A Healthier Future: analysis of consultation responses

8. Healthy weight from birth to adulthood (Q7)

8.1 The consultation paper discussed proposals to give families and children the support they need to develop a healthy and positive relationship with food. Respondents were asked if they thought that any further or different action was required.

Question 7: Do you think any further or different action is required to support a healthy weight from birth to adulthood?

8.2 Altogether, 294 respondents (144 organisations and 150 individuals) commented at Question 7. These comments were wide-ranging, with some respondents discussing high-level issues in relation to policy and strategy development; others expressing views about service delivery; and still others making detailed suggestions about the development and targeting of specific kinds of interventions. This chapter focuses on respondents’ comments relating to high-level, policy / strategy issues. A summary of views in relation to service delivery and targeted interventions is provided at Annex 5.

8.3 Comments on policy and strategy development primarily came from public health and third sector organisations (e.g. local authorities and partnership bodies, NHS organisations, public health professional groups) and private sector weight management organisations. The main themes in respondents’ comments related to (i) addressing inequalities, (ii) addressing the obesogenic environment, (iii) the focus and framing of the strategy, (iv) ensuring joined up policy in this area, (v) workforce development, and (vi) funding. Each of these themes is discussed below.

8.4 Private sector / business respondents were less likely to provide comments in response to this question. Those who did often raised entirely different issues to those above. These comments are summarised briefly at the end of this chapter.

Need to address inequalities

8.5 Respondents repeatedly highlighted the link between deprivation and obesity. They emphasised that any strategic plan in this area must demonstrate an understanding of the influence of poverty on diet, and clearly articulate the implications of this. In particular, respondents were concerned that actions targeted at individual behaviour change have the potential to widen health inequalities, rather than reduce them.

8.6 Those affected would include not only people living on very low incomes, but a range of other vulnerable groups (e.g. people with mental health problems, people with learning disabilities, children in care, older people, people with physical disabilities, and people from black and minority ethnic communities). It was suggested that initiatives would need to be tailored to each of these groups.

8.7 Some respondents also discussed issues of food poverty (and food insecurity). On the one hand, there was a view that steps must be taken to reduce the need for people to use foodbanks. At the same time, others thought that the consultation paper should have included actions to improve the standard of food donated to food banks, much of which (it was noted) is processed, poor quality food high in fat, sugar and salt.

8.8 Respondents also called for strategy in this area to be framed in terms of human rights (and child rights in particular) – as they thought that having the strategy framed in this way would help to reduce inequalities, while also giving a legal and moral impetus to public health initiatives aimed at addressing poor diets.

Focus on changing the obesogenic environment

8.9 Related to the issue of addressing inequalities, there was a widespread view that any strategy to improve diet and tackle overweight should focus much more clearly on ‘upstream’ interventions to address the wider determinants of health. This would include, for example, the use of taxes to increase the cost of ‘unhealthy’ food and the use of subsidies to decrease the cost of (for example) fruit and vegetables. There was a view that the consultation paper should also have referred to recommendations from World Health Organisation ( WHO) Commission on Ending Childhood Obesity ( ECHO) (2016) and the ECHO Implementation Report (2017) in particular.

8.10 While the dominant view was that (reducing) obesity should be seen as a societal issue, with action taken at business and government levels, a small number of respondents highlighted issues relating to personal choice and responsibility. These respondents suggested that the focus of any strategy should be on communicating to the public about the health risks of obesity and on encouraging healthy choices.

Focus and framing of the strategy

8.11 There was virtually unanimous agreement that obesity was a serious problem in Scotland, which needed to be addressed. However, respondents repeatedly commented that any strategy that was developed should not focus solely on reducing obesity; rather the strategy should be more ‘holistic’, and directed towards improving health and wellbeing more generally. This meant that the strategy should include actions not just on weight, diet and nutrition, but on physical activity too.

8.12 Moreover, respondents often highlighted the importance of framing any actions to address diet, activity and weight in positive terms (i.e. achieving a healthy weight), rather than in negative terms (i.e. tackling obesity). These respondents emphasised the need to reduce weight-related stigma (‘fat shaming’) and to change the current culture where individuals were often ‘blamed’ for their obesity. They thought that reducing stigma would encourage people to engage positively with initiatives, and would also help to prevent dangerous negative responses (i.e. eating disorders). Such comments were often linked to views about the need to acknowledge the emotional relationships that people have with food, and the importance of providing psychological support within weight management programmes.

8.13 Related to these issues, participants in the ScotPHN engagement exercises thought the issue of weight-related stigma – and its effects on children and young people, in particular – should be considered more prominently in a strategy to promote a healthy diet. This group thought that ‘more needs to be done in relation to social media and the pressure on teenagers’ regarding inappropriate body images. The engagement exercises carried out by the Scottish Youth Parliament and Young Scot also highlighted this as an important issue for young people. It was noted that ‘a lot of people get unhealthy in their attempt to achieve a certain image’.

Need for joined up policy

8.14 Respondents called for more joined up policy on the issue of diet and weight. They noted that any policy to tackle overweight must link closely to policies on housing, transport, active travel, greenspace, education, child poverty, mental health, and other related health policies and implementation plans. They also highlighted the importance of linking to economic policy (in terms of taxes, subsidies, economic growth, etc.) and employment policies (in terms of flexible working and improving work / life balance). In addition, respondents wanted to see a clear connection to Scotland’s Good Food Nation policy.

8.15 Given the recurring views that the issue of ‘healthy diet’ is a cross-policy concern, some respondents also cautioned against framing obesity as an ‘ NHS issue’. There were views that the second half of the consultation paper, in particular, was too NHS focused.

Workforce development

8.16 Respondents identified a wide range of community-based professionals who should have a role in supporting work in this area (e.g. midwives, health visitors, nursery staff, general practitioners and other primary care staff, teachers, social workers, care workers, etc.). They pointed to a need to skill up these staff and give them the confidence to be able to sensitively and effectively engage people in conversations about their weight and behaviour change.

8.17 Some respondents noted the specialist expertise available from dieticians and nutritionists, but noted that these posts were not well resourced and the availability of such staff was variable across Scotland. Other respondents referred to the considerable expertise and experience available from third sector partners.

Funding

8.18 While respondents acknowledged and welcomed the commitment to additional funding for weight management programmes (see Chapter 9 for a discussion of this), they also highlighted a wide range of other areas where additional funding was required – including funding for dieticians, home economics teachers and community-based food initiatives. (See Annex 5 for details.) Respondents saw any strategy to address diet as a long-term strategy, and thus argued that long-term funding would be required.

Views of private sector and business respondents

8.19 As noted in paragraph 8.4 above, private sector respondents in the food and drink industry were less likely than others to offer views in relation to this question. This group of respondents expressed their support for the proposals to provide a greater focus on food, nutrition and physical exercise within the school curriculum, and they generally highlighted the importance of educating consumers to make more informed choices about the foods they eat. Some also highlighted their work in supporting community initiatives (i.e. through sponsorship of local sports teams, through involvement in the ‘Eat Better, Feel Better’ campaign, and through disbursements to communities of funds raised through the plastic bag levy).