Lifestyle: diet and nutrition

A PDF version of this chapter as at 16 August 2019 is available here.
Content may not reflect the latest changes in the State of Suffolk web pages.

 

Note:
On 1 April 2019:
West Suffolk Council replaced Forest Heath District Council and St Edmundsbury Borough Council
East Suffolk Council replaced Suffolk Coastal District Council and Waveney District Council
This State of Suffolk report was created before these changes, so gives information for the pre-2019 council areas.

 

1 Five key points

  1. A healthy balanced diet is the foundation to good health. Eating 5 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. (2 Why is diet and nutrition important in Suffolk?
     
  2. In 2016/17, around 6 in 10 (61.4%) adults in Suffolk ate the recommended 5 a day. This was significantly higher the national (57.4%) and East of England (58.2%) figures. (3.2 Proportion who eat 5 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. (3.4 Accessibility of fast food
     
  4. The proportion of five-year old children with one or more missing, decayed or filled teeth can be used as an indirect measure of whether children are eating a healthy diet. In 2016/17, 1 in 6 (17%) five-year olds in Suffolk had one or more missing, decayed or filled teeth, which is significantly lower than the England value (23.3%) and similar to the East of England value (18%). (3.3 Oral health
     
  5. 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. (4 Policies)

2 Why is diet and nutrition important in Suffolk?

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 5 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.[1]

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

  • eat 5 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

Although food 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 as the most affluent areas.[2], [3] Since 2002, more healthy foods and beverages have been getting consistently more expensive than less healthy ones, with a growing gap between them. This trend is likely to make healthier diets less affordable over time, which may have implications for individual food security and population health, and it may exacerbate social inequalities in health.[4

Although food has never been more widely available, many people struggle to access the good food they need for a healthy diet. In 2014, 1 in 10 (10.1%) UK residents reported struggling to get enough food to eat and nearly 1 in 20 (4.5%) experienced a severe level of food insecurity, typically having gone a whole day without eating at times during the year because they could not afford enough food.[5] On the basis of these figures, it is estimated that 3.7 million people in the UK were living in moderately food insecure homes and 4.7 million people were living in severely food insecure homes in 2014, totalling 8.4 million.[5] Charities report that year on year the number of adults and children using foodbanks have more than tripled in the last 5 years.[6]

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.[7] 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, 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.[8]–[10] 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.[11]

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. All of these conditions, if not managed adequately, can put the sufferer at risk of further health complications. 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.

3 What is the local picture for Suffolk?

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 lifestyle obesity section. Deprived communities are discussed in more detail in Groups at risk of disadvantage.

3.1 Dietary risk factors

Eating an unhealthy diet is the number one risk factor for death in Suffolk, ahead of smoking and high blood pressure.[12] 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 high proportion of all Disability Adjusted Life Years (DALYs) caused by cardiovascular disease, diabetes and cancer can be attributed to poor diet  (42.8% CVD, 31.6% diabetes, 6.4% cancer).[12]

3.2 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 2016/17, around 6 in 10 (61.4%) adults in Suffolk ate the recommended 5 a day. This is significantly higher the national (57.4%) and East of England (58.2%) figures.[13] The proportion of people who eat 5 a day varies by district/borough. Mid-Suffolk and Suffolk Coastal have significantly higher levels than England, whereas all other areas have levels comparable with the England average (Figure 1).

Figure 1: Proportion of adults who eat 5 fruit and vegetables a day, 2016/17, Suffolk[13]

Figure 1: Proportion of adults who eat 5 fruit and vegetables a day, 2016/17, Suffolk[

 

Source: Public Health England. Public Health Profiles.

3.3 Oral health

The proportion of five-year old children with one or more missing, decayed or filled teeth can be used as an indirect measure of whether children are eating a healthy diet. In 2016/17, 1 in 6 (17.0%) five-year olds in Suffolk had one or more missing, decayed or filled teeth, which is significantly lower than the England value (23.3%) and similar to the East of England value (18.0%).[13] 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 2014/15 to 2016/17, the rate of hospital admissions for dental caries was 113.5 per 100,000 children aged 0-4 years. This is lower than the rate for England (234.7 per 100,000) but higher than the rate for East of England (91.7 per 100,000).[13]

3.4 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.[14] 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 5 times more outlets than in the most affluent communities.[15]

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.[16] Within Suffolk, the highest densities were found in wards of higher relative deprivation in Ipswich and Waveney (Figure 2). 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 Forest Heath 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[16]

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

Source: Public Health England. Fast food outlets: density by local authority in England.

4 What policies affect diet and nutrition?

In August 2016 the Government published ‘Childhood obesity: A plan for action’, which included a commitment for Public Health England (PHE) to oversee a sugar reduction programme.[8] This challenged all sectors of the food industry to reduce by 20% by 2020 the level of sugar in the categories that contribute most to the intakes of children up to 18 years. Industry was also challenged to achieve a 5% reduction in the first year of the programme. PHE also aim to reduce levels of salt in food products and drinks with the intention of lowering population blood pressure levels and reducing the risk of cardiovascular disease.[9]

In Spring 2019, the Government consulted on plans to restrict promotions and adverts for food and drink products high in fat, sugar and salt (HFSS).[17], [18] Promotions such as ‘buy one, get one free’ and free refills of sugary soft drinks encourage people to buy more than they need. Restrictions are also being considered to move HFSS food and drink away from checkouts, aisle ends and store entrances. Restrictions of advertising being considered include a 9pm watershed ban on TV, online streaming sites and social media.

