There is now significant attention paid to the various ways in which alcohol impacts on public health, from the effects on individual drinkers’ physical and mental health to the consequences for those in their vicinity via road traffic accidents, intimate partner violence and, from a global health perspective, as a structural driver of HIV infection. It is, therefore, somewhat anomalous that alcohol has not received greater attention as a risk factor for obesity, or been a more prominent focus of obesity policy debates. A recent study of UK obesity policies since devolution identified an almost complete absence of policymaker engagement with alcohol as a driver of obesity, despite attempts by alcohol and public health NGOs to bring this onto the agenda.
Obesity is associated with multiple health conditions such as type 2 diabetes and various cancers. Additionally, it is estimated to cost England’s National Health Service substantial £6.1 billion a year (1). Unhealthy diets made up of energy dense foods and beverages high in fat and/or sugars are the main cause of rising obesity levels (2). Alcohol drinks can have high calorie and sugar contents and their consumption has been identified as a contributory factor for weight gain (3,4,5,6,7). This suggests there is significant potential to decrease population level calorie intake and obesity via alcohol focussed policy measures (3, 7, 8), and would align with wider efforts to reduce intake of “empty calories” from alcohol-free, sugar-sweetened drinks. The failure to focus on reduced alcohol consumption as an obesity policy measure represents a missed opportunity to address this important public health issue and to promote co-ordinated policy responses across related areas of public health.
What we did
We analysed obesity policy documents for England and Scotland from 1999 to 2023 to identify their engagement with alcohol consumption. We examined the engagement of key public health and commercial actors with the issue of alcohol as an obesity policy issue through analysis of policy documents, consultation responses, press releases, reports, and other statements on relevant obesity-related policies since 1999.
What did the policy documents say?
1999 saw the first instance of alcohol being identified as a policy problem within England’s public health strategy (9), although,it wasn’t until the 2005 obesity strategy (10) that the link between alcohol’s energy content and weight gain was explicitly acknowledged. However, no specific policy measures were introduced to address this issue. Similarly, alcohol was not recognised in Scotland’s obesity strategies until the 2010 obesity route map (11). In recent years consultations on calorie labelling on alcoholic beverages have been proposed by the UK and Scottish Governments but have yet to be released suggesting a lack of urgency to introduce these measures (12, 13).
Within the policy documents industry actors were consistently recognised as a key partner to both the UK and Scottish Governments in their efforts to improve population health. Additionally, reducing the prevalence of childhood obesity was a key focus of the policy documents as seen through measures such as the Soft Drinks Industry Levy (SDIL) introduced in 2016 (14).
What did public health NGOs say?
Several public health actors sought to highlight the high calorie content of alcohol and therefore should be included in relevant obesity policy measures. The Alcohol Health Alliance wrote a letter in May 2021 to the Secretary of State for Health, to express their “support for the inclusion of calorie and health information on alcohol products” (15).They argued existing labelling requirements for alcoholic beverages were not providing consumers with the required information to make informed choices. The letter was cosigned by other public health bodies including The Royal Society for Public Health, Cancer Research UK, Alcohol Focus Scotland, and the Institute of Alcohol Studies.
Public health NGOs consistently maintained that, despite the legal prohibition on alcohol consumption for those under 18, UK and Scottish Government strategies to reduce childhood obesity should still address alcohol. They cited evidence illustrating that minors do consume alcoholic beverages, particularly high-calorie, sugary ciders, and argued that such drinks should not be exempt from initiatives aimed at tackling childhood obesity (16).
What did alcohol industry actors say?
Alcohol industry actors consistently argued against the identification of alcohol consumption as an obesity policy issue. They successfully managed to lobby for the exemption of low and no alcoholic drinks from the SDIL. They argued that to include them would be a “major blow” to the ability of these low alcohol alternatives to deliver “positive public health benefits”, as well as arguing that this was a childhood obesity policy and products not available to under 18s should therefore not be included.
To avoid alcoholic beverages being included in mandatory calorie labelling regimes industry actors argued that voluntary labelling commitments would suffice. This was evident when the British Beer and Pub Association stated that they would be “prepared to work with UK Government in their approach to provide accurate and relevant front of pack information on a voluntary basis to UK consumers”. This highlighted their preferences for a partnership based approach rather than restrictive Government regulation.
Conclusions
Alcohol is insufficiently addressed as an obesity-related policy issue in policy documents, with an overdependence on voluntary measures and industry partnerships. Industry actors have exploited this in order to refrain from being subject to mandatory measures. This was evident from the successful lobbying of the removal of low and no alcohol drinks from the SDIL as well as alcoholic beverages not being mandated to include calorie information on labels.
A comprehensive approach is needed to address the two major public health challenges of obesity and excessive alcohol consumption. The UK and Scottish Governments should incorporate high-calorie, sugary alcoholic drinks into obesity policies, such as calorie labelling and beverage taxes, while abandoning ineffective self-regulation by the alcohol industry.
Written by Callum Young and Dr Benjamin Hawkins, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.