Contents

Summary

• Since 2015, the UK government has worked with the food industry to reformulate a wide range of food products to reduce sugar, fat and calorie content. The industry has been given the target of lowering the number of calories in certain products by 20% by 2025. The reformulation scheme was overseen by Public Health England (PHE) until 2021, and is now overseen by the Office for Health Improvement and Disparities. The scheme is voluntary, but some organisations have called for it to be mandatory.


• In modelling published in 2018, PHE acknowledged that lower calorie intake could have a ‘potentially negative impact’ on people who are a healthy weight or underweight, but it excluded these people from its model. Since being underweight is associated with a number of serious health problems, this was a major omission which we address in this paper by modelling the impact of the calorie reduction scheme on the prevalence of underweight among children.


• Using two different estimates of baseline energy flux, our model shows that among 4–5-year-olds, the calorie reduction scheme would lead to a ~4% reduction in energy intake, and a reduction in obesity rates between 0.8 and 1.3 percentage points. However, the prevalence of underweight would increase by between 3.0 and 4.8 percentage points.


• Among 10–11-year-olds, the model shows that energy intake would decline by between 2.6% and 5.4%, leading to a reduction in obesity prevalence of between 0.2 and 1.1 percentage points, but the prevalence of underweight would rise by between 2.1 and 4.1 percentage points.


• Under every scenario, for each child who moves from the obese category to the healthy weight category, at least two children become underweight. If the reformulation scheme works as intended by reducing calorie intake across the whole population, it will increase the number of underweight 10–11-year-olds by at least 30% and possibly by as much as 60%. This will lead to a net increase in the number of children who are an unhealthy weight.


• However, neither our model nor PHE’s model should be taken seriously as a prediction of what would happen if the targets were met. It is much more likely that consumers would compensate by buying more food (or buying different types of food) to obtain the same number of calories. If so, it will increase the cost of feeding a typical household by around 10%. This compensatory behaviour makes it less likely that significant numbers of children would become underweight as a result of reformulation, but it also makes it less likely that the scheme would have its intended effect of reducing rates of obesity.


• The surprising results reported in this paper should be taken as an illustration of the flaws in the reformulation theory.

Introduction

In 2018, Duncan Selbie, then Chief Executive of Public Health England (PHE), announced that ‘Britain needs to go on a diet. Children and adults routinely eat too many calories, and it’s why so many are overweight or obese.’¹

One of the ways in which he intended to put the nation on a diet was by encouraging food manufacturers to reduce the number of calories in their products by 20%. PHE’s 2018 report Calorie Reduction: The Scope and Ambition for Action predicted that if the calorie content of a wide range of processed foods was reduced by a fifth, the average person would consume 68 fewer calories per day. PHE initiated a voluntary agreement with the food industry to achieve this reduction by 2024, and produced a model which predicted that it would lead to a reduction in obesity which would decrease the number of premature deaths by 35,370 over a 25-year period and reduce health and social care costs by £9 billion over the same period (PHE 2018: 31).

A similar scheme to reduce sugar in food by 20% (by 2020) had been in place since 2015. The range of food products affected was broad, including but not limited to bread, crisps, savoury snacks, pizza, cooking sauces, sausages, potato products, ready meals, dips, egg products, processed red meat, processed poultry, pies and ‘food to go’ (ibid.: 30). PHE was disbanded in 2021, but reformulation efforts have continued under its successor, the Office for Health Improvement and Disparities (OHID). In 2022, the World Health Organization launched a European-wide reformulation campaign led by the United Kingdom.²

In England, the target date for both the sugar and calorie reduction schemes has been pushed back to 2025, and there have recently been calls from Nesta and the King’s Fund to make reformulation targets mandatory, with companies fined if they fail to meet them (Leon et al. 2024).³

he logic of the reformulation strategy is simple: the average adult is overweight and consumes too many calories to maintain a ‘healthy weight’. Therefore, reducing the calorie content of the food they eat will – if all other things remain equal – lower their calorie consumption, and reduce obesity rates. Reformulation appears to offer a way of doing this without the public having to significantly change their behaviour; hence it is sometimes referred to as ‘health by stealth’.

The practical difficulties of the sugar reduction scheme have been discussed in a previous IEA paper (Appleton 2019). In this report, we look at the unintended consequences of the calorie reduction scheme if it works as designed.

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IEA Discussion Paper 126_Calories Out_web (2)

About the Authors

Gavin Sandercock is a Professor of Sports and Exercise Science at the University of Essex’s School of Sport, Rehabilitation and Exercise Science. He has a PhD in Clinical Exercise Physiology from Brunel University, and an MSc in Exercise and Nutrition Science from the University of Liverpool. He has authored more than 120 peer-reviewed publications, mainly around physical activity, fitness and health in school-aged children. He led the East of England Healthy Hearts Study, which was then the largest survey of health and fitness of English children and adolescents. He is a co-founder and director of www.fitmediafitness.co.uk, the UK’s leading provider of health-related fitness assessments and well-being in school-aged children.

Alex Scott-Bayfield is a director at Fitmedia, the award-winning health assessment company. A qualified sports lawyer and project manager, she has worked in the Olympic sphere, for international federations, national governing bodies, and central and local government. She is a director of Sportsgroup, the strategic body for innovation in sport and physical activity, and is a regular contributor of papers for central government, the Sports Think Tank and the sector press.

Christopher Snowdon is the Head of Lifestyle Economics at the Institute of Economic Affairs. He is a regular contributor to The Spectator, The Telegraph and The Critic and often appears on TV and radio discussing lifestyle regulation and policy-based evidence. He is the editor of the Nanny State Index and the author of six books: Polemics (2020), Killjoys (2017), Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

Footnotes

1. Britain needs to go on a diet, says top health official’, BBC News, 6 March 2018
   (https://www.bbc.co.uk/news/health-43201586).
2. ‘WHO/Europe to launch new sugar and calorie reduction initiative led by the United
   Kingdom’, BBC News, 20 January 2022https://www.who.int/europe/news/item/20-01-2022-who-europe-to-launch-new-sugar-and-calorie-reduction-initiative-led-by-the-united-kingdom
3. Denis Campbell, ‘Tories and Labour urged to show “courage” to act on unhealthy
   food’, The Guardian, 16 March 2024