Obesity will starve the NHS A&Es can't survive junk food Britain

Britain’s eating habits are shocking, something that’s clear enough from the numbers. According to one recent study, after all, seven of the top 10 global food manufacturers made over two thirds of their food and drink sales in Britain from selling junk. According to The Times, meanwhile, these same firms are responsible for over 90% of Britain’s online advertising, spent on chocolate and chips and ice cream. The target of all this activity, I hardly need to add, is children. In 2022, to give one example, the biggest companies spent £55 million on online ads for products linked with youth obesity.

Nearly a quarter of English children aged 10-11 years are now obese. And if this is a disturbingly recent phenomenon — when Harold Macmillan was prime minister, fewer than one in ten 11-year-olds were overweight — the consequences here go way beyond being mocked in the playground. Obesity, after all, is now the second biggest preventable cause of cancer, itself a disease that one in two Britons will face during their lives.

Shamefully, the UK is now the fattest country in Western Europe. The British Heart Foundation says that since the early 1990s, the proportion of obese people in Britain has almost doubled. Today, almost 30% of adults are obese, or classed as having a body mass index (BMI) of more than 30. That’s the equivalent of over 15 million adults, even as 64% have a BMI over the recommended threshold of 25. In particular deprived corners of the country, the situation is even worse. In Kingston upon Hull, for instance, four in 10 people have a BMI above 40. 

The pressure that obesity puts on our overburdened healthcare system can’t be overstated. In England and Scotland, it is now a bigger killer than smoking. Thanks to its links to cancer and heart attacks, it accounts for one in every 10 deaths. And it’s not just in the numbers. As an emergency doctor myself, I see the damage wrought by food companies each and every day. I see dental infections, and abscesses, and DIY medical interventions, where patients have sometimes removed their own teeth with pliers as they cannot afford dental care.

I’ve seen 35 stone patients in peri-arrest — just about to have a heart attack and die outside of hospital. Any obese patient needs very aggressive cardiorespiratory resuscitation, and that takes valuable time. Without access to the full range of A&E equipment only a minimum of life-saving treatment can be administered in any pre-hospital environment. In other words, if you’re obese and have a heart attack at home, at work or in the street you’re as good as dead before someone like me gets to see you.

British obesity, however, is more than just a matter of physical health. On the contrary, it crushes the spirit just as surely as it bolsters the waistline. It’s not uncommon for hospitals to receive patients who’ve effectively become prisoners in their own homes, with paramedics forced to extract them using specialised cutting equipment. In one case, firefighters had to remove the gable of a semi-detached house to get a patient out. Such extremes are, of course, the thin edge of a very thick wedge. What’s more common, if just as troubling, is the age of the obese patients I see. Very few are old. Why? Because they die young, before they see their grandchildren grow up. 

As that reference to cutting equipment implies, moreover, Year on year, the NHS has to budget for additional kit, redesigned workspaces and even specialised lifting equipment to deal with the increasing number of obese patients. From extra-wide bariatric stretchers, to specially modified ambulances designed for patients who literally can’t fit in standard models, this added burden has prodded NHS obesity costs to £6.5 billion a year, even as Wes Streeting has said the true figure could be almost double. For context, the direct cost of obesity to the NHS 20 years ago was a mere £500 million. And beyond the pounds and pence, I’ve seen the disruption obesity causes with my own eyes. In fact, I’ve treated way more people who’ve had heart attacks from eating rubbish than from people taking cocaine or heroin. While it’s the “war on drugs” that gets the headlines maybe what we really need is a war on junk food to tackle our ever-expanding waistlines.

Given the desperate blend of wasted lives and wasted cash, it’s unsurprising that politicians have long sought a solution to our obesity epidemic. Back in 2021, the Conservative government announced a plan to ban all junk food advertising on TV before the 9pm watershed, all in an attempt to reduce young people’s exposure to sugary, salty and fatty foods. Yet despite upward obesity trends at the time, the Tories pushed back the plan to give the food industry “more time to prepare”. The Labour government now says a ban on junk food adverts being shown on television before 9pm will come into force on 1 October 2025. It says the watershed on junk food advertising will also be enforced, alongside a total ban on paid-for online adverts, both as a way of targeting childhood obesity. 

Considering past failures, and the immense financial heft of Britain’s food companies, I’ll believe it when I see it. Nor should we hold much hope for miracles cures in a needle. For while the Department for Health has recently made much of  weight-loss drug Mounjaro  — including partnering with pharma giant Lilly to run a trial in Greater Manchester — it only fights symptoms not causes. 

As NHS England medical director Professor Sir Stephen Powis warned recently, weight-loss drugs are not a “holy grail” for curing the nation’s obesity ills. If Saxenda and Wegovy doubtless help with weight loss, making patients feel fuller and suppressing appetite, administration can only happen via injection. And if that makes long-term treatment difficult, they’re also only effective as long as the patient uses them. Stop taking them and the fat comes back, alongside the physical and mental health problems associated with weight gain. 

Quite aside from the predatory nature of a Ferrero or a Mondelez, meanwhile, I just don’t think we should put the onus on those millions of Britons struggling with obesity due to congenital conditions, or hormones, incapacitation or the side effects of life-saving drugs. And even for those without medical excuses, for those who could just eat less and exercise more, it’s clear that the big food manufacturers are waging a cynical war against public health for profit — and they’re winning.

What, then, is the solution? Especially given the current state of the NHS, and a obesity-induced healthcare crisis that shows no sign of stopping, the Treasury would do far better dip into the Chancellor’s extra £50 billion and finally tackle the problem at source. 

For starters, the Government needs to go beyond prohibiting when and where unhealthy foods are advertised and marketed and refocus and clamp down on how big brands from fast food outlets to high street supermarket chains use algorithmic techniques, seductive imagery and loss leaders to get consumers hooked on junk food. If sugary, salty, fatty and carbohydrate-rich products are harming more people than smoking then why don’t we marginalise the branding of these silent killers the way we do tobacco instead of fetishising them?

If the NHS is to benefit from Reeve’s budget windfall, it should be invested in the people with the skills and creativity to roll out an anti-obesity, pro-nutrition national programme.

No one wants to see a “fat tax” that punishes people for the odd slice of cake or a cheeseburger. But we also don’t want a two-tier food landscape in which the rich or “educated” stay thin while those who are struggling get fat. Rather than stigmatising the unemployed, as Wes Streeting did recently, the Government must instead bite into the profit margins that make the junk food industry so strong. They’re the ones profiting from the misery of millions of overweight Britons, so why not tax them for the privilege? Of course, they’ll simply pass the cost on to the consumer but if this dampens the public’s appetite for junk food, so be it. Perhaps then we can finally begin to cut down waistlines — and squeeze the junk food pushers down to size too.