Health behaviours: diet and nutrition

Page last updated: 2022 - due to be refreshed in 2024.

 

Five key points

  1. A healthy balanced diet is the foundation to good health. Eating five fruits and vegetables a day and reducing intake of calories, sugar and saturated fat is key to reducing the risk of long-term health problems. (Why is diet and nutrition important?
     
  2. In 2019/20, around 6 in 10 (61.0%) adults in Suffolk ate the recommended five a day. This is significantly higher than national (55.4%) and East of England (56.7%) figures. (Proportion who eat five fruit and vegetables a day
     
  3. Research suggests that deprived areas have worse access to healthy options, not least because they have on average five times as many fast food shops as the most affluent areas. (Accessibility of fast food
     
  4. The proportion of three-year old children with visually obvious tooth decay can be used as an indirect measure of whether children are eating a healthy diet. In 2019/20, 1 in 20 (4.8%) three-year olds in Suffolk had visually obvious tooth decay, which is significantly lower than the England value (10.7%) and similar to the East of England value (6.7%). (Oral health
     
  5. Research suggests that eating habits may have changed during the COVID pandemic because of impaired food supply chains and lockdown measures. Across comparable European countries, it appears that people tended to eat less fresh food (such as fruit, vegetables, meat and dairy products) and more non-fresh food (ready-made meals, frozen food, canned food, cakes, biscuits and alcohol) compared to before the pandemic. (Why is diet and nutrition important?)

Why is diet and nutrition important?

Poor diets are all too common in England and, along with obesity, are now one of the leading causes of disease such as cancer, heart disease and type 2 diabetes. A healthy balanced diet is the foundation to good health. Eating five fruits and vegetables a day and reducing intake of calories, sugar and saturated fat is key to reducing the risk of long-term health problems.

To have a healthy, balanced diet, people should try to:

  • eat at least five portions of fruit and vegetables a day
  • base meals on starchy foods like potatoes, bread, rice or pasta
  • have some dairy or dairy alternatives (such as soya drinks)
  • eat some beans, pulses, fish, eggs, meat and other protein
  • choose unsaturated oils and spreads, eaten in small amounts
  • drink plenty of fluids

Research suggests that eating habits may have changed during the COVID pandemic because of impaired food supply chains and lockdown measures. These factors are likely to have altered how people accessed food, where they ate, and how their food was prepared. Everyone’s experience of the pandemic is unique and this will have shaped the impact on diet. For some people the pandemic made it more challenging to eat healthily, potentially because of difficulty accessing or affording healthy food. For others the extra time at home may have allowed more time to prepare home cooked meals. Across comparable European countries, it appears that people tended to eat less fresh food (such as fruit, vegetables, meat, and dairy products) and more non-fresh food (ready-made meals, frozen food, canned food, cakes, biscuits, and alcohol) compared to before the pandemic.

Although access to a healthy balanced diet is vital for health and wellbeing, food inequalities affect both the accessibility and affordability of nutritious meals. Research suggests that deprived areas have worse access to healthy options, not least because they have on average five times as many fast food shops compared to the most affluent areas. We are biologically programmed to eat and when we are bombarded by advertisements and promotions for food – it’s hard to eat healthily, especially if we are busy or tired or stressed.

There is a considerable difference between the share of disposable income that the lowest income groups must spend on a healthy diet compared to wealthier households. The poorest fifth of households would have to spend 40% of their disposable income to meet the government’s recommended diet, compared to 7% for the wealthiest fifth of households. More healthy foods are almost three times more expensive than less healthy foods for the equivalent number of calories. The mean cost of more healthy foods in 2020 per 1,000 kilocalories was £7.00, compared to £2.41 for less heathy foods. Breaking the data down into the government’s five Eatwell Guide food categories tells a similar story. While the average price of fruit and vegetables per 1,000 kilocalories was £8.21 in 2020 (rising to £8.60 during the first quarter of 2021), the average price per 1,000 kilocalories of food and drinks high in sugar and/or fat was just £3.42 – just 40% of the cost of more healthy products. It is easy to see why people opt for less healthy options when a cheese burger can be quickly bought for 99p.

The number of families who struggle to afford healthy food options is increasing across the UK. Prior to the COVID pandemic, food bank use in the UK had been growing over the last decade. The Trussell Trust network, which is the largest food bank network in the UK, distributed 61,000 emergency food parcels in 2010/11, rising to 1.9 million in 2019/20. It is estimated that around 2.5% of all UK households (700,000) needed to use a food bank in 2019-20. The COVID pandemic led to an immediate spike in provision of food parcels (up 84% from February 2020 to April 2020 at food banks in the Trussell Trust network).

