Can Banning Fast Food From a Neighborhood Help Curb Obesity?
Green spaces where children can play, safe bike paths, grocery stores stocked with fruits and vegetables, fast food–free zones around schools, and affordable housing may sound like Utopia from a number of perspectives, but government and public health officials in the United Kingdom hope to make it a reality in 10 communities—all with the aim of slashing sky-high rates of obesity and chronic illness.
While the debate over a soda tax in the U.K. heats up, the “Healthy New Towns” initiative, a project of the National Health Service, hopes to leverage demand for affordable housing to alter behaviors, urban design, and economic forces believed to be associated with obesity. The effort has harnessed the talent and insight of health care experts, designers, and technologists to construct roughly 76,000 homes in carefully crafted neighborhoods across England.
The 10 locations for the “towns,” announced in early March, were whittled down from 114 proposed sites. The finalists include Barking Riverside, a 10,800-unit housing development being built on a rehabbed brownfield site on the eastern edge of London, and Barton Park, a residential community in Oxford that will provide 885 new homes, 40 percent of which will be rented as affordable housing. The planned communities, housing about 170,000 residents, will “design out” obesity-causing factors, such as a lack of parks or proximity to fast-food joints.
“It’s an experiment, so they have to test what this model would achieve in affluent as well as deprived areas,” Jazz Bhogal, an expert with the U.K. Department of Health, which oversees the National Health Service, told TakePart. Bhogal has worked on national public-health programs at the department since 2001 and helped ensure that the construction of the new towns would be based on sound research and policy.
The project, said Bhogal, has its roots in a study the Department of Health commissioned from Public Health England. The department wanted “to review the evidence on obesity and figure out what would be game changers that would shift the pattern on childhood obesity and begin to help us reverse trends,” she explained. The study found that it’s ineffective to respond to obesity with initiatives solely based on heath care, Bhogal said, “because what you’re doing is gastric-band surgery rather than the preventative stuff.”
Around 62 percent of U.K. residents—about 65 percent of men and 58 percent of women—are currently overweight or obese, according to data from Public Health England. If the obesity crisis isn’t brought under control, roughly 74 percent of men and 64 percent of women across Great Britain are projected to weigh more than they should by 2030, according to the World Health Organization and U.K. health researchers.
Just as there’s no quick fix for people hoping to drop pounds, “there is no silver bullet,” said Bhogal, that can tackle the issue of obesity and solve a problem that has become a long-term, generational, and societal issue. “It’s not something that’s going to get fixed in four or five years. It’s taken us 40 years to normalize unhealthy behavior, so it’s going to take us at least that long to de-normalize it,” she said.
To make health the norm, Bhogal explained, the project borrows heavily from nudge theory—the same subtle messaging tactics often employed by junk- and fast-food advertisers to promote their products. “You think, ‘OK, this a bit David and Goliath here. So if you can’t beat them, you have to join them at the publicity game.’ We have to be making health the normal option,” she said.
Wealthier communities that discourage fast-food restaurants are also proof that the Healthy New Towns concept can work, according to Bhogal. In Wimbledon Village, one of the most affluent areas in the country, “McDonald’s wanted to apply for a license to open a branch..,and the residents stopped it from happening because they didn’t want something as unsightly as a McDonald’s in the village.” A five-minute drive away, where the community is less well-off, fast-food restaurants are common, and “it’s also an area that has poorer health outcomes,” she noted.
What Healthy New Towns are “giving local authorities the freedom to do is to say, ‘If you open up a health-food bar and make it cool and make it somewhere kids want to go, then actually we’ll give you a tax break,’ ” said Bhogal. If an entrepreneur wants to open a fast-food restaurant, “legally we can’t stop you, but we can charge you a much higher business tax rate,” she explained.
This isn’t the first time U.K. health officials, like their peers around the world, have attempted to tackle obesity through community-based efforts. A project launched in 2008 designated nine cities across England as healthy towns—places that focused on specific issues, such as biking or breast-feeding. Anjana Ahuja, a science columnist for Financial Times, wrote in early March that those efforts fizzled out, and the public shouldn’t expect significant results from this latest venture either.
“The scale of the experiment is too modest to allow proper evaluation,” wrote Ahuja, who noted that attempts to curb smoking and get people to eat healthy are working without these towns. Besides, “people do not want radically redesigned lives.”
Catharine Benson, a nationally known primary-care physician who has worked in Oxford for 23 years, is also critical. According to Benson, the project is “an expensive distraction from the NHS crises” and a “monumental waste of time and money.” With the NHS facing a nearly $3 billion deficit and doctors in the U.K. going on strike, Benson likened the effort to “rearranging the deck chairs on the Titanic.”
Governments “don’t need to build a new town to know it makes sense to not have fast food outlets near schools,” Benson wrote. She called the goals of the project “laudable” but wrote that the NHS “can only advise, not enforce—so why spend so much money [on the New Towns project] when there are not enough doctors, nurses, midwives, and other NHS staff to sustain current levels of care?”
But, said Bhogal, with the NHS spending nearly $15 billion “a year just in treating avoidable complications from type 2 diabetes, which is almost exclusively caused by obesity, the public purse is paying for the fact that as a society, we’ve gotten unhealthier.” Therefore, she said, “the NHS has a legitimate voice in challenging that.”