Consultation outcome

Equality assessment: introducing further advertising restrictions on TV and online for products high in fat, salt and sugar

Updated 24 June 2021

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1. Introduction

1.1 This paper examines the impact of the policy on introducing further advertising restrictions for products that are high in fat, sugar and salt (HFSS) on TV and online. This paper focuses on the impact of this policy on people with protected characteristics. The Department for Health and Social Care (DHSC) and the Department for Digital Culture Media and Sport (DCMS) have produced this paper in accordance with our duties under the Equality Act 2010.

1.2 Under the Equality Act 2010, DHSC and DCMS, as public authorities, are legally obliged to give due regard to the Public Sector Equality Duty (PSED) when making policy decisions. The PSED is also known as the general equality duty.

1.3 DHSC and DCMS, as public authorities must, in the exercise of its functions, have due regard to the need to:

a) eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act

b) advance equality of opportunity between people who share a protected characteristic and those who do not

c) foster good relations between people who share a protected characteristic and those who do not

1.4 The PSED covers consideration of the following protected characteristics: age; disability; gender reassignment; pregnancy and maternity; race; religion and belief; sex and sexual orientation with marriage and civil partnership being a protected characteristic under (a) above.

1.5 There is limited evidence to assess whether introducing further advertising restrictions on TV and online for HFSS products impacts people with these protected characteristics in terms of advancing equality of opportunity and fostering good relations as set out under (b) and (c) above. However, DHSC’s and DCMS’ duties under the Equality Act are continuous and will be monitored and reviewed over time.

2. Background

2.1 Childhood obesity is one of the biggest health problems this country faces. More than 1 in 5 children in England are obese or overweight by the time they start primary school, and this rises to more than one-third by the time they leave.[footnote 1] It is also an issue that affects adults, with around two-thirds (63%) of adults being above a healthy weight,[footnote 2] and of these, half live with obesity.

2.2 Obesity is associated with reduced life expectancy. It is a risk factor for a range of chronic diseases including cardiovascular disease, type 2 diabetes, at least 12 types of cancer, liver and respiratory disease.[footnote 3] For children, it can also have a big impact on mental health. Those who are overweight and obese are more likely to experience bullying, stigmatisation and low self-esteem.[footnote 4] It also makes them more likely to go on to become obese adults,[footnote 5] which puts them at risk of the health issues outlined above.

2.3 The prevalence of obesity has become an even more pressing issue because of coronavirus (COVID-19). Evidence shows that people who are overweight or living with obesity who contract COVID-19 are at greater risk of dying from the virus.[footnote 6] As excess weight is one of the few modifiable risk factors for COVID-19, the government has been clear that there is an urgent need to take action.

2.4 Obesity also has significant financial costs. It is estimated that obesity-related conditions are currently costing the NHS £6.1 billion per year.[footnote 7] The total costs to society of these conditions have been estimated at around £27 billion per year,[footnote 8] with some estimates placing this figure much higher.[footnote 9]

2.5 We know that obesity is a complex problem caused by many different factors. No one policy and no one sector will reduce obesity on its own and it will take time to reduce obesity levels in the UK. To tackle obesity, the UK government has now published 3 chapters of the Childhood Obesity Plan, and most recently Tackling obesity: empowering adults and children to live healthier lives, which aims to help adults and children to live healthier lives.

2.6 A critical part of delivering this goal is reducing excessive calorie intake. We make numerous decisions about the food we eat, and every day we are presented with encouragement and opportunity to consume the least healthy foods. This can be through the advertisements we see on TV and online, the range of foods sold in our local shops or delivered straight to our doors, and the food that is promoted in-store and online. All of this is intended to influence the choices we and our children make. Regular overconsumption of food and drink high in calories, sugar and fat is one of the key factors leading to weight gain and, over time, obesity.

2.7 That is why, since 2019, DHSC and DCMS have held 2 consultations looking at introducing further advertising restrictions on TV and online for HFSS products.

2.8 Despite current HFSS advertising restrictions that apply online and during children’s TV and other programming of particular appeal to children, analysis commissioned by DCMS for the 2019 consultation showed that in 2017, children were still exposed to a significant amount of HFSS product advertising. It showed that there were an estimated 3.6[footnote 10] billion child impacts on TV,[footnote 11] and 0.7 billion child impressions online in 2017.[footnote 12] Through evidence received in response to this consultation, we additionally heard that our initial figures for online impressions were a significant underestimation and that online HFSS advertising exposure was 15.1 billion impressions in 2017.[footnote 13] We have updated our analysis to reflect that fewer product categories are now in scope. This indicates there were 2.9 billion HFSS TV impacts and 11 billion impressions online in 2019.

2.9 Furthermore, the diet advertised on TV and online does not reflect the healthy balanced diet that would support us all to live healthier lives. Evidence suggests that HFSS product advertising is more prevalent on TV than other food and drink product advertising.[footnote 14]

2.10 Research from September 2019 shows that almost half (47.6%) of all food adverts shown over the month on ITV1, Channel 4, Channel 5 and Sky1 were for HFSS products and this rises to nearly 60% during the 6.00pm to 9.00pm slot – the time slot where children’s viewing peaks.[footnote 15] Additionally, online food and drink advertising spend has increased by 450% between 2010 and 2017[footnote 16] (it should be noted this percentage includes HFSS and non-HFSS products). This highlights the need to futureproof the policy to align with children’s media habits and to reflect where HFSS advertising spend has been moving.

