To tackle urban obesity, make healthier food available and affordable

by Corinna Hawkes | City, University of London
Tuesday, 29 January 2019 08:00 GMT

Condiments are seen on the counter of a mobile fast food outlet in central London, Britain, September 27, 2017. REUTERS/Hannah McKay

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

London has the highest rate of childhood obesity of any global city with 37.7 percent of 10-year-olds overweight or obese

Professor Corinna Hawkes is Director of the Centre for Food Policy at City, University of London, and a Distinguished Fellow of The George Institute for Global Health. She is also Vice-Chair of the London Child Obesity Taskforce.

On my way to the office each morning from London’s Kings Cross station, I walk through streets that are among the most deprived in the country. On that walk, is a plethora of food outlets - independent fried chicken takeaways, supermarket chains, convenience stores, restaurants, cafés and street-food vendors (which miraculously pop up just in time for lunch).

I often muse about what would change if these outlets were different. If the upscale, faux-Parisian patisserie with its croissants and cake were a feast of affordable fruit, sliced up and ready to go. If the down-at-heel convenience stores sold food that was convenient for healthy cooking, rather than unhealthy snacking. If the entrance to the supermarket was filled with something other than discounted chocolate. If there were water fountains along the way…

These may just be musings, but what I see tells us something pretty bad about the state of what people are eating in our cities. In deprived parts of London, over one third of young people are eating fast food more than twice a week – typically from ‘chicken shops’. Across the world in Dar es Salaam, the most populated city in Tanzania, 23 percent of infants under the age of 2 eat sugary snack foods; in Phnom Penh, Cambodia, this figure rises to 55 percent. Not enough of the good stuff is being eaten. In Cape Town, South Africa, adults in townships are eating less than three portions of veg a day.

The results are awful for health. London has the highest rate of childhood obesity of any global city with 37.7 percent of 10-year-olds overweight or obese, outstripping New York City, Hong Kong, Sydney, Tokyo and Singapore, among others. The picture is similarly bleak for adults in London; 61.3 percent are overweight or obese. And the problem is far from limited to wealthier countries – across urban children (aged 8-15) in Bulgaria, 18.7 percent of boys and 16.6 percent of girls are overweight. Meanwhile, 30.9 percent of men and 37.3 percent of women in urban regions of Sri Lanka are overweight.

Changing the food around people as they go about their everyday lives has to be a major part of the solution. The good news is that city authorities around the world are taking action to improve the food on offer, making it healthier and more affordable.

London’s Mayor Sadiq Khan has banned new takeaways (which doubled in number between 2010 and 2018) from opening within 400 metres of schools. In Amsterdam, the city is working with supermarkets to reduce marketing of unhealthy products and educating young employees about food and health. The government of Curitiba in southern Brazil give permits to vendors to sell fruits and vegetables at a price 40% lower than conventional markets.. It’s not just the big cities, either. The seaside town Blackpool, a signatory to the Local Authority Healthy Weight Declaration, has developed a “Healthier Choices Award” for food service outlets that offer healthier options. 

This is not to say it’s easy; it’s no good serving up healthy fresh fruit if the provider is losing money hand over fist. Yet innovative businesses are finding ways to make it work. In Paris, the supermarket La Louve has adopted a co-operative model that enables it to charge less for the food it sells. In US cities, farmers’ markets are gaining more customers through a voucher programme for people on low incomes. Back in London, the ‘Healthy High Streets Challenge’ initiative aims to stimulate creative ideas for high street businesses to offer healthier foods.

It’s no good making changes, either, if people don’t bite. To make sure actions are actually going to work, city authorities must understand where people shop and why they buy what they do. I can have my own musings - but what really matters are the thoughts and experiences of those in deprivation. Understanding people’s interactions with the food landscapes around them will be necessary to know how to redesign them in a way that works for health.

With The Lancet Commission on Obesity report published yesterday calling for strengthened local governance to address obesity, it’s about time city authorities made more concerted efforts to help their residents become healthier and happier by transforming how and where they get their food.  Cities have the potential to be the new powerhouses for bigger and bolder changes. The question is whether they will. And whether my morning stroll will look any different in a few years’ time.