An overview ofthe government

approach to obesityincluding an updateon the reduction and reformulation

programme

Samantha Montel

Dietary Improvement

Public HealthEngland October2019

GlobalBurdenof Disease:Changes in health in England

Newton JN et al., (2015) Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic

analysis for the Global Burden of Disease Study 2013. Lancet. S0140-6736(15)00195-6.

2 Overview of the Government approach to obesity

Overweight andobesity

3 Overview of the government approach to obesity

Child overweight andobesity

4 Overview of the government approach to obesity

Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/528193/Eatwell_guide_colour.pdf

5 Overview of the government approach to obesity

Eating out of thehome

6 Overview of the government approach to obesity

Whole systemsapproach

7 Overview of the government approach to obesity

Childhood Obesity: aplan for action

8 Overview of the government approach to obesity

Childhood Obesity: a plan for action, chapter 2

Labelling- Mandate calorie labelling

on the out of home sector

(including online food

delivery)

- Explore what additional

opportunities leaving the

EU presents for food

labelling

Local communities- Develop a trialblazer

programme with LAs to ensure

those that want to take action

have the knowledge, support and

leadership to do so.

- Strengthening Government

Buying Standards for Food

and Catering Services

Schools- Review how the least active

children are being engaged in

physical activity in schools to

ensure that our investment helps all

children lead active lives

- A national ambition for everyprimary

school to adopt an active mile

initiative, such as The Daily Mile.

- Introduce secondary legislation to

update the standards for school

food and take steps to ensure

compliance

- Consult on use of healthy start

vouchers to provide additional

support for low income families

Retail- Intend to ban price

promotions of HFSS food

and drink, such as buy one

get one free and multi-buy

offers or unlimited refills of

sugary drinks.

- Intend to ban the

promotion of HFSS food

and drink by location (at

checkouts, end of aisles

and store entrance)

Marketing- Consult on introducing a

9pm watershed for

advertising HFSS

products in broadcast

media with similar action

in the online space

Sugar reduction

9 Overview of the government approach to obesity

- Consider extending the SDIL to milk-based

drinks if they fail to reduce sugar by 2020.

- Consider further use of tax system if sugar

reduction does not achieve the desired

progress

- Consult on introducing a ban to end the

sale of energy drinks to children

Our national ambition is to

halve childhood obesity and

significantly reduce the gap

in obesity between children

from the most and least

deprived areas by 2030.

“We’ve published “Chapter 3” of the Childhood Obesity Strategy, including bold action on:

infant feeding, clear labelling, food reformulation improving the nutritional content of foods, and

support for individuals to achieve and maintain a healthier weight.

In addition, driving forward policies in Chapter 2, including ending the sale of energy drinks to

children.”

Infant feeding

“We will challenge businesses to improve the nutritional content of commercially available

baby food and drinks. PHE will publish guidelines for industry in early 2020. Industry’s

progress will be monitored and reported to the government. If insufficient progress is made, the

government will consider other levers. PHE will also explore including baby food within the

popular Change4Life Food Scanner app to help parents and carers make healthier choices for

their infants.”

Food reformulation improving the nutritional content of foods

“Our ambition is to reduce the population’s salt intakes to 7g per day. To achieve this, we will

publish revised salt reduction targets in 2020 for industry to achieve by mid-2023 and we

will report on industry’s progress in 2024. Influencing consumer behaviour through marketing

and providing advice, including within the NHS, will also help. We will keep all options open if a

voluntary approach does not demonstrate enough progress by 2024”

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/819766/advancing-our-health-

prevention-in-the-2020s-accessible.pdf

10 Overview of the government approach to obesity

PreventionGreenPaper -Advancingourhealth:prevention in the2020s

Sweet biscuits

Cakes

Morning goods

Puddings

Breakfast cereal

Ice–cream

Chocolate confectionery

Sweet confectionery

Sweet spreads

Crisps

Potato products

Processed meat

products

Ready meals/meal

centres

Sandwiches

Pizza

Pies

Meal deals

Savoury snacks

Bacon & Ham

Table sauces

Gravy

Bread

Soup

Cheese

Canned veg

Butter/margarine

Cooking sauces

Reduction and reformulation

programmes

Sugar

Yogurts

SaltCanned fish Calories*

Meal

accompaniments/sides

Juice and

milk based

drinks

Commercial

baby foods

and drinks

11 Overview of the government approach to obesity

*Calorie categories

are yet to be

finalised, and PHE

are continuing to

review products in

scope of the

programme.

The sugar reductionprogramme

• Food industry challenged to

reduce 20% of sugar from

the food categories

contributing most to

children’s diets

• The reductions in sugar

should also be accompanied

by reductions in calories

where possible

• Three options for taking

action: lowering the amount

of sugar per 100g, reducing

portion size, and/or moving

towards lower/no added

sugar products

12 Overview of the government approach to obesity

Secondyear sugarprogress report– September 2019PHE published in September 2019 the second year

assessment of progress towards the 20% reduction

ambition by 2020

• Report looks at progress across categories, by

businesses and in top selling products based on

analysis of data for the year ending August/September

2018 compared to the baseline year of 2015.

