Is the government's obesity strategy a lost opportunity?
If child weight problems are not tackled soon, cancer and diabetes rates will soar, say experts
The long-awaited child obesity strategy undermines efforts by the NHS on cancer, according to nurse leaders.
The UK Oncology Nursing Society says it is ‘disappointed’ with the Department of Health plan, Childhood Obesity: A Plan for Action, unveiled in August, adding that tougher measures would have ‘made a difference’ to the work of cancer nurses.
The society’s criticism echoes concerns raised in other quarters after the strategy failed to include restrictions on marketing, particularly junk food advertising on TV.
Sugary drink tax
Instead, while reiterating that a tax on sugary drinks will be introduced, the strategy relies on a combination of voluntary measures and actions by the public sector to tackle obesity in England. The steps include:
- A voluntary target to cut sugar in products popular with children by 20% by 2020 with a 5% reduction expected in the next year.
- Limits to be set for sugar content per 100g and calorie caps on specific products.
- A healthy schools rating scheme for inspections.
- Primary schools to ensure children get at least 30 minutes of physical activity a day and to help parents ensure that children get the same at home.
- A review of the current voluntary food labelling scheme to see how it can be improved.
- More training for health staff on how to initiate conversations about lifestyle and influence behaviour.
UKONS president-elect Richard Henry says he wanted the strategy to go further by following the lead of the evidence review published by Public Health England last October. This document endorses restrictions on marketing and promotions as part of a package of measures.
Mr Henry says of the DH strategy: ‘Like many health organisations we are disappointed. It is an opportunity missed as the link between obesity and cancer is clear.
‘The best way of treating cancer is to prevent it and nurses are at the forefront of delivering health-promotion messages.
‘The problem with the strategy is that, while it stresses the importance of diet and exercise, it does not go far enough in terms of advertising and promotions. These measures would have made a difference.’
Support for nurses
Royal College of Nursing professional lead for children and young people Fiona Smith agrees, saying: ‘This plan is more notable for what it does not contain than for what it does.’
As well as being tougher on industry, she also wants nurses to be given more support.
‘Nurses working in health visiting, school nursing and public health roles can make a huge difference to the health and lifestyles of families, and these services must be given the sustained investment they so desperately need.
‘Many obese parents go on to have obese children, and this can lead to a cycle of inequality, ill health and social isolation.
‘Unless unprecedented efforts are made we will be storing up problems for years to come.’
Cancer Research UK chief executive Sir Harpal Kumar is also concerned. He points out that the cancer taskforce he led last year for NHS England placed prevention at the heart of creating a ‘world class’ cancer service.
He says that while the government had been promising a ‘game-changing’ strategy, the document has ‘few details, a preponderance of voluntary measures and a blatant disregard for the evidence’.
So what happened? Sir Harpal is convinced the strategy was watered-down.
‘There can be little doubt that prevention has fallen victim to economic scaremongering and industry lobbying,’ he adds.
Similar theories have been put forward by others. One of the reasons that the strategy has surprised and upset many professionals is that, up until its publication, the government had talked tough and shown a willingness to take action.
The sugar tax had already been promised, plain packaging for cigarettes has been introduced and the high-profile One You campaign is being run by PHE to persuade people aged over 40 to improve their lifestyles.
The government maintains it has not got soft, however. A DH spokesperson says that the government will be measuring progress ‘carefully’ and, if industry does not adopt the measures in the strategy, ministers will consider ‘further action’.
In the cancer community and elsewhere, however, there is concern that by this stage it will be too late.
Obesity and cancer: the evidence
After smoking, obesity and being overweight is considered the second biggest avoidable cause of cancer.
Cancer Research UK believes evidence suggests extra fat in the body is linked to one in 20 cancers in the UK.
Numerous studies have highlighted the effect of excess weight on a variety of different cancers, and these findings have been reinforced by a World Health Organization (WHO) review published in August (Lauby-Secretan et al 2016).
The WHO’s International Agency for Research on Cancer (IARC) set up a working group of 21 experts who reviewed more than 1,000 studies released since 2002.
The working group conclude that there is sufficient evidence to link excess weight to:
Breast cancer in women after the menopause.
Colon and rectum cancer.
Gastric cardia cancer (a type of stomach cancer).
Meningioma (a type of brain cancer).
The group also said there is evidence to suggest weight is linked to aggressive prostate cancer, diffuse large B-cell lymphoma and cancer of the breast in men. However, evidence was inadequate for cancers of the lung, testis, urinary bladder, brain or spinal cord.
Lead author Beatrice Lauby-Secretan says that over the past 14 years a lot of evidence emerge about cancer and weight, and believes the science has now ‘been established’.
She says the ‘comprehensive evaluation’ IARC carried out illustrates ‘the benefits of maintaining a healthy body weight in order to reduce the risk of several different types of cancer’.
Research has identified a number of reasons to explain why excess weight increases the risk of cancer.
Studies have shown that fat cells in the body are active, and produce hormones and proteins that are released into the bloodstream and carried around the body. This can affect many parts of the body and increase the risk of several different types of cancer.
Fat cells can also attract immune cells to body tissues. These immune cells release chemicals that cause long-lasting inflammation, raising the risk of cancer.
Scientists have also been studied the impact of belly fat. The relationship is not fully understood, but it is thought that when too much fat is carried around the belly, it affects the speed with which chemicals from fat enter the blood.
So-called ‘apple’ body shapes are linked to bowel, kidney, oesophageal, pancreatic, and breast cancers.
The evidence amassed can also inform forecasts of the future incidence of cancer. In June, the Obesity Health Alliance released an analysis suggesting that, if obesity and overweight rates keep rising, there could be an additional 670,000 new cases of cancer by 2035.
The analysis also suggests there could be another 4.6m cases of type 2 diabetes and 1.6m more people affected by heart disease.
Researchers have described the numbers as ‘shocking’ and said they would require ‘bold action’.
Find out more
Department of Health (2016) Childhood Obesity: A Plan for Action
Lauby-Secretan B, Scoccianti C, Loomis D et al (2016) Body Fatness and Cancer: Viewpoint of the IARC Working Group
Obseity Health Alliance (2016) Being Obese or Overweight Could Cause 7.6 Million Cases of Disease by 2035
Public Health England (2015) The Evidence for Action
Nick Evans is a freelance writer