2.11 Studies show that children’s exposure to HFSS product advertising can affect what children eat and when they eat.[footnote 17] This can happen both in the short term, increasing the amount of food children eat immediately after being exposed to a HFSS advert,[footnote 18] [footnote 19] and in the longer term by shaping children’s food preferences from a young age.[footnote 20] [footnote 21]

2.12 Based on research commissioned by the government to inform the 2019 and 2020 policy consultations, and evidence we received through this consultation, we estimate that introducing a watershed across broadcast TV and a restriction for paid-for online advertising could remove up to 7.2 billion calories from children’s diets per year in the UK.

2.13 It is important to note that this figure is a population-wide estimate and calculating an average ‘calorie lost’ figure per child does not reflect the fact that this policy could have a greater impact on certain children. For example, there is evidence that children from lower socio-economic households spend more time watching TV and online,[footnote 22] and are therefore exposed to more HFSS food advertising compared to higher income households.[footnote 23] These children are also twice as likely to be obese as those from high income households. Evidence also suggests that HFSS adverts have a greater impact on those children who are already overweight or obese.[footnote 24] This indicates that these individuals are more likely to be affected by any restriction to HFSS advertising.

2.14 In total, over the coming years this policy could be expected to reduce the number of obese children by around 20,000.

2.15 Importantly, in our impact assessment, health benefits have been estimated from changes in children’s immediate consumption of HFSS products. Health effects on adults have not been monetised in our analysis. While there is some evidence linking HFSS advertising exposure to changes in adult’s purchases and consumption,[footnote 25] [footnote 26] [footnote 27] [footnote 28] [footnote 29] it is not conclusive enough to be used in quantifying policy impacts. If HFSS advertising does have a positive influence on adult consumption, the policy could generate significant additional health benefits for the adult population.

2.16 This situation has not been replicated on the costs side of our cost-effectiveness estimate. Here, the method used to estimate costs to HFSS advertisers captures all the increased purchases derived from advertising, potentially from both adults and children. The method also includes any effects of a price premium HFSS advertisers can charge as a result of their advertising activity. This means should HFSS advertising have an impact on adults, it would be captured within the costs, but not the benefits, and so the net benefit of the policy would be underestimated. Unfortunately given the available evidence, the presence and magnitude of this effect cannot be estimated more definitively. It is key to reiterate that although it is expected this policy may have some impact on adult consumption, the focus of the policy is removing HFSS advertising from child audiences.

2.17 We know that a number of UK companies are proactively exploring options to reformulate their products. The government commends this and we hope that these advertising restrictions will add a further incentive for companies to make their products healthier, as they will then be able to advertise their products without these new HFSS advertising restrictions.

2.18 Despite a decline over recent years, data from the British Audience Research Board (BARB) (the British Audience Research Board) - the body that compiles audience measurement and television ratings for broadcasters and the advertising industry, shows that children aged 4 to 15 watched 43% less broadcast TV in 2017 than they did in 2010.[footnote 30] Despite this decline, children still spend a significant amount of time watching broadcast TV – 7 hours 56 minutes a week in the first half of 2019.[footnote 31] As such, the government considers it appropriate to introduce a TV watershed to limit children’s exposure to HFSS advertising when they watch TV.

2.19 Ofcom research shows that children’s viewing peaks in the hours after school, with the largest number of child viewers concentrated around family viewing time, between 6pm and 9pm.[footnote 32] In this period, children are watching programming not specifically aimed at them, with half of children’s viewing taking place during adult commercial programming where restrictions on HFSS advertising typically do not apply.

2.20 Ofcom has found that children aged 12 to 15 now spend more time online than watching broadcast TV.[footnote 33] Since 2019, the way that children consume media has changed, with 5 to 15-year-olds spending around 20 minutes more online per day than in front of a TV set, and evidence suggests that this shift will continue.[footnote 34] The platforms they use online are also diversifying, with new forms of social media gaining popularity in recent years.[footnote 35]

2.21 Evidence also suggests that the diversification of viewing habits where traditional broadcast advertising is combining with online consumption may be amplifying the effectiveness of advertising.[footnote 36] This all emphasises the need for robust restrictions for HFSS advertising on both TV and online.

2.22 Between 18 March and 10 June 2019, DHSC and DCMS jointly consulted on introducing further advertising restrictions for HFSS products. Following this consultation, in July 2020, government announced in its Tackling Obesity strategy: empowering adults and children to live healthier lives, the intention to legislate to introduce a 9pm - 5:30am watershed for HFSS adverts on broadcast TV. A further consultation took place between 10 November 2020 and 22 December 2020, to consider how HFSS restrictions could go further online by introducing a total HFSS online advertising restriction to futureproof the policy, and ensure effective reduction of children’s HFSS exposure online.

Following the consultation process, the government concluded that its approach to HFSS advertising restrictions should be to:

  • introduce, simultaneously at the end of 2022, a 9pm TV watershed for HFSS products and a restriction of paid-for HFSS advertising online, via the Health and Care Bill

  • all On-Demand Programme Services (ODPS) under the jurisdiction of the UK, and therefore regulated by Ofcom, will be included in the TV watershed for HFSS advertising

  • non-UK regulated ODPS will be included in the restriction of paid-for HFSS advertising online because they are outside UK jurisdiction

2.23 This policy aims to ensure that the adverts children see on TV and online represent a healthier, more balanced diet, which in turn will support people to make healthy choices.

2.24 This document is intended to be read in conjunction with the government’s response to the 2019 and 2020 consultations, which sets out more detailed information about how consultation responses have helped to shape the overall policy.

