Alcohol misuse: tackling the UK epidemic - London

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The efficacy of traditional educational interventions in preventing obesity, increasing physical activity and
improving nutritional status among adolescents has been questioned. A recent American attitude study 49
found that healthy eating messages are reaching adolescents but interventions are needed to assist them to
translate this knowledge into healthy behaviours. Following the perceived failure of traditional educational
approaches, structural and environmental factors are increasingly considered important.
The importance of structural and environmental change
The World Health Organisation recently concluded that, for adolescents, prevention of obesity
implies the need to:
• promote an active lifestyle
• limit television viewing
• promote the intake of fruit and vegetables
• restrict the intake of energy-dense, micronutrient-poor foods (eg packaged snacks)
• restrict the intake of sugar-sweetened soft drinks.
Additional measures identified included modifying the environment to:
• enhance physical activity in schools and communities, and family interactions
• limit the exposure of young children to heavy marketing practices in respect of energy-dense,
micronutrient-poor foods
• provide the necessary information and skills to allow healthy food choices. 17
It is important that health policy programmes recognise the wide range of structural and environmental
factors, principally inadequate income and inadequate access to healthy food, which can make it much
more difficult for low income families to improve their diets and thus their health.
The modern economy provides a perverse incentive to eat the ‘wrong’ foods because, in general, the
cheapest calories come from fatty, oily foods which are often high in salt and sugar. 44
Research in 1997
found that households in the bottom tenth of the income distribution spend on average 29 per cent of
their disposable income on food (after allowance for housing costs); those in the top tenth spend 18 per
cent. Low income families with children spend a relatively small amount of money per person on food.
This leads to the purchase of foods richer in energy (high in fat and sugar) to satisfy hunger. These are
much cheaper per unit of energy than foods rich in protective nutrients (like fruit and vegetables). 50
The
Joseph Rowntree Foundation 51
found that among low income families the cost of food and the money
available were the most important factors when deciding which foods to eat. The Poverty and Social
Exclusion Survey reported that around one in 10 ‘poor children’ did not eat fresh fruit or vegetables
daily. 52
Several studies have suggested that low income not only restricts the ability to buy foods rich in protective
53, 54
nutrients, but also limits access to the food retailers where healthy food can be purchased more cheaply.
Food deserts
Since the mid 1990s the term ‘food desert’ has been used to describe areas (usually densely
populated and urban) where residents do not have access to an affordable and healthy diet. The
fact that few poor families have access to a private car to transport them to out of town retailers, is
often given as a reason for poor health. 55
The evidence supporting this theory has recently been
questioned. 55
However, it has already begun to inform government policy in the UK. 56
British Medical Association Adolescent health