• There is also an assessment of changes in sugar

levels in drinks covered by the soft drinks industry levy

(SDIL) during the same period.

• Data used comes from commercial datasets:

• Kantar Worldpanel for retailers and manufacturers

including volume sales and nutrition data

• MCA for food and drink purchased and consumed

outside of the home for volume sales; nutrition data

has been collected from information given online,

on menus and some data supplied by businesses

https://www.gov.uk/government/publications

/sugar-reduction-progress-between-2015-

and-2018

13 Overview of the government approach to obesity

Year2 sugar progress report – Key findings

In-homesector

14 Overview of the government approach to obesity

Out-of-homesector• For products purchased from the out of

home sector, there has been a 4.9%

reduction in average sugar content since

2017

• This is calculated using a simple average

and is based on more limited data than

that for retailers and manufacturers

• The data for out of home businesses is not

comparable to retailers and manufacturers

• This is because of the difference in the

metrics used - sales weighted average for

retailers and manufacturers and simple

averages for the out of home sector – and

because the baseline is different. Also,

there may be bias as nutritional

information is not available for some

outlets in the out of home sector

Proportion of brandsshowing changes of 2% or more between

baseline (2015) and year2 (2018)by category

15 Overview of the government approach to obesity

Change in caloriesin singleoccasionproducts– 2015 - 2018

16 Overview of the government approach to obesity

Product category

Calories per

portion

(% change)

Overall -0.4

Biscuits -0.3

Breakfast cereals n/a*

Chocolate confectionary -4.0

Ice cream, lollies and

sorbets3.8

Puddings 4.3

Sweet spreads and

saucesn/a*

Sweet confectionary -5.1

Yogurts and fromage

frais-7.1

Cakes** 3.5

Morning goods** -0.7

Retailers and manufacturers Out of the home

* Data for sweet confectionary has been excluded as the

businesses providing data for 2018 were quite different tothose

providing data in 2017 so comparisons were not reliable

* Products not generally sold in single serve portions**The baseline year for cakes and morning goods is 2017

rather than 2015

Product category

Calories per

portion

(% change)

Overall 1.8

Biscuits -1.4

Breakfast cereals 13.6

Chocolate confectionary 21.9

Ice cream, lollies and

sorbets2.4

Puddings -3.6

Sweet confectionaryn/a*

Yogurts and fromage frais 17.5

Cakes** -6.7

Morning goods** -1.5

Category Timeframe

Biscuits Between Year 1

and Year 2

In November 2017, reformulation of 3 Greggs Cookies (Milk

Chocolate, White Chocolate, Triple Chocolate) was

achieved. The sugar content ranged from 38.8g to 39.9g

sugar/100g before reformulation compared with 27.1g to

28.0g sugar/100g after reformulation. This resulted in a

sugar reduction of between 28% and 30%.

Case studyexamplesGreggs

Pladis UK

Category Timeframe

Biscuits Post-Year 2 The portion size of McVitie’s Iced Gems reduced from 25g to

23g, and the portion size of McVitie’s Choc Gems and 3 Mini

products (Gingerbread, Chocolate Digestives and Penguins)

all reduced from 25g to 19g. The average sugar content per

serving reduced by 19%; ranging from 7.5g to 12.9g/serving,

to 5.7g to 11.9g/serving. The calorie content across the

products reduced from 100 to 124 kcals/serving, to 88 to 94

kcals/serving.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832182/Sugar_reduction Yr2

_progress_report.pdf

Overview of the government approach to obesity17

Case studyexamples

Category Timeframe

Cakes Post-Year 2 In February 2019, Costa introduced a new Gluten Free

Vegan Fruity Flapjack to replace the Fruity Flapjack and the

Nutty Flapjack. The portion size and the amount of

sweetened dried cranberries used in the new recipe were

reduced. This resulted in the sugar content reducing by

25% from 26.5g to 20g sugar/portion.

Costa Coffee

Premier Foods

Category Timeframe

Cakes Post-Year 2 In January 2019 30% reduced sugar Angel Slices were

launched reducing the sugar content from 39.0g to 25.1g

sugar/100g. The sugar reduction is achieved by reducing

sugar in the batter and mallow as well as removing the icing

topping. The portion size was reduced from 33g to 24g

resulting in 28% calorie reduction per slice.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832182/Sugar_reduction Yr2

_progress_report.pdf

Overview of the government approach to obesity18

Category Timeframe

Morning

goods

Between

Year 1 and

Year 2

In April 2018, the recipe of the Smartprice Sultana Scone

was reformulated reducing the sugar content by 42% from

25g to 14.6g sugar/100g.

