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

5 Delivery and Evaluating Success

In addition to actions outlined in this plan to work with individuals, groups and communities we also need to ensure that we have the evidence and infrastructure in place that provide the best support for decision making and service delivery.

The recent Scottish Obesity Action Resource ( SOAR) ⁴² report from the Scottish Public Health Network highlighted the diversity of practice in referral to, and delivery of, healthy weight services across health boards. We are currently conducting a review of best practice in order to provide guidance to NHS Health Boards on preparing local healthy weight strategies. This will cover treatment in primary, secondary and tertiary care, addressing coordination of services through local regional and national pathways and standards for intervention, referral and staff training. The guidance will highlight the needs of key groups such as children and families and pregnant women. The guidance will also take account of the role of the health service in prevention of obesity through health promotion and participation in community planning to address environments that promote weight gain.

• We will publish guidance for NHS Health Boards on locally delivered healthy weight strategies by the end of 2008.
• We will provide resources to NHS Health Boards to support training of primary care professionals to develop a better understanding of obesity and how to manage the condition.

Following a review during 2005 and 2006, the Scottish Health Survey will now run continuously with national results available annually for the first time from mid 2009. The continuous nature of the new Scottish Health Survey will allow more detailed analysis to be carried out. A wider range of results will be available at NHS Health Board level and results broken down at individual Board level for all NHS Health Boards will now be available from mid 2012. The survey contains detailed questions on behaviours and attitudes relating to physical activity, diet and healthy weight. It also includes measurement of respondents' heights and weights in order to calculate body mass index ( BMI), which will be used to monitor against the new national indicator to reduce the rate of increase of children with their BMI outside a healthy range. The new combination of behavioural and attitudinal data collected in this survey will allow comparison of, for example, respondents' reports of their own eating and activity habits with their BMI and respondents' awareness of whether their own weight may be a health risk. This will, amongst other measures, help us better to target the messages of our social marketing approaches.

A significant gap in our knowledge is the relationship we have with food and how our behaviours and health are shaped by that relationship.

• We will commission work aimed at improving our understanding of our relationship with food and how our culture influences the choices we make.
• We will convene a national Physical Activity Research and Evaluation Group to identify existing gaps in current research and knowledge.

For the past three years we have supported the Scottish Physical Activity Research Collaboration ( SPARColl). ⁴³SPARColl is a Scottish based collaboration that brings together the world's leading physical activity academics and researchers. The aim of SPARColl is to contribute to the evidence base on physical activity and health by evaluating the effectiveness of specific practice-based interventions and to share that work with policy makers and practitioners. The current programme of work is focused on identifying the best ways of getting individuals and populations more active through walking. SPARColl have published a systematic review of interventions to promote walking ⁴⁴ and have followed this up with a pedometer study. The main objective is to determine if pedometers, in conjunction with physical activity counselling, can increase and maintain independent walking behaviour.

• We will continue to support SPARColl.

The Food and Health Alliance and the Physical Activity and Health Alliance provide national networks and fora for all organisations and individuals with an interest in delivering Scotland's objectives for improving diet and increasing physical activity. The Alliances are intended to be the catalyst for facilitating and enabling stakeholders to inform national policy and then to support its implementation in Scotland. In line with our desire to improve our joined up working we intend to develop these networks to provide a renewed emphasis and clearer focus on supporting delivery and developing connections to create better joint working across professions and disciplines and sharing of best practice that will support policy.

• We will retain and strengthen the Food and Health Alliance and the Physical Activity and Health Alliance ensuring a focused strategy for future activity.
• This year we will formally assess progress in implementing the National Physical Activity Strategy. This will include a national engagement exercise with all relevant stakeholders to examine what has worked well and what challenges still remain, and a horizon scanning exercise to identify key opportunities in the future that can be used to enhance the promotion of physical activity in Scotland.
• We will publish the report of the group reviewing implementation of the National Physical Activity Strategy.

The National Physical Activity Workforce Development Plan ⁴⁵ (one of the first of its kind in the world), was initially set up to cover the period 2005-2008 and was led by NHS Health Scotland. It was a broad strategy for the physical activity sector, covering workforce and organisational learning and development for paid staff and volunteers to encourage inactive people to become more active. Key programmes of work included the Leadership for Health Improvement Programme, Health Behaviour Change Training for Trainers, Physical Activity Consultation Courses, "Let's Make Scotland More Active" e-Learning course, and Participatory Appraisal Training for Trainers.

In order to achieve joined up action on diet, physical activity and obesity it is important that we have a joined up workforce working towards common goals. This will include members of both the physical activity workforce and the diet and nutrition workforce.

• We will review the National Physical Activity Workforce Development Plan, and, building on its success, develop a Healthy Weight Workforce Development Plan which incorporates key work in physical activity, diet and obesity.

As part of delivering our Strategic Framework for Environment & Health the Scottish Government has developed a methodology for identifying the most fruitful factors in creating health-promoting environments. This methodology allows us to interrogate the complex relationships between environmental factors (in the broadest sense) and health outcomes. We are able to apply this methodology to the excellent evidence-base gathered by the Foresight project and by consulting experts in the Scottish context to identify the key cross-cutting routes to tackling obesity. The outcomes of this project will enable us to move beyond the frame of this action plan to develop a wider long term strategy.

• We are conducting a focused inquiry to identify highest priorities amongst the aspects of Scotland's environment and infrastructure that promote unhealthy weight and the sectors and stakeholders that must be engaged in order to address these.