5 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 5 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

Further details can be found here: www.nhs.uk/live-well/eat-well/the-eatwell-guide

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. More details can be found here: onelifesuffolk.co.uk

The Eat Out Eat Well Scheme 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. More detail about the scheme and which food businesses have an Eat Out Eat Well award can be found here: www.healthysuffolk.org.uk/projects/eating/eat-out-eat-well.

Take Out Eat Well sits alongside the Eat Out Eat Well Scheme and aims to support businesses serving fast food to make it easier for their customers to buy healthier options. More details can be found here: www.healthysuffolk.org.uk/projects/eating/take-out-eat-well

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. More details can be found here: www.healthysuffolk.org.uk/advice-services/children/childrens-dental-health

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: www.suffolk.gov.uk/children-families-and-learning/childrens-health/health-visiting/

Norfolk and Suffolk councils have joined forces with environmental charity Hubbub to launch #FoodSavvy, a collaborative new 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. www.foodsavvy.org.uk/

NHS Choices has a wide range of information and guidance relating to healthy eating and the care of children's teeth. www.nhs.uk/common-health-questions/food-and-diet/

6 References

[1]         Public Health England, “PHE publishes latest data on nation’s diet,” 2018. [Online]. Available: https://www.gov.uk/government/news/phe-publishes-latest-data-on-nations-diet

[2]         S. Williamson, M. McGregor‐Shenton, B. Brumble, B. Wright, and C. Pettinger, “Deprivation and healthy food access, cost and availability: a cross‐sectional study,” J. Hum. Nutr. Diet., vol. 30, no. 6, pp. 791–799, 2017.

[3]         J. Wise, “Britain’s deprived areas have five times as many fast food shops as rich areas,” BMJ, vol. 363, p. k4661, Nov. 2018.

[4]         N. R. V Jones, A. I. Conklin, M. Suhrcke, and P. Monsivais, “The growing price gap between more and less healthy foods: analysis of a novel longitudinal UK dataset,” PLoS One, vol. 9, no. 10, pp. e109343–e109343, Oct. 2014.

[5]         A. Taylor and R. Loopstra, “Too Poor to Eat Food insecurity in the UK,” 2016. Available at: http://foodfoundation.org.uk/wp-content/uploads/2016/07/FoodInsecurityBriefing-May-2016-FINAL.pdf

[6]         The Trussell Trust, “More people than ever expected through foodbank doors this Christmas,” 2018. [Online]. Available: https://www.trusselltrust.org/2018/11/27/foodbanks-christmas-2018/

[7]         HM Treasury, “Soft Drinks Industry Levy comes into effect,” 2018. [Online]. Available: https://www.gov.uk/government/news/soft-drinks-industry-levy-comes-into-effect

[8]         HM Government, “Childhood obesity: a plan for action.” Available at: https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action

[9]         Public Health England, “Salt Reduction Targets for 2017,” 2017. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604338/Salt_reduction_targets_for_2017.pdf

[10]      Public Health England, “Calorie reduction: The scope and ambition for action,” 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/685359/Calorie_reduction_The_scope_and_ambition_for_action.pdf

[11]      Scientific Advisory Committee on Nutrition, “Salt and Health,” 2003. Available at: https://www.gov.uk/government/publications/sacn-salt-and-health-report

[12]      Institute of Health Metrics and Evaluation, “Global Burden of Disease 2017 Compare tool,” 2018. [Online]. Available: https://vizhub.healthdata.org/gbd-compare/

[13]      Public Health England, “Public Health Profiles,” 2018. [Online]. Available: https://fingertips.phe.org.uk

[14]      M. T. Gorski and C. A. Roberto, “Public health policies to encourage healthy eating habits: recent perspectives,” J. Healthc. Leadersh., vol. 7, pp. 81–90, Sep. 2015.

[15]      Public Health England, “England’s poorest areas are fast food hotspots,” 2018. [Online]. Available: https://www.gov.uk/government/news/englands-poorest-areas-are-fast-food-hotspots

[16]      Public Health England, “Fast food outlets: density by local authority in England,” 2018. [Online]. Available: https://www.gov.uk/government/publications/fast-food-outlets-density-by-local-authority-in-england

[17]      HM Government, “Restrictions on adverts for food high in fat, sugar and salt: public asked for views,” 2019. [Online]. Available: https://www.gov.uk/government/news/restrictions-on-adverts-for-food-high-in-fat-sugar-and-salt-public-asked-for-views

[18]      Department of Health & Social Care, “Restricting promotions of food and drink that is high in fat, sugar and salt,” 2019. [Online]. Available: https://www.gov.uk/government/consultations/restricting-promotions-of-food-and-drink-that-is-high-in-fat-sugar-and-salt