The Calorie Reduction Programme: A Move Forward in Tackling Childhood Obesity?
It is known that we are, on average, consuming too many calories on a regular basis. This increases our chances of becoming overweight and obese, which is a leading cause of poor health and premature death. Overweight and obesity is a significant issue affecting over one-third of children when they leave primary school, with children in the most deprived areas having double the rates of obesity of those in least deprived areas. Being obese in childhood increases the chance of being obese as an adult with around two-thirds of men and women now overweight or obese.
• Children and adults are consuming excess calories on a daily basis. • In 2016/17, almost a quarter of children in primary school aged 4-5 years, and over one-third aged 10-11 years, were overweight or obese. • The most recent Health Survey for England found that 58% of women and 68% of men were overweight or obese. • There is a clear case for taking action to reduce people’s daily consumption of calories.
How can calorie intake in children be reduced?
There is a clear need for a structured, and closely and transparently monitored, programme to improve everyday food and drink. This was to be achieved through the revision and reformulation of products to lower the levels they contain of sugar, salt, calories and saturated fat.
This is an effective strategy for improving diets at a population level, providing the most commonly consumed foods are changed.
Product reformulation places the least burden on the public as there is no need for individuals to consciously review and sustain changes to what they eat.
Many do not notice the changes made, particularly if these are gradual and are made across the food chain.
However, if more shoppers were to look for and choose healthier products it could strengthen success and also increase industry confidence and boost innovation.
The UK’s salt reduction programme has seen reductions in foods of up to 50% and the lowering of average intakes by 11% between 2005 and 2014.
What must the food and drink manufacturing industry currently conform to?
The wider reduction and reformulation programme announced in August 2016 has challenged industry to reduce the amount of sugar coming from foods that children up to the age of 18 years consume the most by 20% by 2020. A number of big businesses and household brands have already reduced, or committed to reducing, the amount of sugar in their top selling products either through product reformulation or by reducing portion size.
But this wasn’t enough….
The foods included in the sugar reduction programme account for only 25% of children’s calorie intakes.
If children’s current excess calorie consumption is to be reduced, and obesity trends reversed, a broader programme is needed.
Public Health England was therefore commissioned, in August 2017, to review children’s calorie consumption and to set an extended reformulation programme to cover the foods that contribute significantly to children’s calorie intakes.
How many calories should we and our children be consuming?
In 2011 the Scientific Advisory Committee on Nutrition (SACN) set guidelines for the number of calories that each age and sex group should consume on a daily basis, known as Dietary Reference Values (DRVs) for energy. These were set as Estimated Average Requirements (EAR), which is an estimate of the average requirement for energy across UK population age and sex groups. The guidelines were set at levels of energy intake required to maintain a healthy body weight for otherwise healthy people at what were current levels of physical activity at the time the EARs were set.
While younger children require fewer calories than adults, during adolescence requirements are equal to or higher than those for adults. This is to provide allowances for growth and development during adolescence; and because of body composition and average levels of physical activity differences in adolescents compared to adults. Energy intake figures for those aged 11 and over (including average, physically active adult men and women) have been capped at 2500kcals (10.5MJ)/day for males and 2000kcals (8.4MJ)/day for females to help address issues of overweight and obesity.
What is the calorie reduction programme?
The calorie reduction programme challenges the food industry to achieve a 20% reduction in calories by 2024 in product categories that contribute significantly to children’s calorie intakes (up to the age of 18 years) and where there is scope for substantial reformulation and/or portion size reduction.
This requires work to be undertaken by retailers and manufacturers, restaurants, pubs, cafes, takeaway and delivery services and others in the eating out of home sector.
The products covered by the programme include ready meals, pizzas, meat products, savoury snack products, sauces and dressings, prepared sandwiches, composite salads and other “on the go” foods including meal deals
It does not cover foods included in the sugar reduction programme.
Shifting consumer purchasing towards lower calorie options provides an additional mechanism for action.
The calorie reduction programme focuses on large businesses that are providing the greatest volume of foods and consequentially calories into the food chain.
Why is the calorie reduction programme necessary?
On average, compared with those with healthy body weights, overweight and obese children consume substantial amounts of excess calories every day, above what is required for a healthy body weight. These vary between 140 and 500 excess calories per day, depending on their age and sex. At a population level, on average, adults also consume 200-300 excess calories a day. In reality, the prevalence of excess weight increases throughout childhood and for adults, being highest among adults between the ages of 45 and 74.
The health and economic benefits of reducing the calorie content of these foods and excess calorie consumption are significant.
Excess weight increases the risk of conditions such as heart disease, some cancers and type 2 diabetes in adulthood.
A 20% reduction in calories from everyday foods that contribute to intakes, if achieved over 5 years, would prevent 35,370 premature deaths, save the NHS £4.5 billion healthcare costs and save social care costs of around £4.48 billion, over a 25-year period.
Taking action to reduce calories in this way will incorporate foods providing an additional 19% of the calories consumed by children into the reduction and reformulation programme.
Together with the sugar reduction programme (25% of calories) and the soft drinks levy (5% of calories), this will broadly account for 50% of children’s overall calorie intakes.
The calorie reduction programme will also help adults
The average person in England is now overweight. Consuming a healthy diet means making food choices that are in line with both calorie requirements and the principles of a healthy, balanced diet. On average, diets in the UK are not in line with these principles and contain too much sugar, saturated fat and salt and not enough fibre and fruit and vegetables. Although the calorie reduction programme focuses on foods consumed by children up to the age of 18 years, the reality is that families eat the same foods and the will therefore support all family members in reducing their calorie consumption.
The programme will help all family members to reduce calorie consumption, reducing the risk of weight gain and the consequences of this to health.
It will help to reduce health inequalities, as levels of childhood obesity, tend to be the highest in the most deprived.
As a result of the calorie reduction programme the healthier choice becomes the default choice for families.
It is currently anticipated that the industry guidelines will be published mid-2019 alongside baseline levels of calories in the food categories included in the programme for the year ending August 2017.
The reduction and reformulation programme is a key intervention that can contribute to reducing the incidence of childhood obesity.
If the ambitions set out in the programme are achieved clear benefits should be accomplished.