Can we trust Public Health England?

Victoria Street, 

London SW1 

“Good morning Humphrey.  There’s something in my in-tray claiming that we will cure the national obesity problem by having every item, on the menu of every chain of cafés, restaurants and take-aways, show its calorie count.”

“Yes, I’m sorry about that, Minister.  It’s Public Health England again.” 

“I realise that but it’s obviously a daft idea, so why didn’t you kick it out?” 

“I did advise them of the precariousness of their argument but as we have arranged the interment of almost all their other ideas, its senior enthusiast is clinging onto this one.  He claims their proposals will make the country so healthy we will not need a National Health Service.  It would save us £100 billion a year. The Treasury think that is brilliant.  They might even give us the money for reforming Adult Social Care for which, as you know Minister, we have a ready-to-roll plan.” 

“Poppycock. I read in the papers that this ready-to-roll plan, which I haven’t seen, has cross-party agreement too, except that’s news to the other parties. But what’s that got to do with putting calories on menus?” 

“Apparently, it will result in a new slim Britain, remove eating disorders, sort out mental health and save the NHS £6.1 billion, all by itself.” 

“Humphrey, you are unusually satirical this morning.  Would you like to give me the name of this fantasist?” 

“I regret that our Code does not permit me to do that.  In my view, we should, on this occasion, allow common sense to bow before conviction. In any case, it reflects well on our moral compass that the government is tackling obesity.” 

“Maybe.  What is the evidence that this will make a measurable difference?” 

“You have put your finger on the very point I raised with my Public Health colleague.  He told me it is all very complicated. Obesity is best considered not just as a state of excess of body fat or body mass index above an arbitrary cut-off, but as the disease process, of excess body fat accumulation that has interacting (epi-) genetic and environmental causes and multiple pathological consequences.”

“You took the words right out of my mouth, Humphrey. How about breaking this into identifiable groups of people we can help?” 

“Of course, Minister.  Obesity has many faces.  Our primary concern is with children who have no problem with obesity today but will most probably remain obese as they grow up – and, indeed out. They will then be prone to diabetes, Covid, heart conditions and other disorders. They will die young.”  

“Dying young must save money for both the NHS and Adult Social Care.  The Treasury should be glad.  Have you though of free cigarettes for obese children?” 

“Minister, I did not hear that.  We are talking of human lives. That said, my colleague failed to convince me that calories on menus would make the slightest difference to childhood obesity.  The parents will see the menus, not young children, though maybe teenagers will, but the rot has set in by then. Parents indulging their children with eating out or phoned-for deliveries regard them as occasional treats – not opportunities to make them eat food they dislike.” 

“Well, that disposes of the main group.  What is the next segment?” 

“Now we are into thin people who merely think they are fat: those, mostly teenage girls and young women, with eating disorders.  This is really a mental health problem.  We actually need to get them to eat more. It has been reported that calorie information on menus will be downright dangerous for those with anorexia or other eating disorders.”

“Of course, obesity is often itself an eating disorder and parents of teenage girls know that rational argument is no help. Have Public Health England researched the impact of this on those with eating disorders?” 

“Er, no. As you say, the indications are negative. Furthermore, some research in America showed ‘a slight increase in calorie intake, attributable to increased purchases of higher-calorie entrées.’ So listing the calories is likely to be counterproductive for two of the most critical sectors. Minister, I don’t understand the mind of Public Health England either.” 

“As I understand them, Humphrey, these new regulations only apply to non-packaged food and soft drinks purveyed by large businesses, i.e. those employing more than 250 people. So if you put gin in the tonic, there’s no need to mention the calories.” 

“We do not wish to upset people.  You will notice that the bottom of the press release says that people do not have to have calorie information on their menus if they say they do not want it: ‘people who may find viewing calorie information more difficult may be able to avoid this information in certain situations when eating out.’” 

“So the people who most need this information won’t get it?  Brilliant that. The overweight people I know are mostly middle-aged or older and know they have a problem. They try dieting and fail.  Some, in the spring, are determined to lose weight to get into their swimming costumes, succeed and then put it back on later in the year. Are they the problem we are trying to solve?” 

“Not really.  The category, to which you refer, is the weight-watcher group.  They may not be as slim year-round as Public Health England would wish, but they are more likely to be interested in calories.  So Public Health England is targeting them as a willing audience, even though they pose no problem for the NHS.  That’s just the way Public Health England does things.” 

“Quite correct, Minister. There is, if I may say so, a certain logic in applying the same regulations to unpackaged as packaged foods and drinks.” 

“That seems reasonable but we’ve not been putting calorie content on packaging for very long.  Quaintly called “energy values” have only been required since 2016. The question is whether, in those five years, anyone has shown that that information has reduced obesity.” 

“No.  One Loughborough study reviewed 15 projects but they were not really reliable for this purpose for three reasons: there was a lot of variation, calories were expressed as PACE and the research was under laboratory conditions where respondents had to read and consider the PACE data. ‘PACE’, by the way, stands for Physical Activity Calorie Equivalent. As people do not understand what calories mean, ‘the study added labels to food packaging explaining that you would need to run for example 13 minutes after drinking a 330ml can of fizzy drink; 22 minutes after eating a standard size chocolate bar; and 42 minutes after eating a shop-bought chicken and bacon sandwich.’”

“So by just adding calorie data, we are not giving consumers anything they can relate to?  Great.  If you stopped shoppers coming out of Tesco and asked them about the calorie counts of the packages they have just bought, they wouldn’t have a clue what you were talking about?” 

“I have to admit that you have just expressed the kernel of the difficulty. And no doubt, Minister, you are about to point out that if we cannot show it works on packaged foods, there is no reason to believe it will work on unpackaged?” 

“Indeed I am, Humphrey.  I’m all for indulging Public Health England but there are limits. I gather they haven’t even done a trial run to measure effects in some part of the country that is relatively obese.” 

“The USA is just about the only country in the world that now puts calories on menus and they have done the little research there is.  Inter alia, there are no indications these listings make any difference and the calories shown are often wildly incorrect, partly because of the practical difficulties of portion control. ‘Worse, the food items with the lowest reported calories — the so-called healthiest — were the most likely to be incorrect.’” 

“Humphrey.  Is Public Health England right to focus on calories.  I know losing weight means fewer calories but, from a broader health perspective, that could be misleading.  I read the other day that “Different foods can impact your hormones, hunger, feelings of fullness, and metabolism differently, regardless of the number of calories they contain. Thus, when it comes to your health, not all calories are created equal.”

“Need you ask, Minister.  They have been busy with another bright idea. Public Health England has spawned a new quango to take care of all this: “The Office for Health Promotion.”  Public Health England will be left to take care of all matters that do not promote English health. I am not sure what those are, whether they need doing by Whitehall or, indeed, at all.”   

“Humphrey, this government is driven by the science.  Where is the science?” 

“We are also action oriented, Minister. We need to act now to stem this tide of obesity.  We were too slow to react to the pandemic.  We must not be too slow on obesity.  Our justification is that 79% of those responding to our 2020 consultation agreed with putting calories on menus.” 

“Humphrey, you know perfectly well that one can expect a similar response to any other “nil cost” consultation.  Try asking people if they would like to be better off. WE are just virtue signalling, and you know it.” 

“Minister, it is not for me to be judgmental.” 

“Apart from costs for food retailers, I don’t suppose this will do any harm. The real harm, Humphrey, arises from believing Public Health England’s claims that it will resolve the obesity problem. That is nonsense.”