Change4Life: change we can’t believe in

The UK government’s latest war on obesity is the most cartoonish public-health propaganda in living memory.

Various Authors

Topics Politics

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When tens of millions of taxpayer pounds are spent on a public health campaign, a rational, if naive, expectation is that the campaign is founded upon the latest and most rigorous scientific evidence. Yet the British government’s Change4Life campaign, which began airing TV adverts last Saturday, is both literally and figuratively the most cartoonish public health propaganda in memory.

There are five problems with the Change4Life programme.

First, and most fundamentally, the most recent data do not support the government’s claims about rising and intractable child and adult overweight and obesity. The government claims that by 2050 four out of 10 children will be obese and nine out of 10 adults will be overweight or obese, but there is little reason to think that this will be the case.

The Change4life advert.

According to the just published Health Survey for England, for adult men there has been a decline in the prevalence of overweight and obesity, something that is very hard to square with the government’s claim about an epidemic, while for adult women, prevalence has remained unchanged. Sixty-five per cent of men were either overweight or obese compared with 76 per cent in 2006. When this data is compared with the 2004 results, there have been either declines or no significant changes in male prevalence of overweight and obesity in all age groups from 16 to 54.

As for children, the Survey reports that: ‘There was no significant change in mean body mass index (BMI) overweight/obesity prevalence between 2006 and 2007, and there are indications that the trend in obesity/prevalence may have begun to flatten out over the last two to three years.’

For example, according to the Survey, there was a decrease in obese girls aged two to 15 between 2005 and 2006, from 18 per cent in 2005 to 15 per cent in 2006. Among boys aged between two and 10 years, the prevalence of overweight declined from 15 per cent in 2005 to 12 per cent in 2006.

In fact, the data shows that amongst boys and girls aged between two and 15 years old, overweight and obesity has been declining since 2004. In girls, obesity levels in 2005 were largely unchanged from where they were in 2001. So, the government’s own statistics clearly fail to support its claims about overwhelming obesity in 2050.

Second, the Change4Life campaign is predicated upon the notion that the overweight and obese are at risk of premature death. But this again is not true. A recent academic study by Dr Katherine Flegal and colleagues found the weight group with the lowest death rate was overweight, while Dr Jerome Gronniger’s analysis found negligible differences in risk of death among people with body mass values from 20 to 25 (1)

Even where there are significant associations between overweight and early death, the risks are so modest as to be highly suspect. For example, whereas the reported lung cancer risks for smokers are typically 10 to 15 times higher than for non-smokers, the premature death risks for overweight and obese people are in many instances closer to 0.5 to 1.75 above those for people with normal weight (2).

And despite the supposedly abnormal levels of overweight and obesity in the UK, life expectancy continues to increase. According to the UK Office for National Statistics, the current life expectancy of 77.2 years for men and 81.5 for women will soon rise to 82.7 and 86.2 respectively (3). Again, increases in overweight and obesity have been paralleled by falls in US total cardiovascular mortality and mortality from coronary heart (CHD) disease and stroke, as well as in prevalence of hypertension and hypercholesterolemia (4).

The recently published Flegal et al study (‘Cause-specific excess deaths associated with underweight, overweight and obesity’) reported no statistically significant association between overweight and excess mortality for CVD or CHD. For cancer there was no statistically significant association between excess mortality and overweight and obesity.

Even for cancers considered obesity-related there was no statistically significant association between excess deaths and overweight. Similarly, in the Million Women Study (5), for all cancers overweight was not associated with a statistically significant mortality risk, while with obesity the association was a barely significant 1.1.

Third, the Change4Life programme assumes that ‘eating better’ can reduce the risk for disease and death despite the fact that there is almost a complete absence of evidence from randomised clinical trials that supports any of the claims that reductions in fat and calories and increases in fibre, fruits and vegetables can reduce the risk of certain diseases, delay death, or prevent weight gain. Indeed, some of the largest of these trials, such as the Women’s Health Initiative Dietary Modification Trial, found no statistically significant differences in the risk of breast cancer, colon cancer, CHD, stroke, or CVD between the intervention and control groups (6).

Fourth, there is no compelling evidence that the Change4Life’s exhortations to ‘move more’ have any efficacy in terms of weight loss or longevity in either adults or children. For example, Dr Loretta DiPietro notes that based on the long-term evidence, ‘It is not clear that increased physical activity prevents or reverses age-related weight gain at the population level’ (7).

