Food and drink culture compared with smoking in 1960s

Aug 26, 2023

Does Wales have a problem with unhealthy lifestyles?

This summer, two leading politicians have suggested people need to manage their personal behaviour around eating and drinking in order to help the Welsh NHS function.

But TV's Dr Chris van Tulleken, who is well-known to a generation of children as one half of the CBBC programme Operation Ouch, likened today's obesity and excess drinking to that of smoking culture in previous decades.

Health Minister Eluned Morgan asked people to come on a journey to get fitter, while First Minister Mark Drakeford said there were "shockingly high" numbers of drunk people using A&E.

But for Dr Chris, an infectious diseases specialist at University College London, the problem is not the people but the social and commercial environment they are surrounded by.

His new book, Ultra Processed People, looks at the forces promoting the ultra-processed food.

This is food which is very altered from its original state, with additives and ingredients not found in a typical kitchen.

They are usually wrapped in plastic and make up most of a typical British diet.

Chris said the regulation of alcohol, ultra-processed and gambling apps "that we know function as addictive products" was "so light touch so as to be almost non-existent".

He compared this with the attitude taken towards tobacco 40 or 50 years ago when it was "an addictive product aggressively marketed 24/7".

"Saying that people should drink less and eat healthier is a bit like saying to people in the 1960s that they should smoke less," he explained.

"It was available everywhere, it was as cheap as dirt and so everyone smoked. No-one looks back at the '60s and wonders 'why didn't everyone just gird their loins and stop smoking?' That would be absurd.

"We all understand we were the victim of predatory marketing practices of an extremely addictive product."

That is now the case with food and alcohol, he argues, and takes an sideways look at drink packaging to prove his point.

"We have on all our [alcoholic] drinks the instruction to drink. It says 'drink aware'. Imagine if on your pack of cigarettes it said 'smoke aware', or 'smoke responsibly'. What does that mean?

"We have no understanding as a society that alcohol - ethanol - is a harmful molecule, that it's carcinogenic, that it's extremely addictive, because alcohol is so normal it's everywhere."

The thing that makes him "boil with rage" is the disconnect between politicians working "hand in glove" with the drinks industry and allowing ads "across social media, broadcast media, print media".

When it comes to food, he said people did not suddenly "collectively lose willpower" over how much they were eating, but the type of food available - processed, calorie dense, low in fibre and addictive in a way wholefoods are not.

There is no question Wales has a problem in this regard.

Welsh government figures show 62% of the population is overweight or obese, with the individual statistic for obesity (classed as having a body mass index or BMI of over 30) standing at 25%.

But Chris lays much of the blame for this squarely at the door of social inequality and poverty.

Obesity among the most deprived social groups is 32% compared with 20% in the least deprived.

As an example, the rate among children in Merthyr Tydfil is 17.2% compared with 7.8% in the more affluent Vale of Glamorgan.

Wales is also ranked as the poorest of the four nations by the Joseph Rowntree Foundation, with 23% living in poverty according to its 2022 report.

This provides the perfect breeding ground for harmful health behaviour, he argues.

"One of the ways that the stress and trauma of living with a low income becomes manifest is that people smoke more because people are more vulnerable to advertising for cigarettes.

"People need short-term solutions to the discomfort of their lives. Ultra-processed food is another way of the harms of poverty being manifest," he said.

He added alcohol products were another way this manifested and were marketed in a "very aggressive way" to promote "fun, happiness and joy" when it causes "the very opposite".

He cited the kind of nightlife seen on St Mary Street in Cardiff on a Friday night as "a great example" of the kinds of scenes repeated across British towns and cities, where "emergency services are stretched paper thin by alcohol and drugs".

"The people to blame appear to be the young people who are using these substances, but really they are the victims of very sophisticated marketing efforts," he said.

"We need to think about our cultural understanding of gambling, booze, vape, food, completely transforming."

Martin Blakebrough, chief executive of drug and alcohol charity Kaleidoscope Project, has seen enough drug and alcohol addicts to know those types of problems are multi-layered and people cannot always just try harder to be healthier.

"If you are looking at people who have real problems with alcohol it's clearly linked to deprived situations," he said.

"Their diet is poor, [so] the alcohol is more significant."

Another overlooked factor, he argues, is a large section of people with drug and alcohol problems have suffered trauma when young, whereas people who start off in better social positions might get better support and have more "recovery blocks", such as income and a job to help anchor them.

He added: "We still push alcohol as a society - we're not banning it, we have a very strong relationship with alcohol."

Matt Lambert, president of the Portman Group, the industry-funded regulatory body for marketing alcohol, said most packaging carried drinking guidelines, pregnancy warnings and signposting to the alcohol education charity Drinkaware.

He argued it was "widely understood" that excessive drinking was harmful and there had been a decade of falls in binge drinking, underage drinking and drink drinking as well as alcohol-related crime, but recognised there were a "minority of people" still misusing alcohol.

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Dr Chris van Tulleken