Have you haddock enough?

Posted by Louis Goffe, Research Associate, Newcastle University

That smell. That distinctive saline scent. Your subconscious has your saliva glands brimming before you’re cognisant of what you desire.

Fish & chips is arguably our most iconic contribution to the culinary arts. This most harmonious pairing of Jewish-style fried fish with chipped potatoes, first engaged in the 1860s and have been besotted with each other ever since. At their peak during the inter-war years, there was an estimated 35,000 shops around the country, while in today’s diverse and competitive fast-food market, there remains around 10,500 chippies.

Fish & chips Edwardian style

The interrelating factors that derive our weight are as unique as our fingerprint and untangling and finding solutions is a global challenge. There is no single determinant and competition for a slice of the obesity research funding pie, is as cutthroat as the local high street takeaway shop cluster.

Takeaways are not the prime suspect in unlocking the door to good health, but it’s clear that they do play a role. As such, we need to scope what aspects can change to help provide customers and communities with healthier options.

When it comes to food, there is no universally accepted metric for ‘health’. The term is open to interpretation and keenly fought over, see the fat Vs carbs debate. However, such considerations are rendered obsolete when considering the nutritional profile of independent takeaway food, where meals were found to be “excessive for portion size, energy, macronutrients and salt”. It is the sheer volume of food provided that is the intimidating/wondrous [delete as personally appropriate] factor.

Pizzas are the chart toppers when it comes to portion size, delivering a medium value over 1,800 calories, though fish & chips are not far behind on an excess of 1,600 calories. This is a hefty dollop of energy, given that an adult women is advised to consume 2,000 calories per day. Of course, just because a portion contains this amount of food, it doesn’t mean that one will consume it all. But the evidence is clear “people consistently consume more food and drink when offered larger-sized portions, packages or tableware than when offered smaller-sized versions”.

It was not our assertion that any particular cuisine type is to blame, but to find potential solutions to what has likely been an arms race by traders in response to their most vocal customers to provide the most calorific-kick per quid, as highlighted in this quote from a Scottish fast-food trader.

“They just want chips… they'll have a look and then go along have a look at their deals and then come back and they'll order… they like the value for money. The competition here is unbelievable.”

In our NIHR School of Public Health Research funded study based at Fuse in collaboration with The Centre for Diet and Activity Research at the University of Cambridge, we wanted to challenge the notion that quantity rules above all, to see if traders and their customers were accepting of promotion of smaller meals.

Louis throwing himself into the research

Fish & chips offered the ideal starting template. Their taste is as beholden to us, as espresso is to the Italians, therefore reformulation has limited potential. Despite their volume, they’re presented as a one-person meal, with smaller sizes mainly limited to children, pensioners or as lunchtime specials.

Engaging with traders is a huge challenge. Therefore, we asked Henry Colbeck Limited, an independent specialist fish & chip shops wholesaler, to give the project that foot-in-the-door via a trusted voice. We co-designed the intervention, but crucially, they led on delivery and we retained our independence as a research team for analysis and interpretation of the evaluation data.

We were operating in an intervention landscape reliant on traders’ voluntary participation. This meant an emphasis on the potential financial rewards of provision of smaller meals to traders’ businesses, through articulating the power of customers’ awareness and demand for healthier options.

Henry Colbeck were key to creating a meaningful dialog with and between traders and getting them on-board with the trial. We found both owners and their customers were broadly accepting of the prominent promotion of the lighter meals, with a reported increase in the proportion of smaller meals sales, however our sample size was too small to derive statistical inference.

Lite-BITE box developed by Henry Colbeck Ltd

Interestingly, during interviews with traders, one big question remained, ‘what constitutes a smaller meal?’ During the trial, it was left to traders to define and package accordingly. Concurrent to our independent evaluation, Henry Colbeck sensed an opportunity and developed a new product specific packaging, the ‘Lite-BITE’. They have subsequently sold, along with their partner suppliers across the UK, 12 million boxes in 2018, highlighting that there is the customer demand for a more modest and manageable portion.

