The British food environment actively undermines people's attempts to lose weight and keep it off, and even well-designed weight management services will have limited impact on long-term efforts at weight loss and weight loss maintenance if Government does not employ effective policy to address the food environment, according to the outcomes from a systematic review from UK researchers. The study, 'How does the food environment influence people engaged in weight management? A systematic review and thematic synthesis of the qualitative literature', was published in the journal Obesity Reviews.
The UK has one of the worst records for obesity in Western Europe, with two in three adults having overweight or obesity, and one in three children reaching this stage by the time they leave primary school. Obesity-related illnesses cost the NHS £6bn a year.
The 'food environment' is where people can buy and eat food outside of the home, as well as advertising and promotions they come across. The review suggests that the ubiquity and appeal of unhealthy foods means that people actively trying to lose weight or keep it off must avoid parts of the food environment to be able to adhere to healthy eating plans.
In addition, the review found that the relatively lower cost of unhealthy food options (either perceived or actual) makes weight management particularly difficult for people on a low income, as unhealthy food is more likely to be promoted and on offer.
The systematic review included 26 studies that focused on people's experience of losing weight or maintaining weight loss in their normal, every-day environment, and that were published between 2011 and 2020 from across 12 high-income countries, including the accounts of 679 adults. The relatively small number of relevant studies included reflects a general paucity of evidence in this important research area.
The authors said that governments needed to:
Shift the balance so that there are more promotions and offers on healthy foods, such as fruit, vegetables and nuts, and fewer promotions and offers on 'High in Fat, Salt and/or Sugar' (HFSS) foods;
Support businesses and the public sector to provide healthier options in the workplace for both lunchtimes and social occasions;
Provide clearer labelling on foods detailing portion sizes and nutritional information;
Restrict marketing on HFSS food and drink;
Develop incentives for the introduction of more fast-food outlets selling healthy options, particularly around popular work locations;
Provide sustained financial support for those at the lower end of the socioeconomic spectrum to make healthy food access more equitable; and
Ensure weight management services recognize the significant impact of the food environment on the people they aim to support and build strategies around food shopping and social occasions into all programmes.
"This review highlights not only how difficult it is to lose weight in Britain, and keep it off, but also that it's just not about willpower or self-control: even people trying really hard are thwarted in their efforts by unhealthy food options that are everywhere—they're easy to find, cheap to buy, quick and appealing,” said Kimberley Neve, co-author of the review and Research Assistant at the Obesity Policy Research Unit, Centre for Food Policy, City, University of London. “The narrative needs to shift so that instead of going on the usual January diet, people ask for a food environment that supports them to be healthy. For that, you need policy to level the playing field for industry to start making changes."
The authors undertook the review as part of the National Institute for Health Research (NIHR) Obesity Policy Research Unit that conducts independent research to inform government policy.
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