The Nutritional Supplement

Food Matters Live is a cross-sector event bringing together the food and drink industry with professionals working in health and nutrition.  The event runs over 3 days and this year was free to register and attend.  The event included a wide range of speakers who took part in debates and seminar sessions over the 3 days.  Additionally there was a large exhibition area, with a wide range of products being presented.  Within the exhibition area a number of universities, research centres, health services and community projects were showcasing some of the work they do.  Food Matters Live…2015 was an Association for Nutrition (AfN) endorsed CPD event.  Attending the event provided good opportunity to network with a range of professionals, see new concepts being brought to market in a range of areas including, food ingredients, food products, services and initiatives, research and education.

Conference Programme:

The conference programme was exploring the relationship between food and health, the importance of increasing consumption of healthy foods and the connections between environment, population, health and well-being.  The programme consisted of 17 x 1 hour long debate sessions over the 3 days.  The debates were presented in a large auditorium; the sessions were free to attend and places allocated on a first come first served basis. 

Conference contributors

The debates were chaired by experienced chair people who ensured that all panellists had fair opportunity to present their arguments.  The panellists in the debate sessions were from a range of different sectors including: food industry; governmental, ministerial, policy makers, local government; medical doctors; health professionals e.g. dieticians; service providers; journalists and broadcasters; academics; NGOs; Professional Bodies; researchers, education.  This made for good discussion and presented a broad range of perspectives.  This kind of debate is also useful to help students develop their critical thinking skills.  I found that there were good points made from opposing panellists which made me challenge and develop some of my own thoughts on the issues being presented.

Seminar Programme

There was an extensive seminar programme with a number of different streams each with a programme of workshops covering a series of related topics over the 3 day programme:

• Innovations in nutrition for health and wellbeing
  • Maternal and infant nutrition
  • Nutrition for healthy ageing
  • Mainstreaming sports nutrition
  • Nutrition for weight management
  • Nutrition for digestive health
  • Nutrition for heart health
  • Nutrition for cognitive health and performance
  • Nutrition for immune health
  • Sugar, salt and fat: strategies to reduce consumption
  • Free-from, allergy and intolerance
  • Improving nutrition in the community
  • Sustainable food business
  • Future nutrition
    • Advances in science and technology
    • Packaging: sustainable and healthier by design
    • Marketing matters: strategies for healthy brands

The seminar sessions were run in a variety of styles including: presenting research, debate, presentation of projects, case studies, projections for future needs and innovations.  Each of the streams presented contributions from a wide range of perspectives similar to the conference programme.  As with the conference programme the sessions were free to attend and were on a first come first served basis.  The setting for the sessions was smaller seminar rooms, which provided a more intimate environment and plenty of opportunity to ask questions.

Other Attractions

Alongside the conference and seminar programmes there was a range of other talks and demonstrations.  These were grouped into themes:

• Innovative Ingredients
• Catering for Health
• The Evidence Base
• Food Sensorium
• Sustainable Edibles
• The Growth Lab

Report from specific sessions

Preventing Childhood Obesity conference session Thursday 19^th November

Presenters

Chair: Jonathan Dimbleby

Panelists: Sir David Amess MP Vice-Chair, All Parliamentary Group on Adult and Childhood Obesity; Russell Hobby General Secretary The National Association of Head Teachers; Chris Bavin co-presenter of BBC Eat Well for Less, founder of The Naked Grocer;  Dr. Helen Walters Head of Health, Greater London Authority

The Debate

The debate was exploring the issue that one in five children leaving primary school is obese and a further 14% are overweight.  The key questions presented were what can we do to get our children back in shape? And how can we prevent youngsters from becoming obese in the first place?

The Problem

There is a detailed analysis of the problem in the House of Commons Health Committee Report Childhood obesity – brave and bold action published November 30^th 2015.  The report provides evidence for the scale and consequences of the problem of childhood obesity.  The findings and recommendations from this report underpinned many of the points made by Sir David Amess.  The other panellists who had not seen the report had their own views on the problem. 

Causes

The panellists presented arguments for a wide range of causal factors.