Despite this success of raising the profile of smaller meals, how much of them we consume is still unknown and more work is required to better understand the health implications. Also, like the traders in our study, we the consumer, would also benefit from clearer, potentially standardised, portion sizes that could help support nutritionally informed choices.

Our study was formative in nature, but the Lite-BITE box sales show an appetite for smaller takeaway meals and the access to traders that Henry Colbeck provided far out numbers those we could have obtained through door-stepping as academic researchers. We should put all potential tools on the dinner table that could help create healthier environments, including harnessing customer power. So next time you’re in your favourite fish fryer, if it’s not on the menu, ask for a smaller meal and hopefully the owner will soon start to sniff out that saline scent of profit to be made from healthier options.

Louis stars in our video about the research

Image: 'Beamish offers Edwardian-style fish and chips' from BBC Wear 2011: http://news.bbc.co.uk/local/wear/hi/front_page/newsid_9386000/9386156.stm

Aspiring to new lows in North West waistlines

Guest post by Naoimh McMahon, Postgraduate student, NIHR CLAHRC NWC

In theory weight management is a ‘simple’ balance between consuming enough energy to adequately fuel ourselves and moving enough to ensure that extra energy is used up. However, in reality there is a complex web of influences that determine our eating and activity habits. We are becoming increasingly more sedentary and are prone to consuming more energy-dense foods. This combination is making the energy balance harder to achieve. When it comes to weight management interventions, what works for one individual is rarely guaranteed to work for the next and so there are real challenges to understand what the right mix of actions are to enable people to achieve and maintain a healthy weight.

Last summer, when preparing a doctoral fellowship application I met with providers and service users from a range of local health improvement initiatives in the North West of England. I was really intrigued by one initiative in particular called Aspire. Aspire is a weight loss programme delivered by a local charity. The design of the programme was unlike any other weight loss programme I had encountered and there was a real sense of personal investment in the programme from both the providers and participants. The thinking behind Aspire is that for individuals who have a lot of weight to lose, intensive and ongoing support is needed to make a positive and sustainable change. The programme runs for 26 weeks and each group has 12 participants. Aspire includes all the traditional elements that you would expect to find in a weight loss programme such as advice and education on food and healthy eating. It also supports participants, many of whom have a body mass index (BMI) of over 35, to engage in graded physical activity.

I think what I found most intriguing about this programme was the emphasis it placed on the person, trying to build confidence and esteem to really convince people that they could achieve their weight loss goals. For example one of the activities that participants spoke about with most feeling was a step climb in a local park at the beginning of the programme. The Aspire providers discussed how this activity served two purposes: (i) to act as a ‘shock to the system’ by allowing the participants to really reflect on their current fitness levels and (ii) to provide a goal to work towards and make a commitment that it will never be that hard again. The group returned to this step climb at the end of the 26 weeks with smart phones in tow and there is some really fantastic footage that captures the excitement and pride at the progress they had made along with the disbelief at how it had once taken hours to complete.

There is never a ‘one size fits all’ and any programme will work for some but not for others. It certainly seems like now it is less about finding a single ‘effective’ or ‘perfect’ programme and more about trying to understand what it is about programmes that enable different people to make positive and sustainable changes. I think we will all know people personally who have taken control over their weight by stumbling upon park runs and ‘getting the bug’ or by using commercial weight loss programmes such as Weight Watchers or Slimming World - finding a system that really works for them. Like other weight loss programmes, there were Aspire participants who did not achieve their goal weight and there were participants who regained the weight that they had worked so hard to lose. What is important is not to write-off such efforts as ‘ineffective’ but to get a better understanding of how and why these outcomes came about. Aspire is only one example of a novel approach to enable people to lose weight but there are certainly elements that have been particularly effective for some participants.


