Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011)

2 Trends and Habits in Scotland

The following section provides a brief illustration of the position in Scotland with regard to our dietary and physical activity habits and begins with some of the consequences of those habits.

Trends in obesity among children in Scotland

The increase in prevalence of obesity among children is not a recent phenomenon. Between the late 1960s and early 1990s in Scotland, the percentage of primary school children (aged 4-6 years) who were overweight or obese was generally higher than would be expected according to the UK reference standard. The most recent data for school children at Primary 1 (2006) suggests that the level of overweight and obesity in this age group may be levelling out, but that it is still much higher than expected. See Figure 1.

Figure 1 Trend in Overweight Primary 1 School Children

Source: 1968-1993 SMR10 School Health Record; 2001-2006 Child Health Surveillance Programme ISD Scotland.

Note: The "selected areas" for which trends in overweight are plotted on the chart are NHS Health Borders, Fife, Lanarkshire and Lothian. These areas continuously monitored overweight in P1 children using SRM10 1968-1993 and then using CHSP 2001-2006. The CHSP-School figures published include different NHS Health Boards for different years (as not all NHS Health Boards implemented the system at the same time).

Data from the Scottish Health Survey indicate that between 1998 and 2003, estimates of prevalence of unhealthy weight (underweight or overweight/ obese) among boys aged 2-15 years increased, whilst for girls there was little change over the same time period. See Table 1.

Table 1 Prevalence of children with Body Mass Index outside a healthy range

	1998 %	2003 %
Boys aged 2-15y	28.9	33.7
Girls aged 2-15y	30.3	30.4
Both sexes aged 2-15y	29.6	32.1

Source: Scottish Health Survey

Trends in obesity among adults in Scotland

The Scottish Health Survey indicates that for adults aged 16-64 years there has been a rising trend in overweight and obesity between 1995 and 2003. See Table 2.

Table 2 Prevalence of overweight and obesity in adults aged 16-64 years

	1995 %	1998 %	2003 %
Men - overweight, including obese ( BMI >= 25)	55.6	61.0	64.0
Men - obese ( BMI >= 30)	15.9	18.8	22.0
Women - overweight, including obese ( BMI >= 25)	47.2	52.2	57.3
Women - obese ( BMI >= 30)	17.3	20.9	23.8

Source: Scottish Health Survey

Predicting long term trends for prevalence of obesity is complex because many variables are unknown. However extrapolating from current trends the Foresight Report predicts that obesity levels across the UK could be at 60% in men and 50% in women by 2050.

Current Dietary Patterns in the Scottish Population

A review of dietary intakes in Scotland ⁶ has indicated that although some progress has been made towards reducing total fat intake since 1996, there has been no change in the intake of saturated fat, fruit and vegetables, bread, oil rich fish and breakfast cereals. Furthermore the data indicates that there appears to have been an increase in the consumption of added sugars.

There are also marked differences in diet between affluent and deprived areas. For example, with regard to fruit and vegetable consumption, females in the least deprived areas are twice as likely to consume the recommended 5 or more portions per day than those in the most deprived areas (30% compared to 13%) (Scottish Health Survey 2003) ⁷. A similar picture emerges for males, with 26% consuming the recommended levels in the least deprived areas compared with 12% in the most deprived areas. The same pattern is seen when examining Scottish data from the Expenditure and Food Survey ⁸.

Figure 2 Proportion of adults eating 5+ portions of fruit and vegetables a day and mean number of portions consumed per day (Scottish Health Survey 2003)

Source: Scottish Health Survey

For children aged 5-15 these patterns are continued. Children in the most deprived areas were more likely to consume sweets/chocolates or non-diet soft drinks at least once a day, chips and meat products at least twice a week, and to add salt to their food than those in the least deprived areas. They were also less likely to consume 2-3 slices of high fibre bread a day; potatoes, pasta or rice at least 5 days a week; poultry at least twice a week; white or oily fish at least once a week; and to use low fat milk or to take dietary supplements than those in the least deprived areas. (Scottish Health Survey 2003)

Figure 3 Regular consumption of energy dense food and added salt - Girls aged 2-15y, by deprivation (Scottish Health Survey 2003)

Source: Scottish Health Survey

Figure 4 Regular consumption of energy dense food and added salt - Boys aged 2-15y, by deprivation (Scottish Health Survey 2003)

Source: Scottish Health Survey

Current Physical Activity Patterns in the Scottish Population

To meet the national 2022 physical activity target the percentage of the population meeting current recommendations will need to increase annually by an average of 1%. Despite the overwhelming benefits of physical activity, prevalence levels are still low in Scotland.

Figure 5 Proportion of adults meeting the current physical activity recommendations (30+ minutes on 5+ days a week) (Scottish Health Survey 2003)

Source: Scottish Health Survey

Figure 6 Proportion of children meeting the current physical activity recommendations (at least 60 minutes a day) (Scottish Health Survey 2003)

Source: Scottish Health Survey

Only 39% of Scottish adults and 69% of Scottish children currently meet existing guidelines. Within these figures specific groups of the population remain particularly inactive. These include women of all ages (particularly adolescent girls) and older adults. There is some room for optimism however. Comparing the data from the Scottish Health Survey in 2003 to that derived from the 1998 Survey, the percentage of adults meeting the recommendations significantly increased. The percentage of children meeting the recommendations also showed an increase over this period, although the increase was not statistically significant.