Economics

Economics from a number of difference perspectives was presented as a causal factor.  Managing tightening budgets in households and public spending was linked to a number of factors including:

• A need to increase corporate sponsorship of events such as the Olympics, the companies who have the financial resources seem to be companies who are producing products that are contributing the obesity problem.  This is giving conflicting messages to the public and some of the linked activities such as sports equipment for schools in return for tokens from product packaging could be driving an increased consumption of unhealthy products.
• Household budgets have been tight, particularly in low income families; this necessitates setting priorities in shopping choices.  There are a lot of products which are cheap options for providing a hot meal.
• The food industry is like any other business in that it has to make a profit to continue to operate.  There is a perception that for some companies there is not enough balance between profit and responsibility.  This comes in many forms including:
  • promotions that encourage consumption of unhealthy foods
  • varieties of fruit & veg offered to appeal to sweeter tastes
  • products selected for robust storage and extended shelf life.
  • Following on from economics, many school budgets are too small to allow for facilities to offer opportunities for pupils to cook
  • School cooking activities are often focussed on baking
  • Schools are measured against so many academic and procedural targets that activities not related to performance tables are being reduced or not offered.  Secondary school pupils are able to opt out of PE at age 14.
  • There is a loss of cooking skills, cooking was removed from the school curriculum and more children are now growing up in households where their parents do not cook and do not model cooking for children
  • Loss of food literacy – people are influenced to a greater extent by food manufacturers, retailers and media in the food choices they make. 

Education

• Following on from economics, many school budgets are too small to allow for facilities to offer opportunities for pupils to cook
• School cooking activities are often focussed on baking
• Schools are measured against so many academic and procedural targets that activities not related to performance tables are being reduced or not offered.  Secondary school pupils are able to opt out of PE at age 14.
• There is a loss of cooking skills, cooking was removed from the school curriculum and more children are now growing up in households where their parents do not cook and do not model cooking for children
• Loss of food literacy – people are influenced to a greater extent by food manufacturers, retailers and media in the food choices they make.  

Policy

There seems to be a lack of prioritising the obesity agenda in policy making, with a reliance on voluntary action by the food industry and pushing a personal responsibility agenda to the population.  When industry action is voluntary it is not a level playing field and can make it difficult for small businesses to take the action they would like as it would mean they are no longer competitive.  Personal responsibility is important, however there needs to be a framework to protect people who - for whatever reason - do not have the ability to fully assume personal responsibility for their food and lifestyle choices.

Society and culture

As the population has become larger there seems to have been a shift in body shape norm and obesity has been reframed as normal.  Society is changing with a drive for more people to be employed, which can impact on how the role of parent is fulfilled.  The pressure on children to achieve and be seen to be achieving is increasing and feeding into an anxiety cycle, often issues with food are an expression of emotional issues.  Talking about weight is an emotive topic and often people don’t know how to broach the issue.  Euphemisms about overweight and obesity can be confusing and send the wrong message.  Individuals now have greater power to express personal choice and freedom, this links to education because people are not being provided the skills and knowledge to make choices that facilitate the outcomes they want e.g. not many people would make a conscious choice to become morbidly obese or for their children to become obese.

Simple laws of thermodynamics

The simplest explanation for the problem is that the energy being consumed is more than the energy being expended.  We eat too much and move too little.

Consequences

The increasing level of childhood obesity has serious and long-term consequences.  Probably the most reported consequence is the impact on health.

Health impact

Obesity is known to be directly linked to a number of chronic health conditions including type II diabetes, CVD and some cancers (breast, bowel, womb, oesophagus, kidney and pancreas).  Whilst these diseases are less likely to occur in childhood, they are long term consequences of obesity.  Obesity which becomes established in childhood is likely to persist into adulthood.  Children who are obese are vulnerable to psychological problems and often victims of bullying.  Carrying excess weight can put pressure on the muscular skeletal system of growing children, causing pain and reducing their ability to take part in physical exercise which further contributes to weight gain. 

There are positive correlations between obesity and dental decay necessitating multiple tooth extractions in children.  This correlation is noted in lower socio-economic groups therefore also making links with issues of health inequality.

Malnutrition is being observed in obese children.  This is where there are micronutrient deficiencies alongside obesity, indicating that their diet is providing empty calories.

Economic costs

The most direct costs of obesity are to the Health Service in the form of treatment for direct obesity and the complications of obesity such as type II diabetes.  Alongside the treatment costs there are infrastructure costs such as larger equipment to cope with larger, heavier patients; more staff to safely lift and nurse large patients.  Linked to this are the benefits costs to support individuals who are unable to work or become disabled as a result of morbid obesity and complications of obesity.  There is also a knock-on effect to the wider economy as obesity and its complications can take people out of the workplace.