The evidence is even less compelling with children. Numerous studies have failed to find a link in children between physical activity levels, food intake and obesity. In fact, there is considerable evidence that neither better sports and physical education facilities, nor improved programmes or increased hours of physical education in schools, will reduce childhood overweight and obesity.

Take, for instance, the Hungry for Success programme, a school-based intervention in Scotland, which was designed to reduce weight, increase consumption of fruit and vegetables, encourage healthy eating through cookery classes, end the sale of sweets and fizzy drinks, and improve school meals. According to the most recent report of Her Majesty’s Inspectorate of Education, Hungry for Success has failed to increase fruit and vegetable consumption in children, has failed to reduce overweight and obesity in children, and has prompted the suggestion that lunch-time lock-downs might be needed to prevent children from leaving school and eating inappropriately (8).

Fifth, Change4Life assumes, again without any compelling evidence, that government-determined, facilitated and mandated population-wide behavioural change with respect to diet, weight and physical activity levels is, in fact, possible. Interventions based on creating such behavioural change almost always rely on theories such as cognitive learning and the theory of planned behaviour in which changes in knowledge and beliefs lead to changes in intention and, finally, to changes in what one does. These theories, however, have rarely been subjected to rigorous evaluation and where they have, they have generally been spectacular failures (9).

Part of the problem stems from ‘behaviour decay’, in which behavioural changes with respect to diet and exercise last for a short time, but then gradually decay with little or no long-term impact. For example, even the most optimistic studies on dieting suggest a long-term success rate of less than 10 per cent.

A recent study of behaviour decay that looked at efforts like those envisioned in Change4Life in terms of improving diet and physical activity found that most of the change occurred by week six with significant decay at 18 months (10). There is considerable evidence that community-level interventions designed to modify physical activity and food consumption patterns have been failures (11).

These failures mean that the government will almost certainly follow through with the draconian agenda suggested by health minister Ben Bradshaw, who says that food content, if not the outright banning of certain foods, will have to be considered, if these Change4Life measures do not work. Clearly, the government believes that going one better than Scotland’s Hungry for Success – by launching a UK-wide lunch-time, dinner-time, breakfast-time, snack-time, indeed anytime lock-down on bad eating – is necessary, not just for children, but for everyone.

But that’s the true face of the food police. Hopefully, Britons will recognise this costly, out-of-control nanny before it is too late.

Patrick Basham and John Luik are co-authors, with Gio Gori, of Diet Nation: Exposing the Obesity Crusade, a Social Affairs Unit book. (Buy this book from Amazon(UK).)

Previously on spiked

Patrick Basham and John Luik reviewed a year of myths about smoking and obesity. They also examined new research which taught obesity hysterics a lesson and attacked the proposals to remove children from obese households.Dr Michael Fitzpatrick said we should stop bullying fat kids. Rob Lyons was sick of the endless diet of government intervention. Peter Marsh asked what’s behind the sensationalist child obesity headlines. Or read more at spiked issue Obesity.

(1) Excess deaths associated with underweight, overweight and obesity, Flegal et al, JAMA 2005 293: 1861-67; A semi-parametric analysis of the relationship of body mass index to mortality, Gronniger, AJPH 2006 96: 173-78

(2) Body mass index and mortality in women: a 27 year follow-up of middle-aged men, Jain et al, JAMA 1993 270: 2823-8

(3) UK population set to increase to 65 million over the next 10 years, UK Office for National Statistics Press release, 23 October 2007

(4) Morbidity and mortality: 2002 chart book on cardiovascular, lung and blood diseases, Maryland, National Heart, Lung and Blood Institute, 2002

(5) Cancer incidence and mortality in relation to body mass index in the million women study: cohort study, Reeves et al, BMJ 2007

(6) Low-Fat dietary pattern and risk of cardiovascular disease, B Howard et al, JAMA 2006: 295; Low-fat dietary pattern and risk of colorectal cancer, SA Beresford et al, JAMA 2006: 295

(7) Physical activity in the prevention of obesity: current evidence and research issues, Medicine and Science in Sports and Exercise 1999: 31

(8) Healthy eating fails to impact on secondaries, Holyrood, 15 January 2008

(9) Application of the theory of planned behaviour changed interventions, Hardeman et al, Psychology and Health 17, 2002

(10) Can newly acquired healthy behaviours persist?, Merrill et al, Preventing Chronic Disease 2008: 5

(11) Preventive Strategies against weight gain and obesity, Swinburn and Egger, Obesity Reviews 2002: 3

To enquire about republishing spiked’s content, a right to reply or to request a correction, please contact the managing editor, Viv Regan.

Topics Politics


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