Fast Food Make-Over
Outlets selling food high in fat and salt content have a disproportionate impact on school children and poor communities. But EHOs are fi ghting back. Stuart Spear reports
The takeaway movement is the name given to the increasing number of nutrition initiatives launched recently by EHOs and trading standards offi cers, aimed at local fast-food outlets, often in the face of fi erce media criticism.
The name was coined by Prof Jack Winkler. founder of the Nutrition Policy Unit at London Metropolitan University. ‘What makes the takeaway movement so interesting and potentially successful is that eff orts in the past have been around getting people to make informed healthy choices,’ he says.
‘This starts with the food people like to eat and improves its nutrient profi le, which in my mind is what is so encouraging about this movement.’
In January 2008, then education secretary Ed Balls and health secretary Alan Johnson launched a national obesity strategy, which called on councils to prevent the growth of fast-food outlets near schools.
The movement took a couple of years to get off the ground but, since then, Waltham Forest LBC and last week Barking and Dagenham LBC have introduced planning restrictions on opening new fast-food outlets in their boroughs.
Meanwhile, dozens of other councils have launched nutrition initiatives, many run by EHOs, to reduce the levels of salt and fat in takeaways. These foods are a cause of obesity and cardiovascular disease and are often targeted at schoolchildren.
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Last December EHOs from 16 London boroughs joined the campaign group Consensus Action on Salt and Health to monitor the buying habits of school children in takeaway queues near 45 London schools.
In the biggest study of its kind, EHOs analysed the salt and fat content of 73 of the most popular meals bought. Only three did not fall into the red traffi c light labelling category.
The study revealed that on average kebab meals contained 100 per cent of the total adult daily recommended intake of 6g of salt. One kebab contained 7.4g of salt and 48.7g of saturated fat, more than twice an adult’s daily maximum fat intake.
One portion of chicken and chips bought in Wandsworth was found to have 22.10g of saturated fats, or the equivalent of fi ve and a half McDonald’s McChicken Nuggets and large fries and 22 times the fat content of a chicken BBQ meal provided by Newham catering services.
‘The results surprised us, not only because of the huge variation in fat and salt content between products, but because of how much worse many of the sampled menu items were compared to the national food chains,’ said Helen Clark, area manager for the Wandsworth food team that co-ordinated the study. ‘We found some of the takeaways were marketed purely at school children with “school specials” advertised in the window. These are very cheap ways of feeding yourself aimed at children’s pocket money.’
The takeaway movement has adopted two approaches to stem this tide of health threatening foods. Some councils are introducing planning controls. EHOs have also adopted a health by stealth strategy to change the way foods are cooked and constituted without aff ecting taste and, importantly, the profi t margin of the often struggling fast-food outlet owner.
The first local authority to introduce planning controls was Waltham Forest which, in April last year, imposed a 400m exclusion zone around schools, parks and youth centres on the opening of new takeaways. The council acted after ratepayers’ concerns about rats, litter, smells, noise and antisocial behaviour associated with hot-food takeaways.
Last week Barking and Dagenham LBC approved its supplementary planning document on new hot-food takeaways, which places a 400m exclusion zone around primary and secondary schools and controls on concentrations of outlet in other parts of the borough. It approved a £1,000 hot-food levy on any new takeaway to go towards the council’s healthier cooking initiatives.
In the absence of a national planning policy statement on health, Barking and Dagenham has used planning policy statement 1, covering sustainable development, to draw up its supplementary planning document.
The power of local authorities to consider the health impact of a takeaway has been a grey area for planners in recent years.
In June, the High Court ruled that Tower Hamlets LBC had acted unlawfully in allowing a grocer’s shop to be turned into a takeaway selling burgers and chicken and chips 457m from a local Catholic school.
Mr Justice Cranston said the council had acted unlawfully by following the advice of a planning offi cer that the proximity of a fast-food outlet to a school was not a material consideration.
This ruling means that planning consent now hinges on the ability of the council to provide evidence that takeaways located near a school pose a health threat.
‘The implication is that councils should consider this issue and base their decision on the available evidence as to whether fastfood outlets close to schools are necessarily detrimental to the health of pupils,’ says Matt Thomson, head of policy and partnerships at the Royal Town Planning Institute.
‘Councils will need objective evidence, which demonstrates whether fast-food outlets close to schools do have a harmful impact on health that other forms of retail such as convenience stores, supermarkets and sandwich shops do not.’
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But the problem with planning law is that it does not aff ect existing takeaways which, according to the School Food Trust, deliberately target school children. It says, on average, 23 fast-food outlets open up within walking distance of every school.
‘What you can try to do about that is improve the quality of food on off er,’ says Prof Winkler. ‘That does not mean making the McDonald’s mistake of putting salad and fruit packs into burger bars. It is not putting carrot sticks into kebab shops that we want. We need healthier kebabs, which means reformulating the mainstream product that you sell. That is what people come for and that is what you have to make healthy.’
One of the best examples of reconstituting food can be found in Norfolk, where the county council has just been judged this year’s Food Standards Agency Food Champion winner.
Sausages are a particularly popular part of the Norfolk diet and more than 3,500 kilos are sold each week in fast-food outlets. The Norfolk Council trading standards initiative showed how reducing the salt content in each sausage by a fi fth without impairing taste could potentially remove 190 kilos of salt per week from the Norfolk diet. Removing 1g of salt a day from our diet could prevent 6,700 premature deaths each year in the UK.
