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Obesity and Inequality, Two Peas in a Pod?

This week saw new figures showing a rise in childhood obesity in Britain. On average, one child in every Year 6 classroom is severely obese and a further one in three is overweight.

Back in 2011 the World Health Organisation (WHO) declared childhood obesity one of ‘the most serious public health challenges of the 21st century’. In fact, with 26.9% of the population categorised as obese, the UK has the highest incidence of obesity among all Western European nations. Such statistics not only represent a crisis for our health and wellbeing but pose major fiscal challenges. From 2017 through to 2025, the UK is forecast to spend £180 billion on obesity-related illnesses.

So what is to be done? The government’s recently released second chapter of the childhood obesity plan for action was widely praised for its ‘comprehensive and upstream scope’. Mandatory measures such as the proposed restriction on multi-buy offers on unhealthy foods and the placement of unhealthy options at checkouts and store entrances have the most potential.

Consultations on banning junk food advertising before the 9pm watershed are long overdue yet must also encompass other outlets. Research conducted by RSPH and Slimming World found that half of young people have ordered a takeaway using their smartphone and around a third claimed to have visited a fast food outlet purely because they offer free wi-fi.

In this sense, Amanda Spielman, chief inspector of Ofsted was right when she commented that schools alone cannot provide a silver bullet for the childhood obesity epidemic. Obviously, promoting healthy lifestyles and offering high-quality physical education has a role to play but to steal an old adage ‘education cannot compensate for society.’

As the Marmot Review powerfully illustrated, inequalities in health arise because of inequalities in society – the conditions in which people are grown, born, live, work and age. Children who live in more deprived local authorities are more likely to suffer from obesity just as they are likelier to have a lower life expectancy.

Take, for example, Camberwell Green in South London. Half of all ten and eleven year-olds are overweight or obese – one of the highest rates in the country. A few miles south in leafy Dulwich Village, where household incomes are twice as high, the rate is as low as one in five. Over the past decade, the gap has widened.

In terms of life expectancy at birth, boys in East Dorset can expect to live almost a decade longer than their counterparts in Glasgow City. Overcoming these disparities requires tackling the huge social and economic disparities in the UK, a holistic programme that counteracts regional and income inequalities and not just focused on a specific manifestation of inequality.

The Commission on the Social Determinants of Health determined likewise. They concluded that “the social gradient in health within countries is caused by the unequal distribution of power, income, goods, and services…” In the UK, poorer areas have a higher concentration of fast-food outlets – 11.6 per 10,000 people compared to a country wide 8.2.

This is further compounded by the growing cost of eating well (amid a 17 year period of stagnant wages). The Centre for Diet and Activity Research at Cambridge University found that from 2002 to 2012 the price gap between more nutritious foods and cheap, unhealthier alternatives grew annually at about 10p per 1,000 calories.

The problem of obesity, therefore, is not a failure of the individual. It is a structural problem. In this light, the dismay at families who could feed their families on porridge for about £1 a bag is grossly misplaced. In Evicted, Matthew Desmond writes of 54 year-old Lorraine who spends a whole month’s worth of food stamps on one lobster meal.

Similarly, in the Road to Wigan Pier, George Orwell famously penned that “a millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t… when you are underfed, harassed, bored, and miserable, you don’t want to eat wholesome food. You want something a little bit ‘tasty’.

Through placing blame at the feet of individuals, we ignore the wider social determinants of health. These broader inequalities are not a footnote in the obesity epidemic, they are centre-stage and, as such, any plan of action that does not recognise this is destined to fail.

Liam Kennedy is Research Officer at CLASS