A healthier future: Scotland's diet and healthy weight delivery plan

The Challenge

The impacts of poor diet and overweight are profound. They affect not only our health, but also our ability to lead happy, fulfilling lives. They have also led to increased, unsustainable demand on the NHS and other public services.

The Scottish diet remains stubbornly unhealthy, and we are far from meeting our dietary goals ^[1] . This has a direct impact on levels of overweight and obesity - and therefore health harm – in the population.

These problems start early. Overall, children in Scotland tend to consume foods and drinks high in fat and/or sugar more often than adults ^[2] – an alarming finding that indicates future health problems in store. In Scotland, the rates of overweight and obesity for both children and adults are among the highest in the developed world. The 2016 Scottish Health Survey estimates that 29% of children are at risk of being overweight (including at risk of obesity) – of which approximately half (14%) are at risk of obesity specifically. ^[3]

Source: Public Health Priorities

Being overweight or obese is now the norm for Scottish adults. Two-thirds (65%) of adults are now overweight, with almost one-third (29%) obese. ^[4]

Scottish Health Survey 2016: Obesity

Source: Scottish Health Survey 2016

The health harms associated with carrying excess weight are severe. Obesity is the second-biggest preventable cause of cancer, behind only smoking, and is linked to around 2,200 cases of cancer a year in Scotland. ^[5] Being overweight and obese is also the most significant risk factor for developing type 2 diabetes, ^[6] and can result in increased risk of other conditions including cardiovascular disease and hypertension. ^[7]

Poor diet and weight often also go hand in hand with other risk factors such as low physical activity, smoking and harmful drinking – compounding health harms. ^[8]

Obesity Harms Health

Source: Public Health England

We know that people who live in more deprived areas tend to be most impacted. Significant inequalities in levels of obesity persist between people living in the least and most deprived groups in Scotland – and the gap may be widening for children. ^[9] Overall, around 32% of adults living in the most deprived areas are obese, compared with 20% of those living in the least deprived areas. ^[10]

As well as health impacts, there are significant socioeconomic implications. The annual cost of treating conditions associated with being overweight and obese is estimated to range from £363 million to £600 million. The total annual cost to the Scottish economy of overweight and obesity, including labour market related costs such as lost productivity, is estimated to be between £0.9 billion and £4.6 billion. ^[11]

Source: Public Health Priorities

This situation is not sustainable for either the health of the nation or the health service. It is much better for the individual, society and the health service to seek to prevent ill-health occurring in the first place.

Public opinion backs action. Nearly 70% of people believe that obesity harms Scotland either 'a great deal' or 'quite a lot'. ^[12] The majority of people in Scotland are also in favour of at least one intervention to place restrictions on advertising, sponsorship and packaging of food and drink high in fat, sugar or salt. ^[13]

To make a meaningful impact, we need to tackle the factors that encourage us to make unhealthy choices. Food and drink high in fat, sugar or salt is widely available, and heavily promoted – in fact, UK consumer expenditure on price promotions is the highest in Europe. ^[14] Evidence suggests that, overall, the food and drink provided out of home is skewed towards less healthy options. ^[15]

It's clear our plans to tackle the Scottish diet need to be ambitious and decisive.

Our Vision and Approach

Our vision

A problem of this scale must be met with an equally ambitious aim, and our vision is for a Scotland where everyone eats well and has a healthy weight. Recognising the specific need to tackle weight-related issues at an early stage, this delivery plan also has an ambition to halve child obesity in Scotland by 2030. We are also aiming to significantly reduce health inequalities.

Outcomes

This vision will be achieved by working towards five key outcomes:

• Children have the best start in life - they eat well and have a healthy weight
• The food environment supports healthier choices
• People have access to effective weight management services
• Leaders across all sectors promote healthy weight and diet
• Diet-related health inequalities are reduced

Our approach and principles

In developing this plan, we have listened to a wide range of views: over 360 stakeholders and individuals responded to our 2017 consultation ( A Healthier Future – Action and Ambitions on Diet, Activity and Healthy Weight) and over 630 people attended our engagement events. There was broad consensus, if not on every proposal, that overweight and obesity are significant and serious public health problems that require ambitious action.

The actions set out in this document are informed by and form the Scottish Government's response to that consultation.

Additionally they are set in the context of the UK Government's Childhood obesity: a plan for action Chapter 2 published on 25 June. Most of the measures included in the plan are specific to England. The Scottish Government welcomes the actions being taken at a UK-level, which complement the actions outlined in this delivery plan.

Our overall approach is underpinned by the public health reform principles to which we and COSLA have committed. ^[16] And we will encourage our partners and those working with us across Scotland to reflect similar principles in all that they do. It is also shaped by the following cross-cutting principles:

Evidence-based interventions

We are committed to policy and action which is grounded in the evidence. This means we will continue to evaluate our actions and their impact. We will consider the case for additional measures, where the evidence supports this.

Population-wide measures

The main focus of this delivery plan is the implementation of population-wide interventions to change the environment, which will impact everyone in Scotland - learning from the experience of successful public health policies, such as the ban on smoking in public places. Evidence suggests that population-wide interventions are likely to be more effective in reducing inequalities as they do not rely on individual behaviour change. ^[17]

Targeted measures

Sitting alongside our population-wide approach, is delivery of targeted and tailored support specifically to those children and families who are most at risk.

Reducing inequalities

A key outcome of this delivery plan is to reduce diet-related health inequalities, taking a human rights based approach to ensure that we are supporting those most in need. It is crucial too that our stakeholders and delivery partners place a special emphasis on reducing inequalities when planning, designing and delivering interventions – including through the co-design of services and support where possible.

Joined up policy

Recognising that the causes of overweight and obesity are complex, multi-faceted and shaped by a broad range of factors, our plan for improving diet and weight sits alongside a wide range of government policy and action. It is one of five linked public health strategies being published this year for Alcohol Prevention, Substance Use, Tobacco Control, and Physical Activity. In particular, physical activity has an important role in weight management, and this delivery plan should be read alongside the forthcoming: A More Active Scotland: Scotland's Physical Activity Delivery Plan.

Beyond public health, we also seek coherence across a range of other policies and areas. These include action on welfare reform and child poverty. This delivery plan also aligns to our ambitions for Scotland as a Good Food Nation, and well-established frameworks for improving children and young people's outcomes. The Maternal and Infant Nutrition Framework; Getting it right for every child; Better Eating, Better Learning; Curriculum for Excellence, with its strong focus on health and wellbeing, and proposed changes to school food regulations, are all essential scaffolding for ensuring continuity of support to children, young people and their families across all ages and stages.

Cross-sector leadership

Ambitions and actions on this scale cannot be taken forward by government alone. Tackling obesity is a shared responsibility, and central to the success of this plan will therefore be leadership, collaboration and commitment across the public, private, third and community sectors.

The actions in this plan set out how we hope to achieve our vision.