Find out more about the programme and how participants felt about what worked for them.

Obesity: How neoliberalism made us fat

Posted by Ted Schrecker, Fuse Associate Member and Clare Bambra, Fuse Associate Director

A 2010 editorial in the Journal of the American Medical Association warned: “If left unchecked, overweight and obesity have the potential to rival smoking as a public health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years”. Obesity increases the risk of developing cardiovascular disease (CVD), certain types of cancer, Type 2 diabetes, and orthopaedic problems. At the end of the 1970s it was estimated that 15% of US adults were obese. By 2012, this had more than doubled, to 35%. Among adolescents the increase is even more striking – from 5% at the end of the 1970s to 20% in 2012. In the UK, it is estimated that obesity nearly tripled between 1980 and 2002, from 6% amongst men and 8% amongst women to 23 percent and 25 percent women respectively. Amongst children in England, obesity has increased from 11% among boys and 12% among girls in 1995 to around 20% today.

In our book Neoliberal Epidemics: How Politics Makes Us Sick we argue that obesity in high–income countries is partly the result of political and economic choices made since the 1980s. Since the early 1980s, neoliberalism or “market fundamentalism” has dominated politics and economics across much of the globe, perhaps nowhere more conspicuously than in the post-Thatcher UK. Obesity is a neoliberal epidemic – one of four, along with austerity, stress, and inequality. They are neoliberal because they are associated with or exacerbated by the rise of neoliberal politics. They are epidemics because they are on such an international scale and have been transmitted so quickly across time and space that if they were a biological contagion they would be seen as of epidemic proportions.

North American contrasts between rich and poor urban areas, less than a mile from one another
Photo: T. Schrecker

Other high-income countries have also experienced increases in obesity. Obesity has no single cause; the many influences include changes in the food environment (including advertising, marketing, accessibility and affordability); the growth of sedentary work occupations and leisure time activity, such as television viewing; changing settlement patterns, notably the rise of a privatised approach to planning organised around driving rather than walking or the provision of public transportation; and changes in the built environment that reduce the safety and attractiveness of physical activity, especially for those who do not live in leafy places. However, countries that have gone farthest down the neoliberal road, the UK and the US in particular, have experienced greater increases in obesity – suggesting that neoliberalism has magnified and accelerated trends that are present to some extent throughout the high-income world.

Obesity is a neoliberal epidemic for several reasons. These include: (1) economic and social policies that have meant fewer people can afford a healthy and balanced diet; (2) increasing time poverty, as when the demands of work (often on unpredictable schedules), transportation, and (especially for women) child care within ‘flexible’ labour markets are combined, there is not much time or energy left for eating a healthy diet and the attraction of a quick stop at the shopping park’s fast food outlet are strong; (3) the role of aggressive corporate marketing of unhealthy, energy-dense foods, notably as multi-national supermarkets, manufacturers of ultra-processed food and fast food chains expand into developing economies with the lowering of barriers to foreign investment. This helps to explain why overweight and obesity are now also rising rapidly in many middle- and some low-income countries, with prevalence in Mexican adults comparable to levels in the United States.

Corporate food systems and time poverty interact at the shopping park.
Photo: T. Schrecker

A fourth connection was addressed at a groundbreaking workshop at the University of Oxford in 2009: political structures such as welfare state regimes. More specifically, higher levels of economic insecurity – associated with neoliberal policies like the rollback of welfare state protections and opening up labour markets to the “creative destruction” that Joseph Schumpeter extolled as a defining virtue of capitalism – are causally linked with a higher prevalence of obesity through both biological (stress-related) and psychosocial (comfort eating) mechanisms, in addition to the more direct effects on time and food budgets.

