The FSA's action plan for children's diets

When I started at the FSA four and half years ago, people used to tell me that there was a real difference between the FSA's responsibility for food safety, where we need to manage the risks properly, and its role in relation to nutrition, where we need to inform people.

As the Agency has developed, so has our understanding and thinking on the relative risks that we face on a day-to-day basis. In fact, I now see diet and health as a food risk – just as BSE, food poisoning and food allergies are food risks.

In fact, if you look at the risks in terms of how many people die each year, diet-related risks of cancer and cardiovascular disease are very roughly 200 times as large as food poisoning risks, in the region of 5000 times as big as BSE risk, and more than 10,000 times larger than food allergy risk.

The evidence base on the impact of a poor or unbalanced diet and its implications for public health, and the associated costs, have been well rehearsed both here and in the public debates of recent months.

I am not saying that what may be considered traditional food risks aren't serious in their own right, or that they are not central to the FSA's role. I just want to say that, as far as I am concerned, nutrition and balance of the diet is a big food risk for us all.

And that includes children as well. The effects of poor diet may not show up immediately, but by eating an inappropriate mix of foods, children are storing up problems for their futures.

The children going to school, past the end of my road in Oxford, eating their breakfast as they go – a can of cola and a chocolate bar – say it all. And the most recent National Diet and Nutrition Survey of 5-18 year olds (published four years ago) shows that young people are eating:

• too much saturated fat (14.3% of food energy compared with recommended 11%)
• too much sugar (‘added’ sugar provides 16.5% of food energy compared with recommended 11%)
• way too little fruit (average consumption of fruit, veg and fruit juice was 2.3 portions; one in five ate no fruit at all in the week of the survey)
• too few vitamins and minerals (42% of teenage girls aren't getting enough iron; 13% of all teenagers are low in vitamin D)

The situation is worse for children in lower income households.

In the past year or so, public (and media) interest in diet and health has shot up. To take one crude measure, the number of articles about obesity in the press has tripled since last autumn. I don't, however, intend to dwell specifically on obesity in children, because the problems of nutrition extend more widely than obesity and obesity is only partly about what children eat.

This shift in public awareness is reflected in the FSA's large scale, annual consumer attitude survey, in which:

• 59% of people said they were aware that we should eat five portions of fruit and vegetables a day
• 37% felt they were eating more healthily over the past year
• half were concerned about the amount of fat, sugar, and salt in food

The survey also shows, not surprisingly, that there is still a big gap between awareness and action. For instance, over half of the population has got the five-a-day message, but only a quarter puts it into practice.

With people becoming more concerned about diet and health, and the long terms costs of obesity and other health effects becoming apparent, there is a growing pressure for action to improve our children's diets. But who is going to take the action, what should they do and how?

Is it up to the food industry? To parents and families? To central or local government? To schools and teachers? To doctors and other health professionals? Will changes come through voluntary action or by legislation?

I don't think it's a matter of either/or. All these different groups have to be involved, and some of the changes will be voluntary, others mandatory. But there is a window of opportunity now, especially for the food industry, to take a lead, rather than following behind kicking and screaming. If there are no changes, public pressure for more controls will grow.

The FSA is about half way through a consultation period on its action plan for improving the diets of children. It's called an Action Plan on Food Promotions and Children's Diets. Although some observers have focused on our suggestions about TV advertising, this is actually only one part. I am going to say a few words about some aspects of our plan, but please remember that its still in the consultation phase.

Our aim is to create an environment in which healthy choices are the easy choices. Of course, individual children, their parents and families have a responsibility to choose a healthy diet, but others, Government, educators, the industry and so on, also have a duty to ensure that it's easy to do this. At the moment healthy eating is more of an uphill struggle than a downhill ride – particularly for those in the lowest income groups – where choices are more difficult and more restricted.

Nowadays, many of the choices that children and their parents make are between snacks, meals, or foods that are processed and prepared by others. This means the distinction between healthy diets and unhealthy diets, and healthy foods or options, and unhealthy options has become blurred. It's not like it was when mum cooked a meal from the basic ingredients such as meat and two veg. It is possible to think about healthier foods –those that make it easier to eat a balanced diet – and less healthy foods; that is, those that are high in fat, sugar and salt.

So one opportunity for the food industry to take the initiative is by reformulating foods, especially those marketed specifically at children, so that they are lower in fat, sugar and salt. At the moment there are children’s ranges of foods, that parents might buy, with the best of intentions, that are at least as fatty or salty as the adult equivalent.

Take, for example, this can of pasta shapes in tomato sauce – clearly branded with cartoon characters to appeal to children. One serving of this contains 3.75g salt – and the target recommended by the FSA (based on expert advice) for four to six year olds is no more than 3g per day. So, you, as a parent, go to the supermarket, and buy this tin of pasta – a perfectly reasonable thing to do; it's made for children and marketed using cartoon characters. And you are already condemning your child to eating too much salt. Interestingly, if you bought a similar product of the same brand but not aimed specifically at children (spaghetti in tomato sauce) you'd be doing much better on salt.

Food manufacturers and retailers always stress that they respond to consumer demand (they do of course also create consumer demand). One way they do this is by offering healthy eating ranges. This is fine. But let me make two points. Let's be sure that healthier ranges really are what they say, and here the proposed EU rules on health claims should help, second, let's see healthy options becoming the mainstream.

As far as the FSA is concerned, we will develop guidelines and criteria for children's ranges, and we will survey the uptake of these guidelines and publish the results. Children’s products are included in the surveys of pizzas, baked beans and canned pasta due to be published next month.