2.25 The following sections will examine the impact of the policies in the plan on various groups sharing protected characteristics. We have considered whether there are any unintended consequences and how we can mitigate any disadvantages. This valuable insight has helped us to understand how we can meet our objective significantly to reduce the inequalities gap in obesity by 2030. This is part of the government’s intention to address inequalities, surge community renewal and ‘level up’ the UK, through a programme of world-leading policy change, infrastructure development, and investment in education, skills and scientific research and development.

2.26 Although not a legal requirement of the PSED, the government invited views as part of the consultation process to better understand whether this policy would have any impact on socioeconomic status. We present the responses in this document.

3. Consultation feedback

2019 consultation

Question 37: Do you think that introducing further HFSS advertising restrictions on TV and online is likely to have an impact on people on the basis of their age, sex, race, religion, sexual orientation, pregnancy and maternity, disability, gender reassignment and marriage/civil partnership?

Yes No I do not know Total
284 (20%) 865 (62%) 244 (18%) 1,393

3.1 The consultation sought views on whether this proposal would be likely to have an impact on people on the basis of a number of protected characteristics. Respondents could select as many characteristics as they believe applied. 284 respondents stated “Yes”, the policy would have an impact on people with protected characteristics, 865 stated “No” and 244 stated “I do not know”.

3.2 Of those who answered “Yes”, respondents could provide a justification to explain their answer in a free text box. Free text answers were analysed to assess whether the respondent believed the policy would have a positive or negative effect on the characteristic. Respondents could comment on an impact for more than one protected characteristic in their response. There were 152 responses in this field. However, it was unclear in 14% (21) responses on which protected characteristic there would be a positive or negative impact (only impact mentioned) or whether the impact on a named protected characteristic was positive or negative (only characteristic mentioned).

3.3 The most common area that respondents would see a positive impact from the policy was age (47%, 71 responses), going on to elaborate that, as children are more vulnerable to advertising, they therefore have the most to gain from these policies, which is in line with the policy aim to reduce HFSS advertising exposure to children. Conversely, eight responses (5%) said that the policy would have a negative impact on the basis of age, due to a decline in the quality of daytime TV due to the economic impact of the policy. Respondents cited that this would also have an impact for older adults. Views were also expressed that the policy would have a negative impact on freedom of choice for adults, who are not the target of the restrictions.

3.4 The policy focuses on advertising shown pre 9pm. HFSS product advertisement (subject to the existing rules that prohibit HFSS advertising in media of particular appeal to children, or where more than 25% of the audience is under 16 years old, as set out by the UK’s Code of Broadcast and Non-broadcast Advertising; BCAP and CAP codes respectively) will therefore largely be unrestricted on TV after 9pm, ensuring adults maintain freedom of choice to watch these adverts.

3.5 Feedback highlighted disability as the most common (11%, 17 responses) characteristic to be negatively impacted by the policy. Health stakeholders raised that a possible exemption on TV for child audiences below 1% would have a negative impact on children who are on the autistic spectrum. Their reasons cited that children with autism tended to watch specialist TV programmes that have low child audiences, and therefore if included, this exemption may mean that they are exposed to more HFSS advertising than children who are not autistic. As mentioned in the full consultation response, the government has decided not to include a 1% exemption on TV with low child audiences as it would undermine the policy intent.

Question 38: Do you think this proposal would help achieve any of the following aims?

a) eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010

b) advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it

c) fostering good relations between persons who share a relevant protected characteristic and persons who do not share it

Answer Yes No I do not know Total
a) 230 (18%) 537 (42%) 503 (40%) 1,270
b) 222 (20%) 419 (37%) 495 (43%) 1,136
c) 191 (18%) 394 (38%) 454 (44%) 1,039

3.6 From each aim, respondents could state “Yes”, “No” or “I do not know”, if they thought the policy would help achieve this aim. Respondents could state that the policy met more than one of the aims:

  • 230 respondents thought the policy would support eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010
  • 222 respondents thought the policy would support advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it
  • 191 respondents thought the policy would support fostering good relations between persons who share a relevant protected characteristic and persons who do not share it

A free text box was included after each aim for respondents to provide further information on why they felt the policy would meet the aim. Respondents provided justification in free text boxes across the three aims, these have therefore been analysed together (for this reason, percentages are not included). 259 responses were provided in these free text fields, that gave further information to explain the response of those who answered.

3.7 The most common reason respondents thought that the policy would help eliminate discrimination was by reducing the fat shaming, bullying, harassment and stigma surrounding obesity (36 responses). The most common reason respondents thought the policy would advance equality of opportunity was by reducing the inequality in obesity (35 responses). The most common reason respondents thought the policy would support fostering good relations between persons who share a relevant protected characteristic and persons who do not share it was because the policy would affect everyone, and therefore work towards a shared goal of improved health (3 responses).

3.8 However, 59 responses indicated that equalities were not relevant to the consultation and 30 responses indicated they did not feel it was the government’s job to intervene.

3.9 Four responses raised that the proposals would disadvantage children who are on the autistic spectrum who tend to watch more specialist TV programmes. This has been addressed above in paragraph 3.5.

3.10 If respondents answered “No”, they could further provide information on how the proposals could be changed so that they are more effective, in a follow up question. Responses here included that healthy food should be made cheaper, to let people have the right to eat what they want, that equalities were not relevant to this consultation and that the policy should not be implemented.

Question 39: Do you think that the proposed policy to introduce further HFSS advertising restrictions on TV and online would be likely to have a differential impact on people from lower socio-economic backgrounds?