Table 3 Adults (16+) - frequency of walking in the previous seven days*

	1999	2000	2001	2002	2003	2004	2005	2006
	column percentages
As a means of transport:
No days	48.2	46.9	45.4	45.7	46.4	46.6	47.1	46.8
1-2 days	18.7	18.4	19.1	18.2	17.2	16.6	15.2	15.6
3-5 days	17.9	20.4	21.4	21.9	21.7	21.1	21.7	20.9
6-7 days	15.1	14.3	14.1	14.2	14.7	15.7	16.0	16.6
1+ days	51.8	53.1	54.6	54.3	53.6	53.4	52.9	53.2
All	100	100	100	100	100	100	100	100
Just for pleasure:
No days	60.3	58.7	57.4	59.3	56.4	56.4	54.1	53.4
1-2 days	15.8	16.6	17.9	17.7	17.4	16.1	16.6	16.3
3-5 days	10.5	11.7	12.0	10.8	12.4	13.2	14.2	13.8
6-7 days	13.5	12.9	12.7	12.1	13.8	14.3	15.1	16.4
1+ days	39.7	41.3	42.6	40.7	43.6	43.6	45.9	46.6
All	100	100	100	100	100	100	100	100
Sample size (=100%)	13,768	14,533	14,643	14,041	13,936	14,737	7,001	7,111

*The number of days in the previous seven days on which the person made a trip of more than a quarter of a mile by foot for the specified purpose.
The figures here exclude those who said "don't know", and count those who said "unable to walk" as walking on none of the previous seven days.

Why does it matter?

People who are overweight or obese have an increased risk of a wide range of serious diseases: the greater the amount of overweight, the greater the risk to the individual. Indeed being obese has been shown to double the risk of dying among men and increased the risk of death among women by 60%. ⁹ Table 4 below taken from the recent Scot PHO epidemiology briefing report ¹⁰ highlights the numbers in Scotland suffering from particular disease with an estimate of those that can be directly linked to obesity.

Table 4 The prevalence of obesity and related diseases and the number of people who have each condition as a result of obesity

Disease	Estimated number in Scotland annual incidence/ prevalence	Estimated proportion attributable to obesity	Estimated number in Scotland attributable to obesity (2003)
Cardiovascular	Number	Percentage	Number
Hypertension	1,329,696 (p)	36	478,691
Angina pectoris	250,344 (p)	15	37,552
Myocardial Infarction	135,432 (p)	18	24,378
Stroke	92,340 (p)	6	5,540
Endocrine
Type 2 diabetes	73,872 (p)	47	34,720
Neoplastic
Colon cancer	2,242 (i)	29	650
Ovarian cancer	616 (i)	13	80
Cancer of the Uterus	449(i)	14	63
Musculo-skeletal
Osteoarthritis	118,500 (p)	12	14,220
Gout	20,150 (p)	47	9,470
Gastro-intestinal
Gallstones	11,350 (p)	15	1,702

(p) = prevalence, (i) = incidence

Health Inequalities

The most recent evidence, from the 2003 Scottish Health Survey, indicates no clear or simple correlation between deprivation and obesity across the population generally. Only amongst adult women is there a clear linear pattern of increasing obesity with increasing deprivation, ranging from 20.7% obese in the least deprived fifth of areas to 31.8% obese in the most deprived. This may be partly explained by the diet and physical activity levels in deprived areas as measured by the Scottish Health Survey. While clearly deprived people have the poorest diet there is not such a straightforward correlation between deprivation and physical activity although there are gender differences which further complicate the picture.

The Foresight Report indicates that this disparity between the sexes in respect of the relationship between obesity and deprivation may persist in future UK-wide trends. It suggests that UK obesity levels amongst adult women in the least deprived category may increase by between 10% and 15% by 2050, while obesity levels for women in the most deprived category may increase from 25% to 62%. In contrast only a modest social gradient is forecast for increases in obesity amongst adult men.

The Foresight Report recognises that obesity is not exclusively a problem related to social class or inequality. It suggests that to assume that it is primarily a feature of lower-income groups is to disguise the society-wide character of the epidemic. However, efforts to combat obesity in lower-income groups will have positive consequences for both health and inequality. The impacts of the chronic conditions associated with obesity may be compounded by other health behaviours, such as poor diet, physical inactivity, smoking or lower levels of breastfeeding.

We have already stated in Better Health Better Care ¹¹ that our top priority in improving the health of the nation is to tackle health inequalities. The Ministerial Task Force on Health Inequalities ¹² published its report and recommendations on 19 June 2008. The actions set out in this document to improve diet, increase physical activity and support people to achieve and maintain a healthy weight are targeted mainly towards those at greatest risk of health inequalities.