Under consumer trials, the Norfolk scheme’s reduced salt mix was deemed the tastiest by far. The secret is adding dry seasoning to water and then to the sausage mix rather than direct to the mix. Not only does the water distribute the salt more evenly, it also intensifi es the taste. The wet mix cuts the butcher’s production costs, produces tastier food and has been found to produce less microbiological activity. Norfolk trading standards, working with seasoning manufacturers, have produced an on-line sausage salt calculator to help butcher modify their recipes.
This sort of innovative production technique, when applied to takeaway foods, could revolutionise fast-food practices across the country. Prof Winkler believes reformulating the way kebabs are made would be a good start. ‘A kebab is a kebab so why don’t we start by reformulating kebabs across the whole of London so that the costs don’t fall to individual authorities,’ he suggests.
But not all public health interventions require partnership working with industry experts, as in the case of the Norfolk sausage.
A simple initiative by Gateshead EHOs involves putting fewer holes in a saltshaker. By working with salt pot manufacturers, EHOs devised a cap with fi ve holes instead of the traditional 17. One thousand of these were given to fi sh and chip shops. The result was a 60 per cent reduction in salt consumption and a favourable response from traders, who found that it cut costs.
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In Wigan, the local primary care trust has funded a fi ve-year obesity project to help EHOs work on unhealthy restaurant and takeaway practices in the borough. It has allowed Wigan Council to employ food scientist Jemma Grime to help EHOs with the more technical aspects of food production, particularly deep-fat frying oils.
‘It is interesting to see how a non-EHO works,’ says team leader Rosemary Lee. ‘I have inspected hundreds of fi sh and chip shops and yet when I went in with Jemma, I realised there was a world of stuff unrelated to food hygiene that as EHOs we never think about.’
The types of oils being used, the frying temperature and the frequency of oil changes are key factors in the fat content of deep-fried foods. Frying techniques, such as how often the frying basket is shaken and whether the chip tray has holes, can also reduce fat. Even the way potatoes are stored can aff ect the way the chips cook in the oil.
The Wigan EHOs unearthed some alarming practices. One chip shop owner had for the last 17 years been reducing his oil to a thick concentrate of fats and potential carcinogens before diluting it with fresh oil for his customers to eat.
Some of the work on oils developed by Wigan has been adopted by the Food Standards Agency (FSA) for its most recent advice sheets on healthier chip frying aimed at sole traders. The FSA’s focus on small outlets follows the work it has done with the larger takeaway chains on improving the nutritional quality of their foods.
Another FSA initiative that can claim membership of the takeaway movement has been initiated by Sharon Gilmore, an EHO with 20 years’ experience in local government, who has now joined the nutrition team at FSA Northern Ireland.
Through her links with the profession and with joint funding from the Northern Ireland Public Health Agency, 55 Northern Ireland EHOs have over the past two years received diploma-level training in nutrition. Each local authority now has one or two EHOs capable of giving nutritional advice and providing caterers CIEH level 2 nutrition training.
The training has allowed the FSA to help fund a Northern Ireland nutrition award that will be run by local authority EHOs to focus on the healthy constitution of takeaway foods.
‘The award very much leads on from the nutrition training that we have done, without which the EHOs would probably not have the confi dence to run with this,’ says Ms Gilmore. ‘There is now a nutrition working group formed as a result of the training, as EHOs have developed a real appetite for this and feel they can go out now and speak to caterers on nutrition with authority.’
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The FSA is also funding seven local authority schemes across Northern Ireland working on diff erent aspects of nutrition, including takeaways near schools. Fish and chip shops and Chinese takeaways are the main fast-food outlets in Northern Ireland while Indian takeaways and kebab shops are relatively uncommon.
Changes to the FSA (see page 2) could affect such initiatives as its nutritional work is to be transferred to the Department of Health. The prospect of such a move has enraged public health campaigners, who fear it is a sign of the coalition government’s desire to protect business interests rather than public health.
Prof Winkler, however, has taken some comfort from comments made by health secretary Andrew Lansley in a recent speech to the Faculty of Public Health, in which he said the government wanted ‘strong local leadership, supported by resources devoted to tackling those crosscutting causes of ill health’.
Mr Lansley went on to say: ‘Leadership, from local authorities working together with their public health partners, through the critical role of directors of public health, will have the resources and the authority to make preventative interventions to improve the health of their communities.’
Prof Winkler believes that because takeaway foods have been in the sights of government for a number of years, Mr Lansley’s comments could be seen as a lifeline for the takeaway movement as spending cuts bite.
‘There are many reasons for those concerned with food and health to be suspicious but I believe on this issue of takeaways and the work being done by environmental health, there is more hope,’ he says.
‘Anyone involved with policy has to be pragmatic and we are just going to have to work with what we have got.’
Giving further support to local action, public health guidance 25, just published, from the National Institute for Clinical Excellence (NICE), explicitly calls on planners to ‘set limits for the number of takeaways and other food outlets in a given area’ and on EHOs to ‘improve the nutritional quality of the food they provide’ by providing ‘advice on content and preparation techniques’.
To join the takeaway movement and receive updates on developments Contact: Prof Jack Winkler Email: jtw@blueyonder.co.uk