Yes No I do not know Total
675 (51%) 343 (26%) 295 (23%) 1,313

3.11 As before, if a respondent answered “Yes” they could provide a justification to explain their answer in a free text box. Free text answers were analysed to assess whether the respondent believed the policy would have a positive or negative effect on people from lower socio-economic backgrounds. Respondents could name more than one way the policy could give either a positive or negative impact. There were 464 free text responses. From these 464 responses, it was clear in 422 responses that the policy would have either a positive or negative impact on people from lower socio-economic backgrounds.

3.12 73% (339) of responses indicated the policy would have a positive impact on people from lower socio-economic backgrounds and 5% (25) of responses thought it would positively benefit all, irrespective of income. The most common positive impact mentioned was that children living in lower income households are more likely to be overweight and therefore will benefit the most from reduced exposure (40%, 187 responses).

3.13 5% (25) of responses indicated the policy would have a negative impact on people from lower socio-economic backgrounds, as the policy would make all food and drink more expensive which would impact those on low incomes more. 7% (33) of responses also thought that more education of what constitutes a healthy diet is needed, and that advertising less will not change this. The government is not requesting any change in pricing strategies as a result of this policy. Any price rises are at the discretion of the food and drink industry. There are a number of options companies can consider before raising the price of their products. Additionally, manufacturers may also see this as an opportunity to reformulate restricted products. The government will conduct a post-implementation review of the policy to understand the impact of the policy further.

2020 consultation

Question 28: Do you think that introducing further HFSS advertising restrictions on TV and online is likely to have an impact on people on the basis of their age, sex, race, religion, sexual orientation, pregnancy and maternity, disability, gender reassignment and marriage/civil partnership?

Yes No I do not know Total
520 (23%) 1,206 (53%) 561 (25%) 2,287

3.14 The consultation sought views on whether this proposal would be likely to have an impact on people on the basis of a number of protected characteristics. Respondents could select as many characteristics as they believed applied. 520 respondents stated “Yes”, the policy would have an impact on people with protected characteristics, 1,206 stated “No” and 561 stated “I do not know”.

3.15 Of those who answered “Yes”, respondents could provide a justification to explain their answer in a free text box. Free text answers were analysed to assess whether the respondent believed the policy would have a positive or negative effect on the characteristic. Respondents could comment on an impact for more than one protected characteristic in their response. 267 responses were included here. It was clear from 45% (119) of responses which protected characteristic was being commented on and the impact the policy would have but unclear in 52 (19%) responses, either which protected characteristic the respondent was referring to or if the policy would have positive or negative impact. In 7% (18) of responses, respondents indicated it was not the government’s job to intervene. Although not a protected characteristic but asked about later in the consultation, 9% (24) of responses stated that there would be a positive impact on people from lower socio-economic backgrounds and 4% (11) of responses indicated there would be a negative impact on people from lower socio-economic backgrounds. 16% (43) of responses indicated the policy would affect everyone equally.

3.16 36% (97) of responses stated there would be a positive impact from the policy on protected characteristics. The most common area that respondents felt there would be positive impact was age (30%, 81 responses), going on to elaborate that, as children are more vulnerable to advertising, they therefore have the most to gain from these policies, which is in line with the policy aim to reduce HFSS advertising exposure to children.

3.17 7% (19) of responses stated there would be a negative impact from the policy on protected characteristics. The most common area that respondents felt there would be a negative impact was based on race (5%, 14 responses), stating that some culturally important foods are often high in calories. The government has decided the scope of products restricted on TV and online will include those products that currently contribute the most to childhood obesity. If cultural foods are classified in the policy as HFSS products, their advertising will be restricted on TV and online due to the nature of the products being high in sugar or calories. It is not the government’s intention to impact the diversification or availability of food, but to reduce child exposure to HFSS advertising.

Question 29: Do you think this proposal would help achieve any of the following aims?

  • eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010

  • advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it

  • fostering good relations between persons who share a relevant protected characteristic and persons who do not share it

Yes No I do not know Total
607 (27%) 754 (33%) 907 (40%) 2,268

3.18 In contrast to the same question asked in the 2019 consultation, in this consultation respondents were asked whether they thought the policy met at least one of the aims (and reply with “Yes”, “No”, I don’t know”) and then provided a free text box to further elaborate which aim they felt the policy would help meet and why (therefore a table like the one provided previously is not displayed). Of those that said “Yes”, there were 239 responses in this free text field. Of these 239 responses, in 73% (174) of the aim the policy would help was made clear, was relevant and was applicable.

3.19 10% (23) of responses indicated the policy would help achieve all 3 aims. 14% (33) of responses indicated the policy would help eliminate discrimination by reducing fat shaming, harassment and bullying. 101 (42% of) responses indicated the policy would help advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; 23% (56) of responses further explained they felt this way, as lower socio-economic groups stand to have a great benefit from the policy; 11% (27) of responses thought this would provide more opportunities for those who are of healthy weight; and 8% (18) of responses thought this would advance opportunities as some ethnicities are more affected by obesity. 7% (17) of responses indicated the policy would promote good relations between persons who share a relevant protected characteristic and persons who do not share it and that everyone would work towards a shared goal of improved health.

3.20 Respondents were also asked whether the proposals could be changed so that they were more effective to meet the 3 aims. Responses included here indicated that equalities were not relevant to this consultation, that it is not the place of the government to intervene; and, that there would have to be tougher penalties for enforcement of compliance and greater education of how to live a healthy lifestyle was necessary. The government has considered the level of penalties that should be imposed. We were mindful to ensure parity with those not complying with broadcast restrictions. Furthermore, this policy is being implemented alongside existing public education campaigns such as One You, Change 4 Life and Better Health.

