A Healthier Future: analysis of consultation responses

11. Making obesity a priority for everyone (Qs 11-12)

11.1 The consultation paper described a range of actions for making obesity a priority for everyone and for building a ‘whole nation movement’. The actions covered (i) creating a network of local government and health leaders to enhance and share their improvement work on weight and diet; (ii) developing plans to further support the health and wellbeing of Scottish Government staff and encouraging others to commit to action; (iii) ensuring that health and environmental sustainability are key considerations in the public procurement of food; (iv) expanding the Healthy Living Award to publically funded catering locations which do not currently offer customers a mark of health; (v) exploring opportunities to extend Healthcare Retail Standard criteria beyond the NHS; and (vi) renewing the commitment to community food initiatives.

11.2 The paper asked respondents about these proposals.

Question 11: What do you think about the action we propose for making obesity a priority for everyone?

Question 12: How can we build a whole nation movement?

11.3 Altogether, 283 respondents (134 organisations and 149 individuals) provided comments in response to Question 11 and 263 respondents (119 organisations and 144 individuals) provided comments in response to Question 12. For organisational respondents, whether or not a comment was provided varied by organisational type. In particular, a smaller proportion of private sector and business organisations commented, as compared to public health and third sector organisations.

11.4 There was broad support for the idea that ‘everyone should be involved’ in the effort to reduce obesity, and there was agreement that tackling obesity would require effective collaboration between the private, public and voluntary sectors. The only caveat was that there was a possibility that by making obesity ‘everyone’s problem’, it could become ‘no-one’s problem’. Thus it would be important to be very clear about what exactly the strategy / approach involved, and who had lead responsibility in relation to the delivery of individual elements.

11.5 Reducing obesity and promoting healthy eating and active living was described as a long-term agenda involving major cultural change. It would require sustained investment, political will, ‘joined up’ thinking (and specifically more joined up thinking than was currently the case), and leadership at all levels over a substantial period of time. However, as discussed elsewhere in this report ( Chapter 8), respondents repeatedly commented that it was important that any strategy that was developed should not be simply an obesity strategy.

11.6 In their comments respondents focused on (i) leadership and exemplary practice, (ii) the workplace environment, (iii) environmental sustainability, (iv) community food initiatives, and (v) learning from elsewhere. Each of these areas is discussed below.

Leadership and exemplary practice

11.7 There was discussion about the importance of leadership across all sectors and at all levels and the point was repeatedly made about the importance of ‘leading by example’. Respondents characterised this leadership in different ways as (i) national, local, and community levels or (ii) political, organisational and grassroots. Partnership bodies, and third sector organisations focused more on the importance of leadership at ‘grassroots’ or community level, while those in professional or representative bodies were more concerned with (national) strategic leadership – at least in the first instance.

11.8 Respondents from all groups thought it was vital that hospitals, schools, care homes, prisons and other public sector locations provided nutritious food. Individuals who commented on current provision in hospitals criticised the vending machines selling unhealthy foods and the ‘substandard frozen meals’. The provision of food in schools (including school meals) was also criticised. However, it should also be noted that respondents wished that more pupils actually took advantage of the availability of school meals, rather than going outside the school for their food at lunchtime.

11.9 As far as the Healthy Living Award was concerned, respondents who commented were supportive of the idea to expand this to other publically funded catering locations. However, they also thought the impact of the award should be evaluated and that the criteria for the award should be strengthened / made more stretching.

11.10 Only a few respondents discussed the broader adoption of the Healthcare Retail Standard beyond the NHS to other retail settings operating in publicly funded locations. While individual, academic, public health and public sector respondents supported this extension (subject only to an evaluation of its impact to-date), respondents from the food and drink industry argued that this would not be appropriate. The rationale for not supporting wider introduction related to the intense support required to introduce it, the (perceived) lack of capacity for that support, the severity of the restrictions, and the potential impacts on businesses which are (they argued) already providing consumers with healthier items and more information to support healthy choices.

11.11 Finally, there was a predominant view that it was difficult for staff within the NHS to ‘lead by example’ (including raising the topic of weight management with patients) if they themselves were overweight or obese. However, there were also occasional comments to the effect that overweight or obese individuals found it ‘easier to relate’ to nurses and other healthcare professionals who themselves had problems with their weight.

The workplace environment

11.12 Respondents commented on the importance of the workplace environment, especially in relation to offering support to employees to develop healthier lifestyles. The general view was that employers should ensure that employees are able to have a good work-life balance, including proper breaks during the working day, flexible working arrangements, and opportunities in relation to improved physical activity. (Issues relating to workplace initiatives to encourage physical activity in are discussed in detail in Annex 6.) A range of organisational respondents across diverse sectors also described their own approaches to supporting their employees’ health.

11.13 It was noted that the NHS has committed to support healthy eating, physical activity and weight management for all NHS staff through the Health Promoting Health Service ( HPHS) initiative. Respondents queried why the HPHS was not mentioned in the consultation document

Environmental sustainability

11.14 Health and environmental sustainability were mentioned by respondents particularly in relation to (i) public sector procurement where it was thought commitments to sustainability made in other policy initiatives (e.g. Good Food Nation) should be implemented; (ii) the adoption of sustainable diets (vegan diet, vegetarian diets and plant-based diets were particularly mentioned); and (iii) increasing awareness among both consumers and producers of the importance of adopting sustainable practices within the food industry.

Community food initiatives

11.15 There was widespread support for increased investment in community food initiatives including community gardens. These were thought to be very important in educating people about food and in providing a context for people to work and undertake practical tasks together, thus supporting social interaction and wellbeing. Many specific examples of successful community food initiatives which involved food growing, nutritional education, and the development of cooking skills were offered. The point was made that such initiatives were often operating in communities where food budgets were very constrained.

Learning from elsewhere

11.16 The approaches adopted to address Scotland’s unhealthy relationship with alcohol and in relation to tobacco control were frequently mentioned as models for developing an approach on obesity.

11.17 Respondents also pointed to successful initiatives from further afield where there had been a sustained and integrated effort to tackle obesity. Annex 7 provides specific examples in relation to the Oklahoma Weight Loss Initiative, the French VIF initiative, and the Amsterdam Healthy Weight Programme, among others. Respondents who provided these examples gave substantial accounts of what had been done and what had been achieved.

Other points

11.18 Other relevant points were that:

• There were many areas in which respondents were keen to see increased (financial) support. These included: (national) public campaigns, documentaries and broadcasts; marketing campaigns for healthy food; promotion of healthy eating and active living; training of more public health practitioners, dieticians, applied psychologists / health psychologists, community workers; the development of new roles in obesity leadership; and more investment in public infrastructure, especially transport and active travel infrastructure.
• Respondents, especially individuals and those from partnership bodies and third sector organisations focused on the importance of the approach being accessible to everyone, especially those in difficult financial circumstances; they sometimes framed these comments as taking a ‘rights based approach’. These respondents focused on the importance of ensuring that healthy food was available at a reasonable price, and also that opportunities to get involved with physical activity and exercise were freely available to all. It was suggested that more consideration needed to be given to the infrastructure which was required to promote, encourage and facilitate wide participation.
• It was vital that health inequalities were not increased as an unintended consequence of the efforts to tackle obesity; this would mean ensuring there was a strong focus on actions to deal with the obesogenic environment and the social determinants of health.