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Calorie reduction: The scope and ambition for action

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. Obesity and overweight-related ill health are estimated to cost the NHS £6.1billion annually.

Childhood overweight and obesity is a significant issue affecting over one-third of children when they leave primary school. Children in the most deprived areas have double the rates of obesity of those in the 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.

‘Childhood obesity: A plan for action’ was published in August 2016. Amongst the government’s commitments was for Public Health England (PHE) to lead a structured, and closely and transparently monitored, programme to improve everyday food and drink. This was to be carried out through the revision and reformulation of products to lower the levels they contain of sugar, salt, calories and saturated fat (pending a review of current dietary recommendations).

Action of this kind has already proven to be an effective strategy for improving diets at a population level, providing the most commonly consumed foods are changed. Product reformulation also places the least burden on the public in terms of improving diets as everyday foods are changed so there is no need for individuals to consciously review and sustain changes to what they eat. Indeed many do not notice the changes made, particularly if these are gradual and are made across the food chain. By working in this way 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.

To date 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. Industry guidelines to facilitate this ambition were published in March 2017. 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.

The foods included in the sugar reduction programme account for around 25% of children’s calorie intakes. However, if children’s currently excess calorie consumption is to be reduced, and obesity trends reversed, a broader programme is needed.

PHE were therefore commissioned in August 2017 to consider the evidence around children’s calorie consumption and to set the ambition, scope and timeline for extending the reformulation programme to cover the foods that contribute significantly to children’s calorie intakes. This document sets out the detail on these.

The evidence set out here first illustrates the recommended levels of calorie intake published by the Scientific Advisory Committee on Nutrition in 2011. Weight gain happens when calorie intakes are habitually above requirements for health. Although evidence shows that people are consuming more calories than they require as body weights are above the ideal, when monitoring the number of calories people actually eat, dietary surveys suggest that calorie intakes are below recommendations. This mismatch is seen because survey respondents do not record everything they usually eat and drink meaning surveys are unable to provide a true reflection of calorie consumption. Additionally, those who are overweight and obese are more likely to underreport their consumption, meaning that issues with underreporting will increase as the population continues to gain weight.

Separate analysis was therefore necessary to identify the true picture of excess calorie consumption. Analysis included in this report shows that 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. These figures are conservative estimates as the analysis assumes no further weight gain occurs. This means that for many the number of excess calories they consume will be higher. In reality the prevalence of excess weight increases throughout childhood and for adults, being highest among adults between the ages of 45 and 74.

As well as these data, when setting the plans for the calorie reduction programme PHE also considered a range of other evidence. This includes insights and achievements from earlier reformulation programmes and the results of an initial stage of engagement with 21 leading businesses across all sectors of the food industry (according to market share), and 1 non-government organisation that represents around 40 public health bodies. Consumers’ perceptions and understanding of calories, and their views of the actions that could be taken to address the current obesity problem, have also been taken in to account. This shows that there is public support for the government working with businesses to develop products with fewer calories and in smaller portions. Finally an economic assessment was conducted to identify the benefits of implementing a calorie reduction programme. The result of these considerations is the calorie reduction programme outlined in this document.

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 health and economic benefits of reducing the calorie content of these foods and excess calorie consumption are significant. 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.

Businesses are encouraged to start work now to reduce the calorie content of everyday foods included in the calorie reduction programme. PHE will support their efforts by setting guidelines for products; establishing baseline calorie levels in each food category; and regularly reporting progress across the different sectors, food categories and for the top contributing businesses and products. The year ending August 2017 will be the baseline against which progress will be measured. PHE will advise government if progress is not being made.

PHE will engage with stakeholders over the coming months to set specific product category guidance, using a sales weighted average approach across broad food categories which focus on top selling products. These will be published in mid-2019. PHE will also consider whether separate guidance for the eating out of home and takeaway/delivery sectors is required in order to achieve the same level of ambition. In parallel to these discussions and the setting of guidance for industry, including for smaller businesses, PHE will discuss with stakeholders the metrics and analyses that will be used to monitor the programme.

The UK nations recognise the need to focus on calories and the purpose of a calorie reduction programme. PHE will continue to involve them closely in the further development of the programme and forthcoming guidance to industry.

The calorie reduction programme focuses on large businesses that are providing the greatest volume of foods and consequentially calories into the food chain. 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 drinks (5% of calories which come from drinks that are included in the soft drinks industry levy and PHE’s separate programme), this will broadly account for 50% of children’s overall calorie intakes.

Although the programme focuses on foods consumed by children up to the age of 18 years, the reality is that families eat the same foods. This programme will therefore support all family members in reducing their calorie consumption, particularly with continued support through for example the Change4Life and OneYou campaigns. It should also help to address health inequalities, as rates of obesity in children tend to be highest in the most deprived. PHE will therefore seek to gather evidence of the impact of the programme across all economic and geographic groups.

Achievement of the calorie reduction programme’s ambitions offers a significant opportunity to address excess calorie intakes in children, and the consequent health harms, and to deliver significant health and economic benefits. However, any significant progress in reducing calorie intakes would yield benefits.