Case studyexamplesASDA

Sodexo

Category Timeframe

Morning goods Post-Year 2 Sugar reduction was achieved in 19 morning goods. The

percentage sugar reduction achieved was from 2.9% to

30.9% per 100g; with the sugar content across the range

reducing from 5.8g to 41.4g sugar/100g before

reformulation, compared with 5.3g to 34.5g sugar/100g

after reformulation. Portion size reduction from 1% to 4%

was completed in 10 of the 19 products in the range.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832182/Sugar_reduction Yr2

_progress_report.pdf

Overview of the government approach to obesity19

• There have been continued reductions in sugar

levels in drinks that are subject to the SDIL

decreased by 21.6%. Equivalent figures for the

out of home sector are not available

• Socio-economic group analysis using data for

retailers and manufacturers shows the sugar

purchased from these drinks has decreased in all

socio-economic groups, although the decrease is

smallest in the lowest socio-economic group.

Although this analysis has not accounted for

other factors that could be causing some of the

differences between groups

Soft Drinks Industry Levy(SDIL)

TotalSugarSales

TotalSales

• The total sugar content decreased by 28.8% per All

100mls for retailers and manufacturers between

-22% 10%

2015 and 2018 AB -24% 11%

C1 -20% 13%

• Results for drinks consumed out of the home are C2 -23% 7%

similar with simple average total sugar per D -26% 4%

100mls reducing by 27.2% between 2017 and E -7% 22%

2018

• The sugar sold in soft drinks subject to SDIL has

-30% -20% -10% 0% 10% 20% 30%

Proportion of sales(%)

TotalSales

TotalSugar

Sales

Change in sales (litres) and change in total sugar

content of drinks

Change in sales (litres) and change in total sugar sales

of drinks by socio-economic group

20 Overview of the government approach to obesity

Salt reformulationIntakes of salt in the UK have reduced significantly (by

around 1g/day or 11%) since the voluntary salt reduction

programme began

• In 2004, the Food Standards Agency and Department of Health

commenced a voluntary programme to reformulate foods focusing

on reducing the salt content.

• This followed recommendations from the Scientific Advisory

Committee on Nutrition (SACN) that adult population salt intakes

should reduce to 6g per day (children were set lower limits)

• Four sets of salt reduction targets (published in 2006, 2009, 2011

and 2014) have been set for around 80 different food categories.

Backed up by public awareness campaigns, these have resulted

in gradual, stepwise reductions in salt levels across each category

with reductions of up to 50% in some products.

In 2014, average salt intake was estimated to be 8g with 33% of the

population estimated to be meeting the 6g target.

21 Overview of the government approach to obesity

Calorie reduction:The scopeand ambition for action

• Requires all sectors of industry to achieve a

20% reduction in calories by 2024 in

products that contribute significantly to intakes

• Same mechanisms for taking action as sugar

reduction – reformulation, reduce portion size,

shift consumer purchasing towards lower

calorie options

• Progress will be monitored in a similar way to

sugar (first report 2021; progress towards the

20% in mid-2025)

https://assets.publishing.service.gov.uk/gover

nment/uploads/system/uploads/attachment_d

ata/file/685359/Calorie_reduction_The_scope

_and_ambition_for_action.pdf

22 Overview of the government approach to obesity

Overconsumption of calories

• On average, compared with those with healthy body weights, overweight and obese

children consume between 140 and 500 excess calories per day for boys and 160

and 290 excess calories per day for girls, depending on their age

Gender Age Overweight or obese: excess

calorie intake

Boys 4 to10 146

11 to 15 498

16 to 18 505

Girls 4 to 10 157

11 to 15 229

16 to 18 291

23 Overview of the government approach to obesity

Calorie reduction economic and other benefits

Based on achieving the ambition within 5 years, and outcomes spread

over a 25 year period, the calorie reduction programme would:

• prevent 35,370 premature deaths

• save the NHS £4.5 billion in healthcare costs

• save social care costs of around £4.48 billion

24 Overview of the government approach to obesity

What does leadership looklike?

• Meet PHE guidance on sugar and salt reduction ambitions

• Commit to the calorie reduction programme

• Support PHE data requests

• Calorie labelling to be consistent, visible, clear

• Reformulate the healthier option as the default

• Encourage other businesses to show leadership

• Trade bodies galvanising members

25 Overview of the government approach to obesity

Reduction and reformulation: nextsteps

The next steps for the upcoming months of the reduction and reformulation programme

include:

• Calorie reduction guidelines are due following further stakeholder engagement later in 2019

• Following publication of the report detailing progress towards the 2017 salt targets work

is now underway to revise salt reduction targets

• The second sugar reduction progress report was published in September 2019 and the

third progress report is due for publication in 2020

• The next phase of engagement with specific parts of the out of home sector has

commenced with a specific focus towards engaging travel and leisure businesses

• A report on food and drinks aimed at infants and young children: evidence and

opportunities for action was published in June 2019. PHE will publish guidelines for

commercial baby foods and drinks in early 2020, and monitor industry’s progress

The Reduction and reformulation programme: Spring 2019 update was published in May

and is available at:

https://www.gov.uk/government/publications/reduction-and-reformulation-programme-spring-

2019-update

26 Overview of the government approach to obesity

Samantha Montel

Outof home engagement team leader

Public HealthEngland

October 2019