Malnourishment - It's not just in third world countries
The COVID-19 pandemic has brought a range of ‘health problems’ to light in the UK government, with those who are overweight or obese being at higher risk of fatalities related to COVID-19. This is being reflected in new actions and strategies to tackle obesity throughout the UK.
Thus far, the government has announced that large out-of-home food businesses (for example, restaurants, cafes, takeaways or shops), with more than 250 employees will have to:
- Add calorie labels to their food
- End promotions of high fat, salt and sugar (HFSS) products, such as buy one get one free.
- Alter the placement of HFSS products both in-store and online to be less prominent and therefore less desirable and less likely to be purchased.
There is a strong focus on reducing obesity rates in children, with the intention of banning TV and online adverts showing HFSS food, before 9 pm.
These new legislations are intended to reduce preventable co-morbidities of obesity, such as type 2 diabetes, or respiratory disease, which can increase risk of fatality if COVID-positive, however, in practice, these legislations may not benefit everyone.
There are currently 3 million people in the UK considered to be malnourished, or at risk of malnourishment, with an overwhelming majority of these people (93%) living in their own homes.
The WHO has established that many that are overweight or obese are also extremely malnourished, which can also increase risk of illness and infection, cause a reduction in energy levels, muscle strength, and the ability to carry out daily activities. All these factors are hugely important in keeping fit and healthy, particularly in light of COVID.
According to the British Dietetic Association, malnutrition costs the NHS over £19 billion a year in England alone, making it a huge public health issue.
Malnutrition is often considered primarily to be an issue within third world countries or homeless communities, yet the statistics show that is not at all the case.
So why is it that malnutrition is such a huge issue in this country, and what will the government’s new legislation mean for those affected by it?
The Energy-Density Energy-Cost Relationship
“It would be more worthwhile to make ‘healthy’ foods more affordable, rather than affordable foods less available.”
Eating ‘healthy’ food has obvious benefits for one’s physical health, but often the reasoning for eating ‘unhealthy’ foods is not due to laziness, but more often cost. This is reflected in what is known as the Energy Density-Energy Cost Relationship, which shows that “fats/sweets” have higher energy densities, for a low cost, essentially meaning they are caloric and cheap. This is juxtaposed with fruit and vegetables, which have minimal energy density, but a higher energy cost.
Essentially, “healthier” foods are less calorific and more costly. When cooking en-masse (i.e. for a family), the cost can often outweigh nutritional content, as ensuring everyone is fed and full is more important than having a healthy but unfulfilling meal, especially where children are concerned.
In practice; a McDonald’s Happy Meal costs £2.79 and can be eaten instantly. This provides a full meal for a child, without the need to shop, cook, or wash up, or pay for the means of these things (e.g. the cost of petrol or a bus fare to get to the supermarket, the gas or electricity required to cook the food, or water to do the washing up).
The caloric value of a Happy Meal can range from 194 kcal to 663 kcal, depending on the options chosen. As mentioned, the cost of a Happy Meal (in London) is £2.79. For comparison, 100g of strawberries contains ~33 calories, and costs ~44p per 100g.
To meet the same calorie amount from strawberries, an individual would have to consume between 587-2000g strawberries, which would cost between £2.59-£8.80, would not provide the same composition of protein, fats and carbs, and furthermore, and would not be considered a complete meal, especially to a child.
Therefore, parents may prefer to purchase such foods for their child’s dinner, rather than buying fresh ingredients and preparing a meal themselves. In more deprived areas, convenience and cost often outweigh nutrition (Davis et al., 2013), which is further mirrored by the number of fast-food restaurants in deprived areas being five times higher than in affluent ones (BBC, 2019). In addition to this, the government recently voted against providing Free School Meals to children that need them during school holidays.
While obviously, not everyone has a child and not everyone is affected by the vote against Free School Meals, the same principle still applies - ‘unhealthy’ food is cheaper, more convenient, and can often make up a meal.
Which begs the question will making fast food, and now food in general, less accessible actually help those that it’s intended to?
While it’s great to try to improve the health of the public, the efforts will be redundant if those that are being targeted are no longer able to afford to eat. The main issue, as illustrated, is that eating a healthy diet can be expensive, or at least more expensive than an ‘unhealthy’ one. Voting against Free School Meals is also counterintuitive in the Government’s actions against obesity, as the families that count on the meals will now be more likely to have ‘unhealthy’ foods as a cheaper, go-to option in the holidays.
It would be more worthwhile to make ‘healthy’ foods more affordable, rather than affordable foods less available.
Disrupting Relationships with Food
These legislations could also compromise individuals’ relationships with food, inducing a more ‘forbidden effect’ on foods, and creating food labels, which can lead to an increased caloric consumption (i.e. a binge) (Jansen, Mulkens and Jansen, 2007; Golden, Schneider and Wood, 2016). Furthermore, studies have previously found that only 36.7% of eating disorder (ED) patients seeking treatment had previously been overweight/obese (Lebow, Sim and Kransdorf, 2015), and EDs notoriously arise from bingeing and/or restricting behaviours.
Moreover, obesity prevention messages are often misinterpreted by both parents and their children of healthy weights, leading to complete elimination of “bad”/“unhealthy” foods (Golden, Schneider and Wood, 2016). Only 36.7% of ED patients have been overweight, there is large scope for EDs to develop in those that are not obese, whom the prevention plan does not directly apply to. It is therefore possible that demonising food groups as such may potentiate the development of eating disorders.
Being overweight or obese has been shown, thus far in the pandemic to be a large contributor to preventable COVID fatalities, as such the legislation to combat overweight and obesity are well-intended, but these should not take precedent, in a COVID-context, over combatting malnutrition within the UK.
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