Chapter 22.
The UK faces a health crisis characterised by interconnected challenges spanning every life stage—from escalating diet-related illnesses and health inequalities in children to malnutrition in older adults and the impact of lifestyle choices on working adults. Addressing this demands a proactive, holistic strategy focused on nutrition and food education. Japan’s “shokuiku” philosophy offers a model that could transform the UK’s approach to well-being, productivity, and quality of life.
The current health landscape reveals a complex web of challenges. Childhood obesity is a concern, with a substantial proportion of children classified as overweight or obese, and these figures are often higher in areas of socioeconomic deprivation. These early dietary issues can have lasting consequences, predisposing individuals to a range of chronic diseases and placing a burden on the National Health Service (NHS). Among working adults, sedentary lifestyles and poor dietary choices contribute to rising rates of obesity, type 2 diabetes, and cardiovascular disease. Malnutrition is a problem among older adults in the UK, particularly in hospital or care settings, where factors like loss of appetite, social isolation, and limited access to nutritious food can lead to frailty and increased hospital admissions. Health inequalities linked to socioeconomic status persist across all age groups, with disparities in access to affordable, nutritious food and effective health education.
Addressing these challenges requires a holistic, cradle-to-grave strategy that places a strong emphasis on nutrition and food literacy. The principles that underpin Japan’s success—nutritionally balanced meals, integrated food education, a focus on local sourcing, and a deep respect for food—offer a framework for transforming the UK’s approach to health. In schools, where lifelong habits are formed, implementing a system that provides universal, high-quality school meals is paramount. This would need a shift towards healthy menus prepared from fresh, minimally processed ingredients, and a reduction in the reliance on packed lunches, which often lack essential nutrients. Integrating food and nutrition education, or “shokuiku,” into the core curriculum across schools is also important. This would empower children with practical cooking skills and a thorough understanding of healthy eating principles.
Beyond the school gates, hospitals present another setting for promoting health. While hospital food in the UK has faced criticism, nutrition plays a vital role in patient recovery. Japan’s emphasis on restorative and carefully prepared meals offers a lesson in this regard. Hospital menus should be designed by dietitians to support patient recovery, prioritising fresh ingredients and appealing presentation. Creating a dignified and supportive mealtime environment in hospitals is also important. Hospitals can serve as centres for nutrition education, providing patients and their families with practical advice on healthy eating for their specific conditions. The workplace is another key environment that influences adult health. Sedentary jobs and the availability of unhealthy food can contribute to poor dietary habits. To address this, workplaces should prioritise high-quality, affordable, and nutritionally balanced canteen meals and healthy vending machine options. Governments can also play a role by providing incentives for businesses that promote healthy eating environments.
The home environment is where lifelong habits are truly established, and fostering a culture of healthy eating within families is essential for long-term health. Japan’s “shokuiku” philosophy extends to families, encouraging a cultural reverence for food preparation and shared meals. In the UK, a multifaceted approach is needed to empower families and promote a healthier food culture. This includes widespread food literacy initiatives for adults, providing accessible cooking classes in communities and public health campaigns that provide evidence-based dietary advice.
Individual choices are central to health. A growing body of evidence highlights the detrimental impact of ultra-processed foods (UPFs) on health. UPFs, which are industrial formulations made with ingredients not typically used in home cooking, are often high in calories, unhealthy fats, sugar, and salt, and low in essential nutrients. A study by King’s College London for BBC Panorama provided a stark illustration of the potential harm of UPFs. In this study, 24-year-old identical twins, Aimee and Nancy, followed different diets for two weeks. Aimee, who consumed a diet high in UPFs, experienced several negative health outcomes, including weight gain and worsened blood sugar levels. In contrast, Nancy lost weight on a diet of raw or minimally processed foods. Professor Tim Spector, who oversaw the study, highlighted that evidence has been accumulating over the past decade, linking UPF consumption to an increased risk of various health problems, including cancers, heart disease, strokes, and dementia. The UK has one of the highest rates of UPF consumption in Europe, and this is paralleled by increasing rates of diet-related diseases. These findings reinforce the need for individuals to make a conscious shift away from ultra-processed foods and towards a diet based on whole, minimally processed ingredients. Promoting a return to home cooking, using fresh, seasonal ingredients, and fostering the tradition of shared family meals can improve dietary quality. Beyond the direct physical consequences, ill-health can disempower individuals in all aspects of their lives, limiting their ability to work, pursue education, and participate in social and civic life.
This shift towards whole, minimally processed ingredients is strongly supported by UK-specific data that highlights the benefits of plant-based whole foods on health. Research from organisations such as the British Nutrition Foundation and Public Health England consistently advocates for diets rich in fruits, vegetables, whole grains, and legumes. The Eatwell Guide, the UK government’s healthy eating model, emphasises a high proportion of plant-based foods, recommending that fruits, vegetables, and starchy carbohydrates make up over two-thirds of the food we eat. Studies from the University of Oxford have shown that vegetarians and vegans in the UK typically have lower BMI, serum LDL cholesterol, and blood pressure than comparable regular meat-eaters, which translates to a lower risk of heart disease, diabetes, and other diseases.
Analysis by the Office of Health Economics suggests that widespread adoption of plant-based diets in England could save the NHS around £6.7 billion per year, with 2.1 million fewer cases of disease. The Vegan Society also points to evidence that well-planned plant-based diets contribute to lower rates of obesity and improved cardiovascular health among Brits. The NHS itself promotes a balanced diet with a strong emphasis on plant-based foods.
Socioeconomic factors create challenges in the pursuit of a healthy life. Poverty, food deserts, and a lack of access to healthcare can create barriers. The stress of financial insecurity and limited access to nutritious food can lead to both physical and mental health issues, making it difficult for individuals and communities to maintain healthy lifestyles. The influence of the food industry also poses a challenge to the promotion of healthy eating. A recent investigation revealed that the UK government dropped key guidance urging retailers to offer promotions on minimally processed foods after lobbying by major ultra-processed food companies, such as Nestlé and Unilever. This highlights the influence of the food industry on government policy and its potential to undermine efforts to promote healthier diets. However, several organisations are actively campaigning to counter this influence, such as the Soil Association, Obesity Health Alliance, and Action on Sugar. Addressing issues of food affordability and accessibility is also important, ensuring nutritious food is affordable and accessible to all households through support for local food markets and community gardens.
It is also important to recognise the role that doctors and other healthcare professionals play in shaping public health. Studies have consistently shown that medical students receive a limited number of hours of dedicated nutrition training, despite the link between diet and the rising rates of chronic diseases. This gap in knowledge can lead to missed opportunities for preventative care and an over-reliance on pharmacological solutions. To bridge this gap, a concerted effort is needed to embed comprehensive nutrition education into both undergraduate and postgraduate medical training. This includes increasing the mandatory hours dedicated to nutrition science and providing practical skills for future doctors.
To transform the health of the nation, the UK needs to embrace a national vision, one that transcends departmental silos and fosters collaboration across government agencies, healthcare institutions, and community organisations. This requires a long-term commitment to sustained investment in initiatives that promote healthy eating. A significant expansion of roles for nutrition professionals is vital for providing expert guidance and ensuring the effective implementation of evidence-based strategies. Large-scale public engagement campaigns, similar to Japan’s “Shokuiku” month, could help to raise awareness about the importance of food, nutrition, and healthy lifestyles. By learning from Japan’s comprehensive approach, the UK can move beyond a reactive healthcare system towards a proactive, preventative model that nurtures well-being and resilience from childhood through to old age.
Next Chapter: Repentant: The Power of Self Honesty
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