Professor Kevin Fenton is the Director of Health and Wellbeing at Public Health England. That means he’s the man responsible for a number of health campaigns that aim to help men to beat fat. MAN v FAT got the chance to talk to him about his views on obesity, carbs, the ever-controversial Eatwell Plate and whether enough is being done to support men.
Hi Kevin, thanks for taking the time to answer the questions we’ve got and those we had from our readers. The volume of suggestions shows that this is a topic that a lot of men feel strongly about! Just so our readers know a bit about your own background with weight loss have you tried any particular diets before?
Over the years I’ve explored various options whether it’s the paleo diet or following the no carbs after a certain time idea, but I actually enjoy the process of being mindful about what I’m eating and drinking. I can see the different that it makes with my energy levels and my weight and how I’m feeling. I’ve always had to be very mindful about my weight, because I have a family history of high blood pressure. Whenever I’ve put on a few extra pounds I can see the change in my systolic blood pressure almost immediately.
Also, over the summer I started running in addition to the weight training I was already doing. I’m thoroughly enjoying it now. There is a body of evidence that says it takes between six to eight weeks for a new behaviour to become ingrained as a habit and I can tell you that getting out of bed and going out running at 5.30am took some time to become ingrained! I can see this becoming really infectious though so I’m already starting to explore 5k and 10k runs and trying to curb my natural competitiveness.
Given your position presumably there’s an extra pressure on you to maintain a healthy lifestyle?
I don’t feel a pressure because of my job, if anything it’s a priviledge. Doing the work I’m doing, which is really being a national champion for wellbeing means that you understand so clearly about how your activity, your alcohol intake, your social connectedness with others, all these behaviours are not only influencing my own health but also through my networks. My position as an examplar means you become far more mindful about your healthy behaviours, but I’ve come to enjoy that.
At PHE you’re responsible for a range of health initiatives that cover sexual health, smoking cessation as well as weight – how do you decide what gets priority?
There are a number of ways we decide what takes priority. The first is looking at data to see what are the factors that are driving premature death or disability within our society and asking how do we as a public health organisation help the NHS and government to address those. Second we have to think about where we’ll get the greatest return on an investment. Investment into obesity now will have huge impacts on the pressures on the NHS, reversing the tide of the diabetes epidemic and cardiovascular disease. It’s also likely to have an impact on the levels of dementia that we’re seeing in the future and the collateral benefits of more activity and better nutrition will impact on the levels of cancer, muscular-skeletal diseases and disorders and mental health. Obesity is absolutely a priority.We have to think about where we’ll get the greatest return on an investment. Investment into obesity now will have huge impacts on the pressures on the NHS.
You’ve worked in a number of different areas through your career – what is it about the challenge of the obesity epidemic that makes it particularly complex?
It’s a number of things. One big one is that as a nation we’ve lost the perspective to see that the vast majority of people are now obese or overweight – we’ve lost that sensitivity to understanding what a normal weight is. That makes it harder for us to appreciate the benefits of being a normal weight and knowing what that looks like.
Second the obesity problem is very complex because it’s a dynamic interaction between environment, societal factors, family factors and individual behaviour and there’s no one simple solution – otherwise we would have solved it! You do need to have all of those factors addressed, almost at the same time to get a lasting impact and that makes the work more challenging.
Third, it’s about understanding that the obesity epidemic didn’t occur overnight, but it’s been slowly occuring over decades. Reversing the trend is going to take some time as well.
Are you optimistic about the progress in the battle against obesity?
I am cautiously optimistic. We are at a position now where we have new players in this space who can think about this problem in new ways and bring about solutions to what has traditionally been a complex and intractable problem. Whether it’s Local Authorities who are able to look at local assets including leisure facilities, public parks and transport. Or the NHS thinking about clinical health interventions.
I’m also encouraged because starting last year we began to see some changes in the prevalence of childhood obesity and a reversal in some of the trends which is the first time that’s been reported. In the US they’re also seeing similar trends (see infographic left). Adult obesity is going to take some time and we need to show that we’re preventing young people from becoming obese but we’re also providing tailored programmes to help overweight and obese people to get back to a healthy weight.