The UK Government have introduced a combination of policy and challenges to industry to tackle the issue of poor diet at a population level. As a first step towards tackling childhood obesity, a soft drinks industry levy was introduced across the UK in 2018. The tax on soft drinks, commonly referred to as the ‘Sugar Tax’, resulted in more than half of manufacturers reducing the sugar content of drinks – the equivalent of 45 million kg of sugar every year. In addition, the UK Health Security Agency (previously Public Health England) have challenged all sectors of the food industry to reduce levels of sugar, salt and calories in the food products and drinks that they produce. Research indicates that a reduction in average adult salt intakes to 6g per day, with lower levels set for children, would lower population blood pressure levels and reduce the risk of heart disease.

In July 2020 the Department of Health and Social Care published ‘Tackling Obesity: Empowering Adults and Children to Live Healthier Lives’. This contained the following options:

  • Introducing a new campaign for those who are overweight to take steps to move towards a healthier weight
  • Working to expand weight management services through the NHS
  • Publishing a consultation to gather views on the traffic light labelling system
  • Requiring large out of home food businesses to add calorie labels to the food they sell and consulting on calorie labelling on alcohol
  • Ending promotions of high fat, sugar and salt food and banning their advertisement on TV and online before 9pm

In recent years the UK Health Security Agency (previously Public Health England)  have overseen a sugar reduction programme, which challenged all sectors of the food industry to reduce the level of sugar in a wide range of commonly eaten food items. The latest sugar reduction progress report (published in 2021) showed a 3.0% reduction in total sugar per 100g in products sold between 2015 and 2019. There were larger reductions for some specific products such as yoghurts (12.9%) and breakfast cereals (13.3%). While this represents good progress, it is some way short of the target sugar reduction of 20% by 2020.

It is difficult to accurately estimate the societal cost of eating a nutritionally poor diet because there are many factors at play. The majority of costs are incurred by the health system because those who eat a poor diet are at increased risk of developing long-term health conditions such as diabetes, heart disease or obesity. The financial impact on the NHS is vast. In 2014/15 the NHS spent £6.1 billion on treating obesity-related ill health and this is forecast to rise to £9.7 billion per year by 2050. More generally, poor diet may contribute to wider cost implications of individuals who are unable to work due to poor health, through reduced tax and National Insurance contributions and increased payments towards out of work benefits.

What is the local picture?

There are several data sources linked to diet that have not been included in this section because they are in other sections of the State of Suffolk. More information about excess weight and obesity can be found in the State of Suffolk healthy behaviours obesity section. Deprived communities are discussed in more detail in Groups at risk of disadvantage.

Dietary risk factors

Eating an unhealthy diet is the third highest risk factor for death in Suffolk, behind tobacco and high blood pressure. Additionally, eating a poor diet directly contributes to a range of other significant risk factors for death, such as high fasting blood glucose, high body mass index and high cholesterol. Dietary risk factors contribute to both of the leading causes of death and disability in Suffolk, cardiovascular disease and cancer.

A disability-adjusted life year (DALY) is a universal metric that allows researchers and policymakers to compare different populations and health conditions across time. DALYs equal the sum of years of life lost (YLLs) and years lived with disability (YLDs). One DALY equals one lost year of healthy life. A high proportion of all DALYs caused by cardiovascular disease, diabetes and cancer can be attributed to poor diet (33.5% CVD, 29.0% diabetes, 6.0% cancer).

Proportion who eat 5 fruit and vegetables a day

A healthy diet should include at least five portions of fruit and vegetables a day. In 2019/20, around 6 in 10 (61.0%) adults in Suffolk ate the recommended five a day. This is significantly higher the national (55.4%) and East of England (56.7%) figures. The proportion of people who eat five a day varies by district/borough. All districts and boroughs have significantly higher levels than England, with the exception of Ipswich (which is comparable with the England average).

Figure 1: Proportion of adults who eat 5 fruit and vegetables a day, 2019/20, Suffolk

 

Oral health

The proportion of three-year old children with visually obvious tooth decay can be used as an indirect measure of whether children are eating a healthy diet. In 2019/20, 1 in 20 (4.8%) three year olds in Suffolk had visually obvious tooth decay, which is significantly lower than the England value (10.7%) and similar to the East of England value (6.7%). The trend in Suffolk has been increasing (getting worse) in recent years whereas it has been decreasing (getting better) nationally.

Tooth decay, also known as dental caries or cavities, is a breakdown of teeth due to acids made by bacteria. In cases where decay is extensive, teeth may need to be removed under general anaesthetic. The rate of hospital extractions for dental caries can be used as a proxy for oral health and dietary habits in a population. During the period 2017/18 to 2019/20, the rate of hospital admissions for dental caries was 192.1 per 100,000 children aged 0-5 years. This is lower than the rate for England (286.2 per 100,000) but higher than the rate for East of England (81.7 per 100,000).