Is the industry ready to change? Our experience over the past 18 months with salt in processed food suggests a tentative 'yes'. After a slow start, I see an increasing momentum of change. We know it is possible to reduce salt, because equivalent products may vary by as much as twofold in their salt content with no difference in acceptability and we know from the scientific evidence that reducing the salt content of processed foods will bring real health benefits for children and adults alike.

I predict that those who don’t respond with genuinely healthier options will, like the dinosaurs, be doomed to extinction because they have not adapted to a rapidly changing environment in which new lifestyles demand new kinds of food products.

What about the labels on our food? If you are going to ask children or their parents to choose, is the information clear and easy to follow?

The first thing to say about labels is that, according to the Institute of Grocery Distribution's recent research, only about one in five shoppers reads them. Our own results are not dissimilar (31%). And if my observations are anything to go by, these are the people who are already fully engaged and least need help.

The second thing to say is that, for those who do want to read them, labels don't always help. Take this snack bar that was being given away in the lobby. It does contain a lot of information about energy, protein, carbohydrates and fat. But it doesn't about how much of my daily allowance I am using up by eating it.

On its own, nutrition labelling isn't going to solve the problem of poor nutrition. But it is a part of the solution.

What the FSA is proposing is that, ahead of any changes in EU nutrition labelling rules, the industry should adopt a very simple signpost system – whether high, medium, low labelling or a traffic light system. Our extensive research shows that this is what people would find most helpful. It might guide at least some parents and children towards recognising that some things we call foods are treats to be eaten sparingly and others are staples of our diet.

I’ve said quite a bit about the industry's role, and I am going to come back briefly at the end to TV advertising and other forms of promotion, but what about the school environment?

I am not going to have to time to discuss what children are taught at school, other than to say we have been working closely with DfES to develop a list of core competencies that we think every child should have by the time they leave school. We are also sponsoring a pantechnicon - called the Cooking Bus - that brings practical cooking skills to children at school.

But we also give children messages about food, diet and health in their school lunches, the tuck shop, the vending machines and so on. That’s why we strongly support the 'whole school approach' that DfES is taking. I’ve seen this in practice in a number of schools and it is very impressive.

I’ll just touch on two pieces of work that we have been doing.

The first is a pilot study of vending machines in schools that sell only healthy options (water, fruit juice, semi-skimmed milk). Though admittedly small scale (12 schools across four regions in England and Wales), the results show that children will buy healthier drinks – about 70,000 drinks over the 24 weeks of the project. That's equivalent to 14 million bottles and cartons of healthier drinks if the pilot was extended to just one in five of the secondary schools in England and Wales. And, significantly, the results show that the school can make extra income without resorting to fizzy drinks. One school cleared nearly £1,300 in profit. I recently heard that similar results have been found in the USA.

The second is our survey, joint with DfES, of school meals in England and Wales. As an aside, I learnt the other day that the average daily amount spent on a child’s school meal is about a quarter of that spent on feeding an army dog for a day! Our survey, to be published very shortly, will assess whether the food provided by the school caterer meets the statutory national nutritional standards, and will examine the food consumption and nutrient intakes of secondary school children from school meals. It will also look at factors influencing food choices made by children. Detailed results are not available yet, but I am confident that there will be lessons in it for some schools.

Public procurement of food, including schools, should be one area where Government can directly influence our children’s diets. In England alone, the public sector spends £1.8 billion a year on food and catering services. The Minister for Public Health and I wrote to those responsible for procurement about this time a year ago to urge them to specify salt levels to their contractors – and we'll be following this up shortly to see what progress has been made.

Those of us involved in the Government side of this work should reflect that reducing salt, or changing nutrition profiles, is not the only demand being put on providers of school meals. Other Government departments are encouraging, for perfectly reasonable arguments, procurers to buy locally, or to buy organic. And it has been put back to me, ‘What are the Government’s priorities?’ I think, clearly, we have to have priorities and make sure we approach this consistently. And I think we are some way behind parts of the USA in this arena.

Finally, let me turn to TV advertising. You have heard earlier on today from Professor Gerard Hastings, who led our independent review of the evidence, and from Dr Brian Young, who authored an industry-sponsored paper, and from OFCOM.

As far as the FSA is concerned, we have subjected Gerard's review, and the various counter reviews and critiques, to an extraordinary degree of independent scrutiny. And, although things are never going to be absolutely cut and dried, we are satisfied that the evidence does point to an independent effect of promotion and advertising on children's diets.

We also accept that the quantitative effect of TV alone cannot be measured, and the effects of many different influences all interact and could amplify one another.

Our recommendation in the draft Action Plan is that there is a case for action on TV advertising to children – either to redress the balance away from the overwhelming preponderance of adverts for high fat, sugar and salt foods, or in restricting food advertising in slots specifically targeted at young children.

Time does not allow me to go into all of the elements of our Action Plan in detail but I hope I have given you an indication that the FSA is committed to helping to bring about major changes – as one of the many players pulling together on many fronts.

Unless we have targets, milestones, and timetables, the danger is that commitments drift. In our Action Plan, the FSA has identified targets and deadlines for the bits that it is going to be doing. Such as developing guidance on healthy options, on healthy vending in schools, and nutritional guidelines for reducing fat, salt and sugar in processed foods.

But there must be targets for others as well – who, in a way, have a much bigger role that we do. We can only be a facilitator for many parts of this. And one of the things we are looking for in the responses to our consultation is for people to tell us – whether from industry, consumer, health or other groups – what they think are realistic targets and timescales.

Targets and timescales for school governors and heads to improve the healthy eating environment and culture in schools.

Targets and timescales for food companies to reformulate their products.

And for those involved in broadcasting, advertising and promotion generally, targets and timescales for redressing the balance in the promotion of foods to children.

And to end on a positive note, I think the work that BBC Worldwide is doing – looking at how their icons are being used to advertise and promote foods – is a very powerful example to us all.