for specific foods, backed up by legislation to punish failure to meet them, a public ranking of shops/supermarkets (to ensure transparency) and mandating of industry to reformulate their main products (rather than creating two tiers of products where one is the healthier alternative.)
This is not a magic bullet, as Lauren Bowes Byatt suggests in this blog, but a potential big step forward.
What to make of this?
The pivotal assumptions are that the main issue is excess calories, that these foods could be reformulated to reduce their calorie content by 10%, and that consumers would not look elsewhere for the extra calories.
What if there was something else in these foods – in addition to a lot of calories – that was leading to excess consumption?
The Nesta report completely fails to mention the growing body of evidence of the panoply of harms caused by ultra-processing and the possibility there is something else about ultra-processed foods (UPFs) that make us consume more calories.
Kevin Hall and colleagues, however, suggests there is.
In a one-month randomized controlled trial of ad libitum food intake, they investigated whether ultra-processed foods affect energy intake. Subjects were randomized to receive either ultra-processed or unprocessed diets for two weeks followed by an alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fibre. Subjects were instructed to consume as much or as little as desired.
Results – energy intake was significantly greater with the ultra-processed diet. More than 500kcals per day, which seems like a huge difference.
Other studies have pointed to significant differences conferred by ultra-processing e.g. Dicken and Batterham who conclude by suggesting the adverse consequences of UPFs are independent of dietary quality or pattern, “questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.”
And Bonacchio et al who conclude: “A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing”
These differences seem to exist with UPFs but we don’t yet know what causes them, or why people over-consume UPFs – whether it’s something to do with hydrogenation, additives, emulsifiers, sweeteners, compounds released by packaging or something else…
People crave UPFs and, as with any craving, they will find ways to satisfy it.
How does the Nesta research address this?
In her blog, Bowes Byatt cites two papers to support her contention that substitution is unlikely to be a big issue. The first — a systematic review – finds that people who consume less calorie-dense foods don’t fully compensate by eating more. although there is no significant difference with weight. The second suggests that foods substituting a sweetener for sugar suggests that reformulation leads to a significant reduction in body weight. But…surprise, surprise…many of these authors have been funded by the sugar industry…so we can safely discount this one.
The key indicator has to be weight, as weight (or BMI) will determine any impact on overweight and obesity. And, as the first study concludes: “Future research will therefore be needed examining the effect that manipulations of energy density have on body weight in order to understand whether mass reformulation of the energy density of food products is likely to benefit population level obesity.”
What’s really surprising is that the Nesta report doesn’t mention UPFs at all, and when a question was asked about ultra-processing at the launch, it was ducked.
In a twitter exchange prior to the launch, a Nesta deputy director suggested to me that UPFs were a distraction.
This is puzzling – especially when two years earlier, Nesta had this blog on their website just over a year ago.
- What’s changed, and why are UPFs now considered to be a distraction?
- How will a 10% cut in calories deal with the craving that leads to excess consumption, as we continue to live in an obesogenic food environment flooded with UPFs?
At the beginning of the launch, Henry Dimbleby spoke forcefully about the situation we’re in right now.
Last year, in the US, he said, 73,000 limbs were amputated due to poor diet. He reminded the audience about Dolly Theis’ excellent work on the hundreds of anti-obesity policies that had been drafted in the UK over the years.
And yet ‘f**k all has happened!’
His biggest fear was that, unless we get to grips with the food environment, the only way out of this crisis will be a needle – perhaps half the population will be on a prescription for weekly semaglutide jabs.
Is that the future we want?
A monofocus on calorie-reduction of selected foods seems to me like a magic bullet (calorie-cutting) within a magic bullet (nutrient-focus). After nearly four decades in the world of nutrition, I haven’t come across one single convincing bullet.
Reducing calories in selected foods, while ignoring ultra-processing seems to me a little like trying to prevent deaths from shark attacks by reducing the size of their teeth (…but then again, that’s a little harsh on sharks.)
Perhaps it’s more like deck chairs on the Titanic — not rearranging them, but throwjng them overboard to reduce the speed at which it sinks.
But that time has long gone. We need to make big strides to turn things around.
The rising wave of orange and red figures in the Food Foundation graphic are caused by the ‘business as usual’ approach of a handful of immensely powerful transnational food companies, coupled with the persistent failure of governments to rein them in through comprehensive regulation.
Government must get tough with Big Food and wield the big stick to shut down the upstream drivers of the fake food we’re drowning in.
Granted, in the UK, we have a bit of a fake government right now that’s become distracted by itself. So, then let’s make sure that access to a healthy diet for all is an election issue.
I hope I’m wrong but it seems to me that mandating the cutting of a few calories from foods – even if it was successful – risks being the bigger distraction than draining the ultra-processed food swamp.