Is enough being done to help men who want to lose weight?
I think this is a big area of opportunity. I’m not sure that the market as a whole has tapped into the fact that actually there are more men who are overweight than women. If you thought about engaging with men and what works with weight reduction as well as how best to engage it’s a huge opportunity. We certainly see it as a huge opportunity for the work we’re doing and we’re working with the Men’s Health Forum to think about innovative programmes and we’re looking at working with Local Authority programmes.
That said, we get it. This is an area where we can add value, but we also need to stimulate our external partners to think about how we help men as well. We have focused on weight loss programmes that disproportionately recruit women and now is the time to think about equating the gender balance.We have focused on weight loss programmes that disproportionately recruit women and now is the time to think about equating the gender balance.
As part of your role you’re responsible for Change4Life and the Eatwell Plate, which often comes in for a huge amount of criticism, do you think that’s fair?
We know that the eatwell plate works. We know that because we’ve done focus groups with stakeholders, members of the public; we know it because it’s been adopted by many other government departments, educational settings and charities that are using the plate to ensure we have consistent messages. This concept of a national plate that can make recommendations real to families and individuals isn’t new, but we do know that it works. I accept that it may not be perfect to meet the needs of every stakeholder, but it is what it is. The key question we need to ask is how do we continue to evolve and develop the Eatwell Plate as we get better evidence and that’s something we’re commited to doing.
The two biggest areas of concern I routinely hear are the role of carbohydrates and the role of fat as depicted in the Eatwell Plate – are they up for review?
You may know that the Scientific Advisory Committee on Nutrition (SACN) recently presented their draft recommendations on carbohydrates in the British diet and arising from their final recommendations we will update the Eatwell Plate. That will also be a chance for us to make some of the amends that we’ve heard from colleagues. One continued source of concern is that it doesn’t include any reference to liquids such as sugary drinks and alcohol which have become sources of excess calorie intake and should be on the plate.
At the moment we are not going to be looking at the role of fats. We do know that with saturated fats the big concern we have is the strong relationship it has with high levels of cholesterol and its relationship with cardiovascular disease. The evidence and the debate on the role of fats in the diet waxes and wanes, but we are clear at the moment about the link between saturated fat and heart disease. All I can say is that we’re working on the Eatwell Plate as a result of feedback and changes will be made in the next year.We desperately need a new generation of food literate children, children who understand food provenance and nutrition.
Do you think the government needs to intervene to stop the food industry adding so much excess sugar to foods?
Before we get to government intervention there is going to be a change in the zeitgeist. We need that change in the relationship we have to sugar and the role of sugar in our diet. It started over the last year and there has been a growth in the advocacy organisations that are focused on that. We have come out very strongly about the role of sugar and the need for us to reduce it. We’re not wanting to demonise any specific product but we want to ensure that there’s greater mindfullness about the food types in our diet and the consequences of over-consumption of any one.
We learned a lot from the campaign to reduce salt in our diet. For salt it was the collaboration with industry that was driven by strong policies and public education that saw changes in salt reduction. That’s been a powerful lever and we’re at the beginning of the journey with sugar and there are lots of lessons we can draw from the situation with salt. We have to be really careful to rush to legislate on sugar because there are many countries that have instituted policies or taxations but there has been very little evidence on its effectiveness.
Finally, one criticism that is often leveled at Change4Life is that its budget is so small in comparison to the money that big food companies can put into marketing less positive messages. What would you do if the budgets were reversed?
If the tables were turned I would address this issue in the comprehensive way that it deserves. Thinking about better policies, education on diet, changing the obesogenic environment we’re living in at the moment and really thinking about the burden on high streets of cheap calories and fast food. We need to do work on education because we desperately need a new generation of food literate children, children who understand food provenance and nutrition. Then I’d spend money on the inequalities around food – we’ve seen a growth in food bank usage and a growth in food poverty and I’d like to be able to have programmes that specifically address those issues. That’s what I’d spend the money on!