The global discourse on obesity is full of people saying it's a complex problem but offering simple solutions - it's time we put in place a bottom-up and top-down approach, says food and health expert Dr Mike Gibney.
“The whole global landscape of obesity is dominated by single issues -- sugar taxes, labelling -- and although you find in, for instance, The Lancet they talk about top-down / bottom-up approach, everything written there is top down," the professor of food and health at University College Dublin told FoodNavigator.
"Bottom up is where money has to be spent -- but in The Lancet series on obesity the word budget isn’t mentioned once,” he said.
Gibney, who has recently published a book exploring human obesity, Ever Seen a Fat Fox?, believes that the top-down focus on big multinational companies is also somewhat misguided. “The danger is thinking you can solve the problem of food chain by tackling the multinationals. Quantitatively they don’t [contribute to diet] as much as is made out to be. In the USA it may be different but in Europe the local supplier – whether for fresh or processed foods – [dominates].”
This means that although reformulation and portion control should be used to tackle the problem, it's not easy creating a level playing field to do so – even if all major processed companies are involved - because local players will not be
“If a top European pizza supplier reformulates at great expense it doesn’t mean the local pizza supplier will. The big companies will take a long-term view, will have a perspective on their sales markets and brands and know they don’t have much choice – if they are in any way socially responsible – but to make their products healthier. This may mean slightly changing their business models.
“The problem is that small and medium companies will not do this because they don’t have the long term resources. They need incentives to help them and the possibility of governments making them do it.”
Does stealth reformulation with independent monitoring really work? A case in salt: In 2005 the UK food industry set salt reduction targets for 86 categories of food. Eight years later, stroke deaths had fallen by 42% and heart disease by 40%, according to a study published in the British Medical Journal.
It achieved this by gradually reducing salt in food by 20-40% from 2005 with industry efforts monitored by an independent agency. This was achieved without harming industry sales and without the public noticing a difference in taste. However when the subsequent government removed funding for the independent agency, salt levels crept back up increasing salt intake, according to public health campaigners.
But that doesn’t let Big Food off the hook– “The big ones can easily start this process of reformulation- they should and must - and also need to verify it has had a meaningful impact using existing consumption data,” he said.
This is where the multi-faceted approach comes in - because these top down measures do have a role to play but only as part of an initiative that includes bottom-up strategies as well.
Looking at the tobacco or alcohol model with their top-down measures is flawed because neither has very much in common with food. “You don’t need alcohol and you certainly don’t need tobacco but everyone needs food. And while those two industries are dominated by maybe ten companies, the food industry is the opposite. Supply is widespread and it’s much more complex,” said Gibney.
A successful mixed approach that incorporates both bottom-up and top-down measures could be the road safety campaign in Ireland. For instance, legislation to make wearing a seatbelt mandatory has been accompanied by bottom-up advertising campaigns on TV as well as awareness sessions in schools with talks in schools organised by local authorities.
Gibney wants to see national programmes operated at a regional level where people are facilitated to walk more, able to attend free weight-loss clinics. Without this, banning, restricting and taxing will have little effect.
Examples are few and far between even on a global scale, he said, but pointed to one school-based intervention that took place in two towns in northern France, with two comparable towns acting as a control, that later inspired the national EPODE scheme (Ensemble Prévenons l'Obésité Des Enfants – Together Let’s Prevent Childhood Obesity).
The local French councils fully supported the initiative and built new sports and physical activity facilities as well as training teachers in nutrition. Dietitians, doctors, pharmacists, shopkeepers and sports and cultural organisations also took part and in just over ten years the average BMI for boy fell from 16.7 to 15.6 and for girls from 16.4 to 15.7.
“It’s important to note that the effects only became evident after eight years of constant reinforcement of the programme’s objectives with full community support. […] Without community-based activities, however anonymous, no real progress will ever be made in tackling physical inactivity and obesity,” writes Gibney in his book.
There is no quick-fix, silver bullet solution to this problem.
Crucial to the success of all these measures is monitoring by “a standalone independent agency that isn’t bullied by policy makers, [the] food industry or farming industry,” he said, adding that the structures are already in place in most countries but they are being applied to food safety rather than an obesity-specific focus.
“Most countries have a food safety authority that is independent of government departments, receives a budget that is usually covered by law and has a long-term view. Nowhere on the planet has a national obesity control authority but in my view that’s the only way of getting beyond the short-term project,” he said, adding that he would be interested in getting involved in “seeing how it could be done”.
This is something that even industry has called for – the British Retail Consortium recently said reformulation is possible but only with an agency to ensure everyone complies.
"No matter what way you do the maths, the bottom line is that permanent, independent, well-funded agencies are within most national budgets. The resources are there. It's just the will that is lacking. No dough, no go!," Gibney concluded.