Food bank usage

As of September 2021, there were 46 emergency food providers operating over 68 venues across Suffolk. The specific locations can be viewed on an online map.

Locally collected data indicates that the amount of food needed by local foodbanks increased from the start of the COVID-19 pandemic. These figures are likely to underestimate the true number of people who use foodbanks because many smaller, community led foodbanks are not included. All figures relate to Suffolk.

  • The average weekly weight of distributed food rose from 1,500kg (1.5 metric tonnes) in April 2020 to 4,000kg in July 2020
  • In February 2022, over 2,200kg of food was distributed via foodbanks
  • Over 300,000kg of food have been delivered since April 2020
  • During the first lockdown an additional 20 foodbank providers were in operation

Accessibility of fast food

The local environment has a major influence on behaviours and streets crowded with fast food outlets can influence food choices. Many fast food outlets have little nutrition information available in store and the food tends to be less healthy than home cooked meals. Children exposed to these outlets, whether out with friends or on their way home from school, may find it more difficult to choose healthier options. More deprived areas have a higher density of unhealthy options available, with England’s poorest areas having five times more outlets than in the most affluent communities.

In 2017, the density of fast food outlets across wards in Suffolk varied from 54.3 to 128.5 per 100,000 residents, compared to an average of 96.1 per 100,000 in England. Within Suffolk, the highest densities were found in wards of higher relative deprivation in urban areas, such as Mildenhall, Bury St Edmunds, Sudbury, Ipswich, Felixstowe, Beccles, and Lowestoft. In these areas, easy access to unhealthy food and high levels of deprivation combine to make eating a healthy diet more difficult. This may influence dietary choices and thereby contribute to health issues in those populations. Although some northern parts of West Suffolk have a high density of fast food outlets, it is worth noting that the populations in these areas are small.

Figure 2: Density of fast food outlets per 1,000 population by electoral ward, Suffolk

Figure 2: Density of fast food outlets per 1,000 population by Electoral Ward, Suffolk[

 

Further information 

The EatWell Guide is an NHS resource which offers information and advice about healthy eating. The advice says that to have a healthy, balanced diet, people should try to:

  • eat five a day
  • base meals on starchy foods like potatoes, bread, rice or pasta
  • have some dairy or dairy alternatives (such as soya drinks)
  • eat some beans, pulses, fish, eggs, meat and other protein
  • choose unsaturated oils and spreads, eaten in small amounts
  • drink plenty of fluids

OneLife Suffolk is a local resource, which offers support and advice on a wide variety of different health improvement programmes. Specific programmes include help to lose weight, quit smoking, get more active and the NHS Health Check programme. OneLife Suffolk provides free weight management programmes for adults and children, including Slimming World on referral. The weight management services are designed to create long lasting shifts in behaviour and give support and tools throughout the programme.

The Eat Out Eat Well Scheme (part of Suffolk Public Health and Communities' healthy eating work) recognises the work of food businesses (cafes, restaurants and staff canteens) who are making it easier for customers to make healthier choices when eating out. Businesses are assessed by environmental health teams against a set of standards linked to the types of ingredients they buy, how they prepare their food and how it's promoted to customers. There's an emphasis on using less fat, sugar and salt, making healthier menu changes and staff training. In March 2019, around 140 Suffolk businesses had won an Eat Out Eat Well award.

Take Out Eat Well sits alongside the Eat Out Eat Well Scheme as part of Suffolk Public Health and Communities' healthy eating work and aims to support businesses serving fast food to make it easier for their customers to buy healthier options.

Ensuring good dental health from an early age is important. It stands children in good stead for the long-term health of their teeth and gums. The Keep Suffolk Smiling campaign encourages parents to introduce young children to good dental health routines through brushing teeth regularly and following a ‘tooth-friendly’ diet.

Foodbanks are provided across Suffolk by larger organisations such as The Trussell Trust and Families in Need (FIND) and smaller, independent groups such as charities and churches.

Health Visitors are qualified nurses or midwives with specialist community public health training. Health Visitors provide families with children aged 0–5 years with a range of support for the health and wellbeing of the whole family. Further information and support regarding healthy eating and dental health can be found from the Health Visiting Service.

Norfolk and Suffolk councils have joined forces with environmental charity Hubbub to launch #FoodSavvy, a collaborative initiative designed to help households cut food waste by a fifth, in line with the United Nation's Sustainable Development Goals. Individuals, community groups and businesses are invited to get involved. 

NHS Choices has a wide range of information and guidance relating to healthy eating and the care of children's teeth.