Question 30: Do you think that the proposals in this consultation could impact on people from more deprived backgrounds?

Yes No I do not know Total
1,401 (60%) 476 (20%) 455 (20%) 2,332

3.21 As before, if a respondent answered “Yes” they could provide a justification to explain their answer in a free text box. Free text answers were analysed to assess whether the respondent believed the policy would have a positive or negative effect on people from lower socio-economic backgrounds. Respondents could name more than one way the policy could give either a positive or negative impact. There were 774 responses provided in this field. In 92% (713) of responses it was made clear if respondents thought the policy would have a positive or negative impact on people from lower socio-economic backgrounds (including those who thought the policy would affect everyone negatively, and those that thought it would be positive irrespective of income). However, there were 8% (61) of responses where it was unclear if respondents thought the impact of the policy would be positive or negative.

3.22 73% (564) of responses thought that there would be a positive impact on those from lower socio-economic backgrounds. 3% (26) of responses thought the policy would benefit all in a positive way irrespective of income. The most common positive impact (58%, 448 responses) mentioned was that children living in lower income households are more likely to be overweight and therefore will benefit the most from reduced HFSS ad exposure.

3.23 10% (80) of responses indicated that the policy would negatively impact those from lower socio-economic backgrounds, particularly people earning lower incomes. It was also raised that healthier food is more expensive than HFSS products, further negatively impacting on people with low incomes. Concerns were also raised that this policy may raise food prices. As outlined in paragraph 3.13, it is not the government’s intention for food prices to rise as a result of this policy. An additional four (1% of) responses thought the policy would impact on everyone negatively.

3.24 5% (39) of respondents also thought more education of what constitutes healthy foods was required and restricting HFSS advertising will not change this. The public health support and advice that the government is investing in to support this is addressed in paragraph 2.25.

4. Assessment against protected characteristics

4.1 The primary objective of introducing these restrictions is to reduce children’s exposure to HFSS advertising and subsequently reduce children’s overconsumption of HFSS products. Even though the policy is specifically targeted at children and focused on those products that contribute towards childhood obesity the most, it may influence the wider food and drink environment and therefore have a positive impact across the population.

4.2 We recognise that the positive impact of the policy may be greater for some groups. Some protected characteristics, for example race and disability, are associated with differential rates of overweight and obesity than average. Therefore, populations with certain protected characteristics could experience greater health benefits as a result of this policy.

4.3 This section will examine the impact of the policy on various groups sharing protected characteristics.

Age

Obesity prevalence

4.4 Obesity prevalence is different across age groups. Public Health England (PHE) analysis of National Child Measurement Programme (NCMP) data shows that obesity and overweight prevalence increases in children in England as they progress through primary school. Around 1 in 10 children in Reception and 1 in 5 children in Year 6 are living with obesity.[footnote 37]

4.5 In adults, the 2018 results from the Health Survey for England (HSE) showed that 63% of adults were classified as overweight or living with obesity.[footnote 38] Obesity and overweight rates went up with age but decreased in the oldest age groups. Obesity rates ranged from 13% in men aged 16 to 24 to a peak of 36% in men aged 45 to 54, and the equivalent range for women was from 14% aged 16 to 24 to 37% aged 55 to 64. This decreased to 28% for both men and women aged over 75.

Impact of advertising restrictions

4.6 Data shows that the diets of children in the UK are not balanced. Children consume too much sugar, saturated fat and salt and too many calories, but not enough fibre, fruit and vegetables. Data specifically shows that children between 11 to 18 years old, consume up to nearly three times the recommended maximum amount of sugar, at 14.1% total energy (around 70g of sugar) per day. This decreased to around 11% total energy for adults.

4.7 As mentioned, evidence suggests that children’s exposure to HFSS product advertising can affect what they eat and when they eat. Several studies investigating the effects of TV advertising on children have demonstrated that exposure to advertising increased children’s desire for advertised products,[footnote 39] [footnote 40] and the number of their purchased requests.[footnote 41]

4.8 The intent of this policy is to reduce children’s exposure to HFSS product advertising and in turn, to reduce children’s consumption of HFSS products so that over time childhood obesity rates reduce. Feedback from the 2019 consultation highlighted that the most common area that respondents could see a positive impact from the policy was age. As children are more vulnerable to advertising, they therefore have the most to gain from these policies, which is in line with the policy aim to reduce HFSS advertising exposure to children. Respondents also mentioned the United Nations Convention on the Rights of the Child, which came into force in the UK in 1992, and legal analysis commissioned by UNICEF in 2018, which concluded that many of the core rights outlined in the Convention are undermined by HFSS advertising.[footnote 42] Other respondents citing a paper published by the World Health Organization proposing that children have the right to participate in digital media; to have their health and privacy protected; not to be exploited economically; and that it is not only up to parents/guardians to facilitate this but is also incumbent on governments to support parents/guardians in doing so.[footnote 43] The government is confident that the aims of this policy go towards upholding these important rights.

4.9 Overweight or obese children are far more likely to go on to become obese adults[footnote 44] and respondents flagged the impact the policy would also have to adults, both positive and negative. We therefore include a brief summary of these potential impacts, but this does not change the policy aim. The positive aspects for adults raised were that, as the policy reduced exposure of all people to HFSS advertisements, it would have a beneficial effect on all. However, the research on the link between an adult’s exposure to HFSS advertising and their immediate calorie consumption is less developed than for children and does not currently show a measurable impact.

