A Healthier Future: analysis of consultation responses

Annex 5: Action to support healthy weight from birth to adulthood

Question 7 asked respondents for their views about what further or different action is required to support a healthy weight from birth to adulthood. Responses to this question covered a very wide range of issues. Chapter 8 discusses respondents’ comments in relation to high-level policy and strategy development. This annex covers the more detailed suggestions respondents made in relation to service development and targeted interventions.

These comments generally focused on children, young people and families. There was little comment on actions needed to support healthy weight in adulthood – except to say that the strategy should include a focus on the nutritional needs of older people. However, there was a great deal of discussion about the importance of community based initiatives (see below), many of which work with adults.

Early years

Respondents highlighted the importance of the first 1000 days of a child’s life (from conception to age 2) for laying the foundation for the child’s future eating habits. Respondents cited evidence demonstrating the links between mother’s weight and the child’s future development of obesity, and there was much comment about the need for more and better pre-natal / ante-natal support and education for women, and interventions aimed at helping women to achieve a healthy weight before they get pregnant and throughout their pregnancy. (However, the challenges of this were also noted, since many pregnancies are not planned.)

There was also considerable discussion about the importance and health benefits of breastfeeding. Respondents repeatedly noted that the UK has among the lowest rates of breastfeeding in the world, and they thought any strategy to address diet must address this issue in a much more focused way. Respondents wanted to see more breastfeeding support available to new mothers, and they also wanted to see joined up policies (in relation to maternity leave and flexible working).

At the same time, some respondents also thought there should also be support for women who do not breastfeed (who are more likely to be women living on low incomes and in areas of deprivation) and those who cannot breastfeed.

There were also calls for greater support for weaning and for steps to be taken to ensure that nurseries are providing nutritious meals to pre-school children.

Finally, some respondents commented on existing national initiatives targeted at mothers and infants. In particular, they welcomed the reform of the devolved Healthy Start Scheme, and wanted efforts to be made to maximise uptake of the scheme (it was noted that existing processes and administration of the scheme make it difficult and cumbersome for some families to engage). Some also called for links to be made to the Maternal and Infant Nutrition ( MIN) strategy and framework, suggesting that work to address healthy diet should also include more focussed work to monitor, review and develop the work of the MIN framework.

Primary school years

In relation to the primary school years, it was common for respondents to call for an increase in the availability of free school meals. Respondents noted that there is a great deal of variability in the quality of school meals across Scotland, and they wanted to see improved regulation of school meals. Some thought that free school meals should also be made available during school holidays and the summer recess period, particularly in the most deprived communities of Scotland.

Other respondents (often individual respondents) focused more on making free milk and / or fruit and vegetables available in all schools, or on banning certain types of foods from schools (soft drinks, sweets, snacks), including in packed lunches and other items brought from home.

Respondents also advocated: (i) the reintroduction of health checks and the Child Healthy Weight Scheme; (ii) ensuring that the Curriculum for Excellence focuses more on food and nutrition; and (iii) encouraging more ‘family style eating’ at schools (both primary and secondary).

Secondary school years / adolescence

The two main issues raised in relation to the adolescent years were (i) the importance of providing practical skills to young people (i.e. in relation to cooking, developing a menu and budgeting) and (ii) the importance of restricting the accessibility of ‘junk food’ outlets (burger vans, tuck shops, fast food outlets) around schools.

In relation to the first point, there were frequent calls to address the chronic shortage of home economics teachers in Scottish secondary schools. Respondents also advocated making home economics compulsory for all children (some specified up to age 15). It was suggested that ‘no child of either sex should leave school without being able to cook a decent meal’.

It was also suggested all schools (both primary and secondary) should have space to grow food. Some respondents noted that new secondary schools, in particular, are being built with no green space around the school. Finally, there were calls for school kitchens to be opened up as a community resource for cookery classes.

Among the young people who took part in the Scottish Youth Parliament engagement exercise, there was general agreement that schools had an important role to play in providing ‘effective home economics classes’. This group did not necessarily think that home economics should be compulsory, but they did feel that schools could provide more practical education in relation to shopping for food, budgeting and making healthy meals. They also suggested that Personal and Social Education ( PSE) classes could be used to promote healthy eating.

Some of the young people participating in this engagement exercise also expressed the view that schools are not able to explore making other types of food because ‘it is cheaper and the ingredients for scones / fairy cakes last longer’. It was also noted that participation in home economics classes (at least in some areas) can be expensive for the families of young people, as ‘pupils have to provide the vegetables if they want to make a meal and they have to pay £10 a term’. This effectively limits access to these courses among young people from disadvantaged families.

It was common for consultation respondents to argue that greater efforts should focus on restricting young people’s access to out of school food. However, young people participating the Scottish Youth Parliament engagement exercise had quite a different perspective on this. This group highlighted that ‘going to the shop at break time and lunchtime is cheaper than eating school meals’. Some also commented on the portion sizes of school meals (not large enough), the presentation of school food (‘a salad bowl covered in cling film’), and the lack of choice (‘no fruit available in the school canteen’). This group believed that there was a ‘gap in the market for healthy fast food’ among food outlets near schools.

Community initiatives

Some respondents commented that there was a great deal of excellent work going on in communities, led by grassroots organisations. Respondents particularly mentioned ‘family initiatives’ including cookery classes, community gardens, local food networks, family activity days, etc.

This group of respondents expressed disappointment that there was little recognition in the consultation paper of the work being undertaken by the community and voluntary sector in this area. The point was made that community organisations are often better placed than public sector agencies to engage with and provide tailored support to people in deprived communities – with evidence of successful initiatives cited. These respondents called for partnerships to be established with third sector / community partners, and they highlighted the need for more secure and longer-term funding streams to support these organisations.

The importance of physical activity

There was much discussion about the importance of promoting / encouraging physical activity. Respondents called for infrastructure developments and planning decisions to prioritise outdoor activity and outdoor play; active travel (including the development of footpaths and cycle networks); ‘social prescribing’ of gym memberships; and initiatives to encourage children to walk to school. Chapter 10 and Annex 5 discuss respondents’ views on the subject of physical activity in more depth.