Knowledge, nudge and nanny
On Tuesday 17th March 2015 I attended the Oxford London Lecture at The Assembly Hall, Church House in Westminster, London for a lecture on “Knowledge, nudge and nanny: opportunities to improve the nation’s diet”. Now in its fifth year, the Oxford London lecture is run annually by the University of Oxford and aims to connect with a wider audience, providing them the knowledge of Oxford’s latest research.
Professor Susan Jebb, the speaker for the evening is a member of the Diet and Population Health research team in the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Her research is based around public health nutrition issues, looking into cardiovascular diseases related to obesity and how this can be prevented through primary interventions within community and primary care.
The lecture was focused around two questions; what we are eating and what are we feeding to our children? And, are the problems big enough for change? Food has been a problem in recent years and there have been many arguments as to whether the problems lie with individual actions or just too many choices.
Professor Jebb discussed the question of whether the nation’s diet can be improved in the future. It is understood that the national healthcare system needs to be strengthened to focus on the prevention of avoidable diseases, as poor diet is a major cause of ill health. With over 12% of the population in ill health and 20% of the population obese nationally the population is generally eating too much of everything, especially food and drinks high in fats and sugar, and a diet lacking in fibre. Examples of studies were discussed to illustrate the dietary pattern and relationship between diets that are high in fat and sugar and excess weight gain. Results have shown the higher the risk of becoming obese, weight gain and a higher BMI with the risk of cardiovascular diseases.
Advertising and social media are a big factor, influencing the minds of people on what they eat. People should understand the metabolic information and the nutrients needed to have a healthy balanced diet; understating the patterns and proportions of food intake. The lecture continued to provide examples of studies of the relationship between over consuming of a higher fat and sugary diet and becoming more overweight.
One intervention model that Professor Jebb discussed was the 4Ps. It was found that more interventions should be carried out on the personal and population level. The 4Ps are: People, Products, Promotion and Places.
Recent campaigns such as Change 4 Life have increased the awareness of healthy eating with the aim of providing help for individuals to have targets, educating them on the understanding behind being healthy. Results have shown the behavioural changes by signposting healthier choices through labelling, causing people to think before consuming food and drink. Even though the effect of the campaign did alter a small population, the change was not large enough for the wider public to change their perspective when choosing food.
Over the years, products have changed to make them healthier on the shelves. There are now more and more products to provide the public with choices, reducing the trend of weight gain. Reformulation is the important strategy to reduce fat, saturated fat, sugar and salt and therefore also reduce intake consumptions to reduce calories by cutting portion sizes. As much as public acceptability is vital to maintain a momentum for the change, it is difficult for the food industry to continuously change due to the high cost.
Having the right promotion is important to provide healthy options, changing the population’s perspective on their food choices. Yet some examples provided by Professor Jebb shown no effects. The in-store environment changes the peoples’ choices. Whilst uplifting the sales with gondola-end promotions in supermarkets to increase their sales figures, the way supermarkets place their products in different positions restricts consumer choices, persuading them to buy the products that they might not want to in the first place.
Food is everywhere. Survey data provided by Professor Jebb shows a positive relationship between obesity and the places of where fast food shops are located. It was found that those live nearer the shops and food outlets have increased levels of obesity. Educating the public is important to send the message of being and eating healthy. It was suggested that perhaps using the planning law to develop healthy zoning policies near schools. Banning sugars and confectionary from near schools could have a positive influence on young people.
What do we need to do in terms of health? Professor Jebb discussed the interventions that can we apply to reduce the level of obesity. Information support, product renovation, out of home support, healthier options in all local food outlets, marketing controls, public procurement and provision, workplace incentives (for employees for choosing healthier options) and fiscal measures were just some examples listed.
In conclusion, poor diet is a major concern for the UK population with two thirds of adults being overweight in the current climate. Top level measures are needed to promote a healthier diet as it is an essential complement to the individual lifestyle interventions. Education is useful to provide information to the public but it was rarely sufficient and not always necessary. Therefore, actions from the industry are crucial to transform the food environment preventing the increase of obesity and over consumption. There is a subtle balance of power between policy makers, industry and the public, which needs to be understood and managed if effective policies are to be successfully adopted. However, some argue that foods are often consumed below the level of conscious decision making, implying that nudges in the environment change what we put in our mouth. Is this enough to help make the change? Or do we need strong policy actions acting as a nanny to help change the perspective of food and the opportunity to improve diet?
After Professor Susan Jebb’s lecture, a panel discussion was held with:
Chair: Alice Thomson, a columnist from The Times
• Professor Susan Jebb
• Lord Krebs (House of Lords, Chair of the Food Standards Agency, Science and Technology Committee, Principal of Jesus College, Oxford)
• Mr Joshua Hardie (Director of Group Corporate Responsibility at Tesco)
• Lady Young (CEO of Diabetes UK and previously Chair of the Environment Agency and Deputy Director of the BBC)
By Kiu Sum, first year student, BSc Honours Human Nutrition