Public health researchers, who agree on little else, recognize that reducing overweight and obesity is a formidable challenge. A first step is to avoid the lifestyle trap. A recent literature review on policy interventions to tackle what has been called the obesogenic environment produced by the Scottish Collaboration for Public Health Research and Policy provides some useful directions. Its authors do not shrink from arguing the need for large-scale interventions that may be expensive or challenging to vested interests, noting (for example) that the transport mode split in urban areas is 84% by car versus 9 percent walking in the United States, while it’s 36% by car versus 39% walking in Sweden. “Suffice it to say, it has been a concerted combination of infrastructure provision, integrated transport planning and disincentives for private cars which has helped to bring about the higher active travel rates.” We have no easy solutions, but emphasise that neoliberalism and the associated political choices have exacerbated the obesity crisis. Obesity is an example of how politics makes us sick.

Links: Schrecker, T. and Bambra, C. (2015) Neoliberal Epidemics: How Politics Makes Us Sick, Palgrave Macmillan, available at: http://www.palgrave.com/page/detail/how-politics-makes-us-sick-ted-schrecker/?K=9781137463098

Professors Schrecker and Bambra will be discussing their new book 'How Politics Makes Us Sick' at an event at Durham University on 15 October 2015. For more details click here.

Did you enjoy reading this post? If so, please vote for Fuse in the UK Blog Awards 2016 by clicking here

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About the authors

In June 2013, Ted Schrecker moved from Canada to take up a position as Professor of Global Health Policy, Centre for Public Policy and Health, Durham University (UK). Since 2002, most of his research has focused on the implications of globalization for health; he also has long-standing interest in issues at the interface of science, ethics, law and public policy. A political scientist by background, Ted worked as a legislative researcher and consultant for many years before coming to the academic world, and co-edits the Journal of Public Health. Among his publications, he is editor of the Ashgate Research Companion to the Globalization of Health (2012) and co-editor of a four-volume collection of key sources in Global Health for the Sage Library of Health and Social Welfare (2011). Ted is also an Associate Member of Fuse. Ted can be followed on Twitter @ProfGlobHealth.

As well as being an Associate Director of Fuse, Clare Bambra PhD is Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University (UK). Her research focuses on the health effects of labour markets, health and welfare systems, as well as the role of public policies to reduce health inequalities. She has published extensively in the field of health inequalities including a book on Work, Worklessness and the Political Economy of Health (Oxford University Press, 2011). She contributed to the Marmot Reviews of Health Inequalities in England (2010) and Europe (2013); the US National Research Council Report on US Health in International Perspective (2013); a UK Parliamentary Labour Party Inquiry into international health systems (2013), as well as the Public Health England commissioned report on the health equity in the North of England: Due North (2014). She is a member of the British Labour Party and can be followed on Twitter @ProfBambra.

Party manifestoes, part 2: A war on junk food?

Guest post by Avril Rhodes

The Fuse blog has seen pieces on the marketing of junk food near supermarket checkouts in recent weeks. Interestingly, whilst all the political Parties profess many policies related to children and young people, this is a specific topic where they are silent. Perhaps it’s too micro an issue or maybe involves dealing with too many big business interests. Who knows? However, I wouldn’t wish to be called cynical and neither would our potential political masters, who are working hard on the junk food agenda…to varying degrees.

Conservatives will:

• Act to reduce childhood obesity (how?) 
• Continue to promote clear food information (not all that clear an aim, on reflection) 
• Introduce a national evidence based diabetes prevention programme (sounds interesting) 
• Invest more in primary care to prevent health problems (needs more detail)

Labour will:

• Set a new national ambition to improve the uptake of physical activity (and this means…?) 
• Set maximum permitted levels of sugar, salt and fat in foods marketed substantially to children (assuming we know what these foods are, and can get over the qualifier “substantially” without disappearing in a legislative quagmire, this, could, in the end improve the offer at the proverbial check out)

Liberal Democrats will:

• Restrict marketing of junk food to children, including restricting advertising before 9.00pm, and maintain the ‘5 A DAY’ policy (more specific, but perhaps would have the unintended consequence of driving the advertising onto the internet, and what about the argument that the 9.00pm watershed is an anachronism in light of current TV viewing technology?)
• Encourage traffic light labelling of food and publication of information on calorie, fat, sugar and salt content in restaurants and takeaways (and would this be better than dealing with the check-out offer? Or are people going out already committed to a more unhealthy option in the interests of convenience?)

