Why industry involvement in public health is hindering action in tackling obesity

In July, the UK government announced a new strategy for adult and childhood obesity. The strategy was presented as a radical game-changer in obesity policy. It explicitly drew on recent findings that obesity is a risk factor for COVID-19 complications. The policy did signal a willingness to take more regulatory action, for example in relation to TV and online advertisement of junk food. However, many of the proposed measures do not represent a radical departure from already existing tools. In particular, campaigns encouraging obese and overweight people to lose weight, and labelling requirements have been around a long time.

The extent to which these kinds of tools efficiently improve public health and reduce obesity, however, is highly contestable.

The message in a recent National Audit Office report is clear: childhood obesity is still on the rise and leaders do not know what to do to reverse (or even slow down) the trend. In 2018/19, 20.2% of 10 to 11 year-old children were classified as obese, and the percentage is even higher in deprived areas.  Meanwhile, voluntary industry targets to reduce the sugar content of their products were missed by far (2.9% reduction in 2019 against the 20% ambition for 2020), and no measure has successfully addressed the link between social inequities, poverty, and obesity.

What explains such a failure, and why is it difficult to imagine obesity policy differently?

The food and drink industry has managed to impose its preferred framing of obesity as a matter of individual responsibility.

The commercial determinants of obesity

Commercial determinants of health, including in relation to obesity and diet-related health, have been defined as ‘strategies and approaches used by the private sector to promote products and choices that are detrimental to health.’ These determinants are multifaceted, potentially covering business practices (such as market concentration, labour conditions, taxation payments), market practices (commercialising and marketing unhealthy products), and political practices (sophisticated lobbying). It is important to situate these commercial determinants of health within the broader political and macroeconomic context that incentivises such concentration of power and capital.

Over the past decades, the UK policymaking landscape has become increasingly favourable to the inclusion of stakeholders, and to blurring the boundaries between the public and private sector. For a variety of reasons, stakeholder consultation regimes and impact assessments tend to empower and structurally privilege business interests – often at the detriment of public health.

Keen to protect this privileged position, the food and drink industry has been able to present itself as an indispensable ‘partner’ in the fight against obesity and diet-related non-communicable diseases.

What is more, it has managed to impose its preferred framing of obesity as a matter of individual responsibility. This deeply impacts on how policy solutions are thought about, steering solutions mainly towards education and nudging, specifically targeting low-income population groups.

Within this frame, the industry commits to voluntary targets and corporate social responsibility measures. This projects an image of responsible corporations, while ultimately leaving it up to the individual to make the right choice. The fact that voluntary targets are hardly ever met, however, is one reason why the voluntary partnership model of health promotion governance is increasingly questioned.

Obesity policies that put the accent on individual responsibility have been vehemently criticised for their victim-blaming effects and their blindness to the complexity of the issue. Formulating these policies explicitly in terms of individual responsibility is now becoming less and less acceptable. This is the result of a much welcomed turn towards embracing complexity in public health, and diet-related diseases.

We need to think about obesity beyond consumer behaviour and education.

However, the term complexity is a double-edged sword. Indeed, the food and drink industry has instrumentalised it to claim that regulatory, population-wide measures are too simplistic, and that no single foodstuff can be deemed ‘good’ or ‘bad’, given that individuals are uniquely complex. Petticrew and colleagues have called this the ‘complexity fallacy’, arguing that even if single regulatory measures are not a silver bullet solution, they are still useful (especially when combined) and should still be implemented.

The industry is constantly working to recycle the individual responsibility framing of obesity, finding new ways to direct the focus – and the blame – away from itself. Its (mis)use of complexity shows how resilient and malleable policy framings are. My research has been looking precisely at the malleability of ideas in health promotion policy, especially as they pertain to corporate involvement in policymaking.

We need to think about obesity beyond consumer behaviour and education, but without falling prey to the complexity fallacy.

This will inevitably require engagement with normative questions around what kind of society we want to work towards: should obesity policies be limited to encouraging individuals to lose weight while leaving the processed food and soft drink industry unchallenged, even inviting it at the policymaking table?

Or should obesity policies be part of a broader agenda promoting a fair, sustainable and healthy food system, along with a reduction of socioeconomic inequities? If so, the processed food and drink industry – as it currently exists – can not be seen as a partner, because its interests are inherently incompatible with such an agenda.