Social and Cultural Consequences

One of the most significant consequences is that obesity is a driver of health inequality.  Typically obesity is more prevalent in lower SECs.  These groups are likely to have lower literacy levels, beyond the ability to read words on the page but are less likely to make the wider connections and understand future health impacts of the food choices they are making.  Additionally lower SECs typically have less choice due to a restricted budget and having to make difficult decisions about priorities in food choices.

Obesity has become common place and lost its shock value in the media.  There is now a trend to report on “Britain’s Fattest…” which has the effect of normalising obesity that is not at the extreme end of the scale; feeding into the resetting of society norms for body shape.

The food industry is at risk of being demonised, and this is allowing people to take less personal responsibility.  The voluntary codes of conduct for the food industry make it an uneven playing field for manufacturers and some of the practices are too costly for small businesses which are then viewed as not doing their bit.

What are the solutions?

It was when the proposed solutions to childhood obesity were discussed that the debate got very interesting.  It was here that the different agendas of the panellists became apparent.

Education

Chris Bavin was very passionate about an educational approach which would re-establish food literacy.  He wanted to see food, nutrition and cooking being incorporated into the school environment, in infrastructure and curriculum.  There was also a drive to make reducing obesity form part of school policy and involve school governors.

As a separate topic within education there were also proposals to improve the clarity of food labelling for nutrition to help consumers understand their choices better.

Communication

The way that messages about food are communicated was a hot topic.  Steps need to be taken towards improving diet; an all or nothing approach is unlikely to work as this would potentially be disempowering for the people who need to change the most.

It was felt that there is generally a fear of talking about overweight and obesity, and that we need to be more comfortable about having conversations about food choices, weight and health.  This means responsible media reporting and providing more training to the people who are in regular contact with children e.g. teachers, health professionals and child care providers to open a conversation about weight.

Providing greater support networks and encouraging people to take more responsibility for the health of children within their family and community.

Regulation

There was general agreement that there needs to be a review of marketing practices in regards to food.  One suggestion was to ban character endorsement of unhealthy foods.

Other suggestions included tighter regulation of the food environment in the form of planning applications, setting a limit to the number of takeaway outlets within a defined area and legislating a minimum distance of takeaways from schools.

Greater regulation of the food industry was a point made by many of the panellists.  This seemed to somewhat swerve the issue.  The food industry could do more but they are an easy target and we need to take a wider responsibility for the issue.

Taxes on unhealthy foods was a proposed solution.  This may help to reduce consumption of unhealthy foods however defining which foods should be taxed is problematic.  Fizzy drinks was a proposed starting point, however this again is not necessarily going to help the people who need it the most.  Typically it is lower SEC who consume more soft drinks and an unintended consequence could be a worsening of these diets as the tax could increase their shopping bill and encourage them to reduce fresh foods to support the increased cost of tax on “unhealthy food”.

Reviewer’s Conclusion

It is clear that childhood obesity is a complex problem.  Different classes and cultures have travelled different routes to obesity and will require different approaches to reduce the problem.  I think that we need to better understand the cluster problems and scope projects to address these on a small scale at first.  As we can report small scale success we can begin to develop more programmes.  I think that there are opportunities to create partnerships between different sectors to tackle the problem in a way that does not demonise any particular sector and empowers individuals to take responsibility for supporting and improving the health of their family. 

The initial debate presented a fairly grim picture, the causal factors seemed to have been overly simplified particularly the reductionist idea that obesity is a simple result of the laws of thermodynamics; there is truth in this idea, a positive energy balance can ultimately lead to obesity.  However the mechanisms which operate within individuals to control the energy balance take the debate far beyond simple laws of thermodynamics.  Hearing some of the simplistic arguments presented made me feel very positive about the functional approach that CNELM embeds within its programmes and the development of the mechanism review style of research which seems to have great potential for developing understanding of causes and potential interventions to begin to tackle obesity.   I left the session feeling optimistic that there is real progress to be made.  The debate also re-enforced the value of what we do at CNELM, our mechanistic way of thinking could be a great tool to help bring closer integration of sectors to design effective projects to address childhood obesity.  The skills we are helping our students to develop are very much needed within our growing communities.