Greens will:

• Extend VAT at the standard rate to less healthy foods, including sugar, and spend the money raised on subsidising a third of the cost of fresh fruit and vegetables. This, it is stated, could prevent 5,000 premature deaths a year. (A bold one this. Could the money raised be tracked to ensure this happened? What about ensuring the quality of the subsidised produce? Who provided the calculations on lives saved?)

Before you despair and think that there are more questions than answers, there is some good news here. All the parties (well except perhaps UKIP, who don’t discuss junk food, though are loud on backing British farming and fishing) have got the message that action needs to be taken about what our food contains. This should encourage the world of public health research. 

All views expressed are exclusively those of the author.

Hunting down the seasonal calories: an Easter eggs-ercise

Posted by Avril Rhodes

Will you be looking forward to an Easter egg hunt soon? Well, beware, those Easter treats are really loaded with calories, fat, and bizarrely, a little fibre. I’d love to say I’ve spent hours researching this, but I haven’t - just one trip to this weight loss website and I was overwhelmed with results. So, I picked a few favourites.

No Easter eggs were harmed in the writing of this blog (although some may have been consumed)

 Let’s go for some at the top end, weighing in at 1,250.2 calories, 67.7g fat and 4.0g fibre was the Kit Kat Chunky Easter egg from Nestle. Chunky indeed. Another in the heavyweight division for possibly more sophisticated palates, is the After 8 Giant (clue here) Chocolate egg also from Nestle which has 1,072 calories, per shell (possibly the calorie measuring people couldn’t bring themselves to estimate the whole egg). It has 64.6g fat and 16g fibre, which is a consolation but not as good as, say, porridge. How about the dark chocolate Easter egg from Green & Black’s, sneaking in at under 1,000 calories with 960, but 69.5g fat (ouch!) and strangely, 16.6g fibre? I know that Garfield, the cartoon cat, once said he’s never met a calorie he didn’t like, but there are limits to how you might increase your fibre intake. However, with Green & Black’s you are buying Fairtrade chocolate, which can’t be bad, and this also applies to Divine Chocolate.

Ding-ding! Round one goes to this heavyweight contender

And what about the children I hear you cry. The Buttons Easter egg by Cadburys is 858.6 calories per medium egg, (who said medium?) with 48.6g fat and 1.1g fibre. The Cadbury Caramel egg, per 38g egg (so a snack really), is 195 calories; with a mere 10.2g fat and 0.2g fibre. Parents might be tempted by the pack of two (to keep each other company, presumably) Cadbury Caramel bunnies, which come in at 200 calories, 10.8g fat and 0.2g fibre. And I couldn’t write this blog without paying homage to the Cadbury’s Crème egg which is 180 calories per egg with a fat rating of 6.3g. Although, I have overheard gossip about the Crème egg being downsized, bearing in mind that you seem to be able to buy these from December 26th onwards.

And what about the office snacking? More bad news. A single Lindt chocolate mini-egg, a mere 5g, is 30calories, a Malteaster bunny (ahhh) by Maltesers is 157 calories; and each Cadbury’s mini egg is 16 calories.

However, you can earn your calories. The same website that calorie counted the eggs, makes some suggestions that seem blatantly sexist…for example a 40 year old female weighing 12st 7lb who is moderately sedentary, can use 100 calories spending 30 minutes hovering/dusting/mopping floors, or, if you prefer, 20 minutes weeding the garden. What a way to earn about half of a Crème egg! I have no idea what you do with the other half.

Well, have a Happy Easter anyway from all at Fuse. That's all yolks!