Imagine a world where life-changing weight loss drugs are readily available, yet the very food environment pushes us towards unhealthy choices. It's a frustrating paradox, isn't it? A decision is looming on whether weight-loss injections like Mounjaro will be covered by the state for medical card holders or under the HSE’s Drug Payment Scheme. This could be a game-changer for many, but is it truly addressing the core issue?
A comprehensive health technology assessment (HTA) is on the horizon, examining the medical, social, ethical, and economic implications of Mounjaro. This assessment is a crucial step in determining who will have access to these potentially life-altering medications. But here's where it gets controversial: While we're focusing on pharmaceutical solutions, what about the elephant in the room – the unhealthy food environment that contributes to the obesity epidemic in the first place?
Dr. Catherine Conlon argues that it makes little sense to invest heavily in obesity treatments without simultaneously addressing the systemic issues that drive unhealthy eating habits. Consider this: obesity affects a staggering one in four people in the population, equating to 1.2 million individuals. The Health Minister, Jennifer Carroll MacNeill, has indicated that Mounjaro's application for reimbursement could be approved before the year's end. Professor Donal O’Shea, the HSE’s national clinical lead for obesity, suggests the availability might mirror the UK's approach, targeting individuals with a BMI over 35 who also have related health complications. This would limit access to these injections to around 80,000 people.
But here's the part most people miss: obesity treatments often overlook the powerful influence of price, aggressive marketing tactics, the sheer abundance of unhealthy food options, and the convenience factor on our eating behaviors and, consequently, our weight. These non-nutritional factors are the real-world drivers of our dietary choices and need to be tackled in tandem with medical interventions.
While the ideal scenario involves preparing fresh, seasonal, and healthy meals every day, the reality is that the current food environment makes this nearly impossible for most people. The deck is stacked against us! So, what can we do?
Dr. Conlon proposes several ways to create a healthier food environment that could significantly improve public health and reduce the risks of obesity and chronic diseases.
Resetting Our Palates: Mandatory Reformulation
The first step is to introduce mandatory reformulation of ultra-processed foods. This would require food companies to reduce the levels of sugar, salt, and unhealthy fats in their products. Kevin Hall, a renowned expert in human nutrition and metabolism, argues that mandatory reformulation would gradually retrain our palates, moving us away from the artificially hyper-palatable foods we've become addicted to. He suggests that governments should set mandatory targets for reducing salt, sugar, refined grains, and saturated fat in ultra-processed foods, stating that "all we need is the political will to start acting."
Mandatory reformulation would ensure that even the most popular unhealthy foods are available in healthier versions. The next step? Target the price of healthy foods to make them more competitive with less healthy options.
Hall suggests taxing foods that can be easily reduced or eliminated from the diet without any negative health consequences, such as fizzy drinks, sweets, biscuits, and crisps. This is already happening! Ireland introduced a tax on sugary drinks in 2018, which has been incredibly effective in reducing consumption and prompting the industry to reformulate their products to avoid the tax. This measure has now been adopted in nearly 120 countries. Colombia has gone even further, introducing a tax on all ultra-processed foods with poor nutritional profiles.
But, to ensure that these taxes don't simply lead to higher food prices across the board, Hall emphasizes the need to use some of the tax revenue to promote healthy alternatives, making them more affordable, accessible, and convenient. This requires shifting the focus of dietary improvement up the food supply chain by actively reshaping the food environment.
Raising the Bar for Supermarkets
Supermarkets play a critical role in shaping our food choices and should be held to higher standards. Just walk into any supermarket today, and you'll be bombarded with displays of highly processed, unhealthy foods, especially during holidays. This is because manufacturers of these foods pay a premium for prime shelf space.
One solution? Ban the promotion of unhealthy foods at store entrances, end-of-aisles, and checkout tills. Another option is to tax the income of food manufacturers to incentivize them to improve the overall nutritional quality of their products.
Furthermore, we should support food businesses that make affordable, healthy prepared food more accessible. Nourish Scotland is piloting public diners in Nottingham and Dundee, offering healthy, freshly cooked meals at a fraction of the price of restaurant meals.
New York City's mayor-elect, Zohran Mamdani, made food affordability a central theme of his campaign, proposing the establishment of municipal grocery stores across the five boroughs. Mamdani argues that the government needs to step in and fix what the profit-driven market has failed to do: make healthy food affordable. These stores could be subsidized by the revenue generated from taxes on unhealthy foods.
Hall suggests there's so much more we can do. For example, what if restaurant chains were also subject to policies that encouraged them to meet minimum quality standards across their entire menus?
Many multinational companies, including Google, now offer their employees free, healthy, fresh, and delicious meals. Google recognizes the value of community and collaboration that arises when employees gather over good food. This policy not only boosts productivity but also reduces healthcare costs and improves employee retention. Who wouldn't want to work in an environment where healthy food reduces costs and makes going to work a pleasure?
"What if we decided that, like clean drinking water, access to delicious, convenient, healthy meals was considered an essential right instead of an employee perk?"
Educating for Healthier Choices
Ultimately, changing our food culture is essential. We can learn from successful anti-tobacco campaigns, which shifted societal norms around smoking by making it illegal and then undesirable in public places. Hall suggests that this might involve regulation, such as ads promoting fruit and vegetable consumption, or educational mandates related to food and nutrition.
Japan has been implementing this approach for over two decades as part of its efforts to reduce chronic disease. All schools are required to teach not only basic knowledge about nutrients and eating for health but also food culture, enjoyment, and appreciation.
The food industry has successfully reshaped our eating habits, normalizing eating on the go, replacing home cooking with ultra-processed foods, promoting snacking, and increasing portion sizes. These tactics mirror those used by the tobacco industry to normalize smoking as a desirable and cool pastime.
"We need to fight back to reverse the unhealthy norms," concludes Hall.
Making obesity medications available on prescription for those who need them is a positive step and is likely to reduce disease complications. However, it must be accompanied by a fundamental shift in our food culture, ensuring that healthy food becomes the norm – affordable and accessible to everyone. Without population-level change, we are simply throwing money at a problem without addressing its root causes.
Now, let's talk about it. Do you think taxing unhealthy foods is the right approach? Should governments have a role in regulating the food industry to this extent? And what are your thoughts on making healthy food an essential right, like clean drinking water? Share your opinions in the comments below!
