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

Outcome 1: Children have the best start in life - they eat well and have a healthy weight

Halving childhood obesity in Scotland by 2030 is a deliberately bold ambition. With nearly three in ten children in Scotland at risk of being overweight or obese, aiming high is not just desirable, it is also necessary if children and young people are to flourish and lead happy, healthier lives.

We also know that early childhood – and, in fact, what happens before children are born – is a critical time for establishing good nutrition and healthy eating habits. If we can achieve this, the likelihood of children becoming overweight or obese in later life is significantly reduced.

Many people are involved in a child's life – including midwives, health visitors, family nurses, GPs, teachers and school nurses - so it is important they are armed with the knowledge and skills to talk about diet and weight to support children and their families to make healthier choices. We also recognise that all environments where children live, learn and play have an enormous influence on what they eat. That includes not just their home but also early years and childcare settings, schools, shops and retail premises beyond the school gates, and the wider community. That is why actions right across this plan, not just those outlined below, will contribute to achieving our ambition for halving childhood obesity.

But fundamentally, we want to ensure parents and carers are supported to make informed decisions, whether it's about breastfeeding and weaning, nutrition, portion size or mealtime behaviours. And should their child's weight become a concern, we want parents to understand why it matters, and to feel supported – not judged - with good advice and services (see outcome 3).

Adolescence is a particularly important stage in a young person's life when they start to make more decisions for themselves and are open to many different influences. The transition to adulthood can be a challenging time, with diet and weight among a wide range of factors affecting their health and happiness. We therefore want to give this specific attention, so that young people feel empowered and supported to make healthy choices.

Healthy diet and weight before and during pregnancy

The Scottish Government is determined that every child, regardless of their circumstances, should get the best start in life. We want more women and their partners, where pregnancy is planned, to feel supported to take steps for a healthier pregnancy prior to conception.

Action 1.1 By summer 2019, the Scottish Government will consult on a pre-conception action plan to improve how services engage, inform and support women before they become pregnant to start their pregnancy at a healthy weight, and in good physical and nutritional health. We will raise awareness of the importance of pregnancy planning and nutrition, focusing on first pregnancies and higher risk groups ( e.g. women of childbearing age who are known to have weight issues, those who are known to be diabetic and women who have previously miscarried).

Supporting women to breastfeed

There is strong evidence that breastfeeding is one of the most important things that a mother can do to give her baby the best nutritional start in life and can also be a means of preventing obesity among infants and young children. ^{[18] [19]} However, we recognise that for some mothers and babies breastfeeding can be challenging. So, where a mother can, and would like to, breastfeed her baby for longer (and a majority of women have said they would), we want to support them to achieve that. ^[20]

Action 1.2 Building on current infant feeding services and the best evidence available, the Scottish Government will, over the next three years, work with Health Boards and the third sector to develop services that meet the needs of women based on their individual circumstances with the aim of reducing the drop off in breastfeeding rates at 6-8 weeks by 10% by 2025.

Advising parents about healthy eating in the early years

We understand that parents want to get it right when it comes to their child's diet and nutrition, but that sometimes differing advice, for example from other parents and family members, can cause uncertainty about the best things to do. We therefore want to ensure that parents and expectant parents know how and where to access accurate and up to date information on child healthy eating and lifestyle habits, through discussions with health professionals, social marketing and by directing parents to a range of online resources through Scotland's Baby Box.

Action 1.3 Building on Eat Better, Feel Better, Ready Steady Toddler and the Parent Club website, email and social media channels, the focus of Scottish Government's social marketing activity to March 2020 will be on giving parents practical advice on weaning, and at the ages and stages that follow: toddlers, pre-schoolers, and primary school aged children.

Action 1.4 The Scottish Government will raise awareness among parents and carers, and the professionals who support them, of the possible longer-term impact of using snacks (such as confectionery, sugary drinks and crisps) as rewards for behaving well. We will do this through Ready Steady Toddler, the Eat Better, Feel Better campaign and the Parent Club website. An independent evaluation will be carried out by end of June 2021 and used to improve information and advice.

Upskilling frontline staff to support parents and children

We want all parents and carers to feel informed, supported and empowered when it comes to making decisions about their child's diet and nutrition. Critical to this is that all those who play a role in supporting parents, children and young people – from midwives, health visitors and other healthcare professionals, to youth workers, early years and school practitioners, teachers and catering staff – have the knowledge and skills to support parents to make healthier choices for themselves and their children.

Action 1.5 To ensure parents receive the most appropriate advice and support, the Scottish Government will in 2018 develop training on diet, nutrition and healthy weight for front-line staff across a wide range of disciplines working with children, young people and families.

Action 1.6 Building on this strong foundation, we will take further action to develop the knowledge and skills across the workforce.

• A programme of eLearning and Continuing Professional Development will be introduced in 2018, to ensure front-line staff across a range of disciplines have the knowledge, skills and confidence to support parents with weaning and toddler diet, including discussing and advising on the timing and introduction of suitable foods based on the age and stage of the child.
• Training for early years practitioners by summer 2019, to support the implementation of Setting the Table nutritional guidance and food standards, which will be updated to reflect current evidence and changes in early learning and childcare ( ELC) provision. The Care Inspectorate will monitor implementation of this guidance.
• Updated resources and tools for GPs, health visitors and the early years workforce in 2019, to equip them to engage with and support families when weight or nutrition is a concern. This will include healthy eating, portion control and mealtime behaviours.
• Health and other professionals will have access to training and support materials in 2020, to enable them to refer children and families to appropriate and supportive diet and healthy weight interventions such as parenting support, cooking classes, and child healthy weight programmes.