4.10 A small number of respondents raised that the policy would have a negative impact on the basis of age, due to a decline in the quality of daytime TV, which respondents highlighted as a possible consequence of broadcasters losing HFSS advertising revenue. Respondents cited that this would have an impact on the older community and would limit the freedom of choice for adults.

Conclusion

4.11 Consultation feedback supports the view that implementation of this policy would have a positive impact on children, which is in line with the aim of this policy. Many respondents have flagged that a positive, unintended consequence of this policy is that it will positively impact adults. The government will monitor the impact (both positive and negative) of this policy through post implementation review.

4.12 There is no evidence that advertising restrictions will be detrimental with regards to age under (a), (b) and (c) of paragraph 1.3. Overall, we expect the policy to have a neutral or positive impact with regards to age.

Disability

Obesity prevalence

4.13 Analysis by PHE suggests children with disabilities are more likely to be obese than those without disabilities. This difference increases with age. Analysis of combined data from the HSE 2006 to 2010 shows that children with a limiting long-term illness are approximately 35% more likely to be obese than children without a limiting long-term illness.[footnote 45] Overweight and obesity in children and young people has also been linked to a range of disabling conditions, including learning disabilities, physical activity limitations, spina bifida as well as audio-visual impairments.[footnote 46] Disabled children are therefore at greater risk of developing obesity-associated conditions as adults, such as Type 2 diabetes.

4.14 In adults, there is a 2-way relationship between obesity and disability. Disabled adults are more likely to be at risk of obesity, while obese adults may develop complications leading to disabilities because of being obese.[footnote 47] Analysis of NHS Digital (NHSD) primary care data showed that people with disabilities have substantially higher rates of conditions with being overweight such as diabetes, heart failure and strokes.[footnote 48]

4.15 People with learning disabilities are more often overweight or living with obesity at higher rates than the general population, with poorly balanced diets and low levels of physical activity.[footnote 49] Data from NHSD, based on data from GPs across England found that obesity is twice as common in people aged 18 to 35 with learning disabilities compared with patients with no learning disabilities.[footnote 50]

Impact of advertising restrictions

4.16 Consultation feedback showed a mixed response to how these restrictions would impact on people living with diabetes. One respondent raised that it would be positive discrimination towards those who use high sugar products as part of managing their condition. Another respondent highlighted that advertising restrictions would be beneficial to people living with Type 2 diabetes who are vulnerable. However, no further rationale for either response was given by either respondent. An organisation flagged that there are estimated to be around 6,000 children living with Type 2 diabetes in the UK today and highlighted that our impact assessment did not consider the health benefits for this specific group. The government is reassured that as this policy will not limit the sale or people’s access to HFSS products, those who use high sugar products to manage their health condition will be able to do so.

4.17 Concerns were also raised about a proposed exemption for low child audience channels and the fact that some of these channels provide programming that is more commonly watched by autistic children. However, the government will not include this exemption to the restrictions and more information regarding this decision can be found at paragraph 3.5.

4.18 Although not directly linked to obesity, Phenylketonuria (PKU) is a rare but potentially serious inherited disorder. Persons with PKU are intolerant to aspartame, an ingredient in food and drink which delivers a sweet taste with lower or no sugar content. In other healthy weight policy consultations, we received views from people affected by PKU. These responses noted that reformulation to reduce sugar in foods and drinks, as through the government’s Soft Drinks Industry Levy (SDIL) and PHE’s sugar and calorie reduction programmes, can lead to increase in usage of aspartame. The advertising restrictions that will be introduced are limited to a specific list of HFSS products and do not explicitly require businesses to reformulate their products, although this may be an action that businesses choose to take in order to be able to advertise their products.

Conclusion

4.19 This policy is expected to have a positive or neutral impact across the population with regards to considerations under paragraph 1.3. This is because there is a higher prevalence of obesity among both children and adults living with disabilities so advertising restrictions have the potential to particularly benefit this group. Although the policy aim is to reduce obesity in children, it is likely that the policy will affect both child and adult exposure to HFSS product advertisement and therefore both adults and children with disabilities may benefit.

Gender reassignment

4.20 We have considered the impact of the proposals on the protected characteristic of gender reassignment. No evidence or views were submitted as part of the consultation to suggest that the proposed policy will have a negative impact on people who share this protected characteristic compared with people who do not share this protected characteristic. Therefore, we expect the policy to have a neutral impact with regards to gender reassignment.

Pregnancy and maternity

Obesity prevalence

4.21 Women who are obese when they become pregnant have increased risks to their own and their child’s health.[footnote 51] They are more likely to experience complications in labour,[footnote 52] [footnote 53] and their children have increased risks of obesity in childhood and adulthood, and other health conditions later in life including heart disease, diabetes, and asthma.[footnote 54] [footnote 55] [footnote 56] [footnote 57] Maternal obesity is also associated with an increased risk of infant mortality.[footnote 58]

4.22 Although maternal obesity rates are not routinely monitored in England, we do know that obesity in pregnant women has increased, which is likely to increase the risks passed on to children. Between 1989 and 2007, maternal obesity (the proportion of pregnant women with a BMI greater than 30) doubled from 7.6% to 15.6%.[footnote 59] [footnote 60] In 2017, PHE analysis found that 49% of women who were pregnant in England were either overweight or obese and therefore they and their children are at greater risk during and after the pregnancy.[footnote 61]

Impact of advertising restrictions

4.23 Even though the policy is targeted at children, it would reduce exposure of HFSS advertisement to all, including people of childbearing age. Again, the research on the link between an adult’s exposure to HFSS advertising and their immediate calorie consumption is less developed than for children.

Conclusion

4.24 Although the policy aim is to reduce obesity in children, it is likely that the policy will affect both child and adult exposure to HFSS product advertisement and therefore we may expect a neutral to positive impact from the policy on maternal obesity rates, and a knock-on positive impact on the associated risks with maternal obesity.

4.25 Overall, we expect the policy to have a neutral or positive impact with regards to pregnancy and maternity on the three aspects of paragraph 1.3.

Race

Obesity prevalence

4.26 Data shows that there are differences in overweight and obesity prevalence across racial groups for both children and adults.

Table 3: prevalence of overweight and obesity for children by ethnic category (NCMP (2019 to 2020))

Ethnicity 2018 to 2019 – Reception 2018 to 2019 – Year 6
Total 23% 35.2%
White British 23.8% 32.9%
White Irish 23.2% 34.9%
White Other 21.2% 36.7%
Mixed White and Black Caribbean 27.1% 41.0%
Mixed White and Black African 27.4% 43.4%
Mixed White and Asian 17.0% 31.4%
Mixed Other 21.2% 36.4%
Indian 13.8% 36.2%
Pakistani 20.4% 40.7%
Bangladeshi 21.5% 45.1%
Asian Other 18.9% 40.0%
Black Caribbean 26.3% 44.9%
Black African 29.8% 46.2%
Black Other 26.7% 42.6%
Chinese 14.9% 32.9%
Any other ethnic group 23.2% 40.4%
Not stated 22.4% 35.2%

4.27 Table 3 above demonstrates that mixed white and Asian, white British, and Chinese pupils in Year 6 had the lowest prevalence of obesity compared to other ethnic groups (31.4%, 32.9% and 32.9% respectively), with children of Black African ethnicity and Bangladeshi children having the highest prevalence of obesity (46.2% and 45.1% respectively).

4.28 Data from the Active Lives Survey 2018 to 2019[footnote 62] [Table 4] demonstrates that Chinese adults had the lowest rates of overweight and obesity (35.3%), with Black adults having the highest prevalence at 73.6%.

Table 4: prevalence of overweight and obesity for adults by ethnic category (Active Lives Survey (2018 to 2019))

Ethnicity 2018 to 2019 – adults
Total 62.3%
White British 63.3%
White Other 58.1%
Mixed 57.0%
Asian 56.2%
Black 73.6%
Chinese 35.3%
Other 52.6%

4.29 Differences in weight between racial groups arise due to various factors such as environmental factors, health behaviours, socio-economic status and access to health care.[footnote 63] [footnote 64] The reasons for differences in obesity prevalence across ethnicities are various and it is difficult to state how different groups will benefit from the policies. The fact that ethnic differences persist even when controlling for deprivation and controlling for interaction suggests that cultural and genetic differences within some ethnic minority groups may account for the increased likelihood of children from these groups becoming obese or overweight.[footnote 65] [footnote 66] [footnote 67] [footnote 68] [footnote 69] [footnote 70]

4.30 People from different ethnic groups have different levels of risk if they develop conditions associated with obesity and being overweight. For the same level of BMI, people of African ethnicity appear to carry less fat and people of Asian ethnicity generally have a higher percentage of body fat than people of the same age and sex.[footnote 71][footnote 72] Some ethnic minority groups (especially those of Asian descent) are at risk of Type 2 diabetes and cardiovascular disease at a lower BMI than other groups.[footnote 73][footnote 74]

4.31 In a recent review published by Public Health England, it was found that adults who are Black, Asian or minority ethnic and who have underlying health conditions (such as Type 2 diabetes and hypertension), are more likely to experience adverse outcomes from COVID-19. For example, diabetes was mentioned in 21% of death certificates where COVID-19 was also mentioned. However, the proportion was significantly higher in all Black, Asian and minority ethnic groups (BAME) compared to White ethnic groups and was 43% in the Asian group and 45% in the Black group. Similar disparities were seen for hypertensive disease. BAME people who are obese, or who have underlying health conditions such as Type 2 diabetes and hypertension might therefore be particularly vulnerable to COVID-19.

Impact of advertising restrictions

4.32 The HFSS advert exposure data used by government to inform the 2019 consultation was not able to draw distinctions between levels of exposure by ethnicity. Therefore, we are unable at this point to ascertain whether children from different minority ethnic groups are more or less exposed to HFSS advertising.

4.33 Concerns were raised in the consultation that small minority ethnic channels may be negatively affected by loss of advertising revenue. Such may impact on the equality of opportunity in relation to race and fostering good relationships in relation to race.

4.34 In the 2019 consultation, the government proposed an exemption from the watershed for programmes or channels with low child audiences (channels with less than 1% of the child population (90,000 child viewers)). Channels would have to continue to abide by the current regulations around HFSS advertising in and adjacent to children’s programming. We considered this exemption as a way to mitigate the impact on smaller, specialist channels who may lose a valuable revenue stream. These channels tend to have lower total audience figures in general (and therefore fewer than 90,000 child viewers). However, the exemption was decided against because a child audience below 1% could potentially include a significant number of children still being exposed to HFSS advertising, which would undermine the policy intent. Therefore, we consider not including the 1% child audience exemption does not present a significant equalities issue. There were also a number of consultation responses that stated advertising restrictions would provide a beneficial effect regarding race as obesity is more prevalent in some ethnicities.