Children and young people have the skills they need to make healthy choices

Health and wellbeing sits at the heart of the Curriculum for Excellence, supporting children and young people to develop essential skills to live happy, healthy lives. The promotion of health and wellbeing is, along with literacy and numeracy, identified as a responsibility for all practitioners working with children and young people in the school environment. Food and Health Experiences and Outcomes are an entitlement from ages 3-15, supporting children and young people to develop their understanding of a healthy diet. ^[21] In addition, Better Eating, Better Learning ( BEBL) currently provides guidance and support to schools, local authorities, caterers, procurement departments, parents, children and young people to work in partnership to make further improvements in school food and food education. ^[22]

Action 1.7 Over the course of this parliament, the Scottish Government will invest £750 million in the Attainment Scotland Fund to tackle the poverty-related attainment gap. Local authorities and schools in receipt of this funding include health and wellbeing interventions as one of three key target areas in their plans for intervention, alongside literacy and numeracy. Amongst the various interventions made by local authorities and schools using this funding, there are programmes that include education on healthy eating and lifestyle as well as some programmes that include provision of meals alongside learning opportunities for children and families.

Action 1.8 Through the work of the Regional Improvement Collaboratives ( RICs), Education Scotland will strengthen and focus the provision of health and wellbeing support to schools and authorities across Scotland. The RICs are due to finalise their regional plans by September 2018.

Supporting young people to make healthier decisions

Our young people stand to gain the most from living in a country that strives to create a healthy eating culture. The Year of Young People 2018 is a great opportunity to build a lasting legacy by listening to young people and asking them to lead key strands of work. Indeed there are some examples of young people leading change in their communities, such as engaging local retailers to improve the food on offer near their school. Alongside this, our messaging on diet and healthy weight and how it is delivered must be informed by young people. We recognise this is particularly important in adolescence when young people are making more decisions for themselves.

Action 1.9 Young people will lead change and action on healthy eating in line with their rights and ambitions to lead healthy and active lives. A coalition of the Scottish Youth Parliament, Young Scot, YouthLink Scotland and Children in Scotland will support their work, together with local partners as identified by the young people. This will include messaging on healthy diet and weight.

Action 1.10 To better understand the extent to which weight-based stigma prevents young people from seeking advice and support, the Scottish Government will, by winter 2018, carry out research into the contribution body image makes to poor mental wellbeing among young people in Scotland, and act on those findings.

All children and young people eat well

We believe that children and young people in Scotland have the right to eat healthy and nutritious foods and that it is important that good food behaviours are consistently modelled wherever they may be. That is why, alongside radical action in the wider food environment, and supporting families to eat well at home, ensuring all children and young people eat well in ELC settings and schools is a priority. This requires a whole learning community approach so that everyone working within the school context is clear about what is expected.

Action 1.11 As part of the Scottish Government's expansion of funded ELC to 1140 hours by 2020, all children in receipt of their entitlement will be provided with a free meal and a drink of milk at their ELC setting. A National Standard will be set which ELC providers wishing to deliver funded ELC will have to meet, which will include a standard that ensures that food provided within funded settings meets the most up to date nutritional guidance for this age group. ^[23]

Action 1.12 The Care Inspectorate will publish Food Matters: nurturing happy, healthy children in autumn 2018. The resource will provide childcare providers and practitioners with examples of good practice from a variety of childcare settings. The resource aims to support improvement and will focus on creating positive eating experiences for children, experiences that will help them to develop positive relationships with food. It also aims to support services to be innovative around healthy eating and to maximise the opportunities for children's learning and social development.

Action 1.13 The Scottish Government is currently consulting on proposed amendments to the nutritional requirements for food and drink served in Scottish schools. ^[24] This includes proposals based on the latest scientific and expert advice, to further reduce sugar and promote healthy, high quality food and drink. In light of the outcome of the consultation, the regulations and guidance for implementation will be updated to further strengthen nutritional standards for food and drink in schools. ^[25]

Action 1.14 To improve food provision and food education, and ensure schools across Scotland are health promoting, Education Scotland will, by the end of 2020, publish a self-evaluation framework to support the implementation of the Schools (Health Promotion and Nutrition) (Scotland) Act 2007. ^[26] This will aim to build on Setting the Table and support the transition between early years and school years food provision.

Action 1.15 The Scottish Government will invest an additional £1 million over the next two years to support children experiencing food insecurity during school holidays, a time when there is a risk of going without healthy food.

Action 1.16 With Welfare Foods policy now devolved to Scotland, the Scottish Government will continue supporting low income families to have access to a healthy diet by replacing Healthy Start Vouchers with a new Best Start Foods smartcard. This includes increasing payments, expanding the range of eligible foods available through the Best Start Foods scheme and simplifying the application process through linking this with the Best Start Grant. The changes will come into force in summer 2019.