Conclusion

4.35 The policy is targeted at children from all ethnicities and is therefore expected to have a neutral to positive effect on all ethnic groups by reducing the prevalence of obesity and improving health outcomes. The policy is to be implemented in a way that does not differentiate by race. Therefore, we consider the policy will have a neutral to positive impact on consideration (a) and (c) of the Equality Act.

4.36 Although the policy is targeted at children, any positive impact on adults from this policy may be beneficial in reducing certain inequalities between ethnic groups relating to obesity prevalence and the risk of developing conditions associated with obesity such as type 2 diabetes and cardiovascular disease. Therefore, it could be seen to have positive implications with regards to consideration (b) of paragraph 1.3.

4.37 Overall, we consider the policy to have a neutral or positive impact with regards to race.

Religion and belief

4.38 There is no evidence to suggest that the proposed policy will have a negative impact on people who share this protected characteristic compared with people who do not share this protected characteristic. As outlined in paragraph 3.17, if cultural foods are classified in the policy as HFSS products, their advertising will be restricted on TV and online due to the nature of the products being high in sugar or calories. Therefore, we expect the policy to have a neutral impact with regards to religion and belief.

Sex

Obesity prevalence

4.39 There are differences in obesity prevalence depending on sex:

4.40 On average, compared with those with healthy body weights, overweight or obese children consume between 146 and 505 kcals more than they need per day for boys, and between 157 and 291 kcals per day for girls.[footnote 77]

4.41 The differences in obesity prevalence by sex have various underlying possible reasons. There is little data to identify the difference in girls’ and boys’ diets. National Diet and Nutrition Survey (NDNS) data, for example, cannot be reliably analysed by sex because of its small sample size and the persistent problem of under-reporting that is common to all diet diaries.

Impact of advertising restrictions

4.42 The HFSS advert exposure data used by the government to inform this consultation was not able to draw distinctions between levels of exposure by sex. A study that conducted content analysis of food advertisements shown during children’s TV programming revealed that healthy foods are associated with females while healthy activities are associated with males.[footnote 78] This study also went on to conclude sex differences that appeared in children’s responses to an advertisement for unhealthy food were due to a greater belief in males that HFSS products can aid in one’s physical abilities.

4.43 Extrapolating the findings from Ofcom’s 2019 adults’ media use and attitudes report,[footnote 79] it appears that sex plays a role in people’s media use. For example, the study found that women are 10% more likely to miss the use of smartphones than men.

4.44 Consultation feedback did not highlight sex as area of concern, regarding to advertising restrictions.

Conclusion

4.45 We have also considered the impact of the policy with regards to the 3 considerations in paragraph 1.3 and do not consider there to be an impact on any. The policy aims to reduce exposure of HFSS to both children of both sexes, and so we consider there to be a neutral impact with regards to sex overall.

Sexual orientation

4.46 We have considered the impact of the proposal on the protected characteristic of sexual orientation. We received no responses to either consultation flagging a potential impact on people living with this protected characteristic. We therefore expect the policy to have a neutral impact with regards to sexual orientation.

Marriage and civil partnership

4.47 We have considered the impact of the proposal on the protected characteristic of marriage and civil partnerships. There is no reason to believe that the proposed policy will have any impact on people who share this protected characteristic compared with people who do not. We received no responses to ether consultation flagging any potential impact on people living with this protected characteristic. Therefore, we expect the policy to have a neutral impact with regards to marriage and civil partnership.

5. Summary of the effects of the policy on people with protected characteristics

Age

5.1 Age: neutral or positive. Maintenance of a lower weight is beneficial across lifespan. However, children may be uniquely vulnerable to the techniques used in advertising and therefore may benefit more from this policy intervention. It is also likely that if healthy eating habits are established in childhood, these will continue into adolescence and adulthood.

Disability

5.2 Disability: neutral or positive. There is a link between obesity and disability. Reducing obesity is likely to result in health benefits for people with this protected characteristic.

Gender reassignment

5.3 Gender reassignment: neutral. We do not believe the proposed policy will have any impact on people who share this protected characteristic compared with people who do not.

Pregnancy and maternity

5.4 Pregnancy and maternity: neutral or positive. There is a link between obesity and pregnancy/maternity and risks to health. The policy does not specifically target women at childbearing age. However, reducing obesity results in health benefits for people with this protected characteristic.

Race

5.5 Race: neutral or positive. Some ethnic groups have a higher prevalence of obesity and encounter health complications at a lower BMI than others. Therefore, there is the potential for this group to benefit more from this policy intervention over time. However, the policy does not specifically target children of any ethnicity. Moreover, as the cause for the differences in prevalence as measured against ethnicity are difficult to measure, we are unable to accurately predict to what extent any ethnic minority group may benefit from the policies.

Religion and belief

5.6 Religion and belief: neutral. We do not believe the proposed policy will have any impact on people who share this protected characteristic compared with people who do not.

Sex

5.7 Sex: neutral. The HFSS advertising exposure data used by government to inform this consultation was not able to draw distinctions between levels of exposure by sex. Statistics show that obesity prevalence differs by sex. The policy aims to reduce exposure of HFSS to both children of both sexes, and so we consider there to be a neutral impact with regards to sex overall

Sexual orientation

5.8 Sexual orientation: neutral. We do not believe the proposed policy will have any impact on people who share this protected characteristic compared with people who do not.

Marriage and civil partnership

5.9 Marriage and civil partnership: neutral. We do not believe the proposed policy will have any impact on people who share this protected characteristic compared with people who do not.

 

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