Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight

5. CURRENT GOVERNMENT ACTIONS CONTRIBUTING TO TACKLING OBESITY

5.1 It is estimated that the Scottish Government's total investment between 2008 and 2011 in the kinds of activity directly and indirectly contributing to tackling obesity (Figure 1) could be as much as £200 million. This ranges from funding specifically targeted at tackling obesity to £100 million for sportscotland, much of which may not impact on population obesity levels (see Appendix 6 for breakdown of contributions). This total includes the £56 million investment from Health budgets, but excludes spending by the NHS, local government and NDPBs from their own core budgets.

5.2 Local authorities are also tackling obesity both directly and indirectly through contributing to the national outcomes and local priorities in their Single Outcome Agreements ( SOAs). Some examples from SOAs that highlight their contribution include: participation in "active schools" and Hungry for Success; the creation of cycle pathways and walking paths; children's play areas and sports and leisure facilities; the protection and enhancement of safe green spaces; and community support through educational and skills development for the sourcing and preparation of less energy-dense food options.

5.3 Furthermore the extension of free school lunch entitlement to all P1-P3 pupils from August 2010 is a significant measure aimed to improve the health of pupils. Expected to benefit approximately 118,000 additional pupils, this concordat commitment underpins many of the Government actions highlighted in this report. The extension of free school lunch entitlement encourages children to eat nutritious, balanced meals from an early age and taken together with the Schools (Health Promotion and Nutrition) (Scotland) Act 2007, teaches them to make healthy, informed choices. Establishing healthy eating patterns from a young age and carrying that skill into adulthood will have, it is expected, a positive impact on obesity.

5.4 This is a significant level of effort and investment and it is encouraging that such a broad range of policies and initiatives across portfolios and across the public sector are seeking to address healthy weight outcomes. There are, however, a number of respects in which our current delivery falls short of what is required from a concerted, sustainable and successful approach to tackling obesity in the long term. We need to redress the balance and join up initiatives such that we spend more on prevention, leading to the need for less to be spent on treatment of the effects of obesity in years to come.

Figure 1: Current areas of Government investment in obesity (detailed in Appendix 5)

Direct contributions to managing obesity

• The HEAT H3 target for child healthy weight intervention programmes
• Counterweight (evidence based obesity management in Primary Care)
• Scottish Enhanced Services for childhood obesity in the Western Isles

Direct contributions to prevent obesity

• The implementation initiatives in Let's Make Scotland More Active
• The National Food and Drink Policy Recipe for Success: Scotland's National Food and Drink Policy
• Eight Healthy Weight Communities programmes across Scotland
• Seven Smarter Choices Smarter Places active travel demonstration towns across Scotland
• The Take Life On national social marketing campaign aims
• Beyond the School Gate and NHS Health Scotland's Healthy Weight Outcomes Framework will provide guidance to support community planning partners to create health-promoting communities

Indirect contributions to preventing obesity

There is a wide range of activity across Government and national agencies contributing to this goal, even if in some cases addressing obesity is not the primary purpose of the work.

Healthier

• The CommonHealth Programme - Active Nation: A Games Legacy for Scotland
• CEL 36 (2008) - Nutrition of Women of Childbearing Age, Pregnant Women and Children Under Five in Disadvantaged Areas
• Changing Scotland's Relationship with Alcohol: a framework for action

Greener

• The draft Cycling Action Plan for Scotland
• The Scottish Sustainable Communities Initiative
• The Climate Change Fund
• The Go-greener campaign
• Environmental volunteer managers
• Promoting the countryside for outdoor recreation and education

Smarter

• Early years framework
• The new Curriculum for Excellence
• The Schools (Health Promotion and Nutrition) (Scotland) Act 2007
• Extended Free School Meals entitlement
• The Active Schools programme
• Getting it Right for Every Child

Safer and stronger

• Scottish Planning Policy on placemaking and open space and physical activity, including SPP Designing Streets

Scale

5.5 The evidence of current population BMI statistics and the levels we predict in section 2 make it clear that, despite good existing action, our current approaches to tackling obesity are still not sufficient to turn around rising trends. We believe that the kinds of actions we are taking are right, but that their scale and reach are insufficient. We should not be surprised that this is the case. The Foresight report emphasises the extent to which our environment, culture and social norms have developed to make weight gain an almost inevitable part of modern life. Turning this around is a significant task. No country has yet succeeded in making sufficient change to reverse the obesity epidemic intentionally. Scotland must be prepared to consider radical action.

Cross-cutting commitment

5.6 A significant proportion of Government's current actions that contribute to tackling obesity do so as a secondary benefit of achieving other primary goals, for example reduction of carbon emissions. Often these benefits are obvious; substituting cycling for travelling by car will reduce both carbon emissions and unhealthy weight. The complex interaction among factors such as deprivation, early life experiences and obesity mean that more initiatives such as the Early Years Framework, Curriculum for Excellence and the Getting it Right for Every Child methodology with their emphasis on the child's development as a whole can encourage healthy approaches to diet and activity. Win-win outcomes are to be welcomed, and we believe that pursuing policies with double benefits such as these will be an important part of our long-term approach to tackling obesity. We now also require healthy weight outcomes to be amongst the explicit objectives of action across portfolios to ensure that their achievement is actively promoted and that the necessary resources are prioritised in future plans and policies.

Recognising and managing trade-offs

5.7 As stated above we already pursue a range of Government actions that help to promote healthy weight. However, we need to identify where our objectives may unintentionally work against the maintenance of a healthy weight. We must be alert to these unintended consequences and seek to minimise their impacts. This is possible, for example, through the National Food and Drink policy in which we address the trade-off between the desire of the Government to expand and develop the food and drink industry by supporting Scottish food and drink producers through distribution of grants which help create or sustain jobs, while at the same time limiting the potential adverse impacts on health of particular products. These are not incompatible goals - there is commercial sense in meeting consumer demand for, and promotion of, healthier options.

5.8 By prioritising obesity prevention across Government we can ensure that policies act as drivers for maintaining healthy weight rather than contributing to weight gain. We are exploring the development of integrated impact assessments on our policies, strategies and programmes that will help us to identify where our activities may contribute to obesity through encouraging excessive consumption of calories or by inhibiting an active lifestyle. It will be challenging to find a balance between objectives that unintentionally promote unhealthy weight outcomes, but it is a challenge we must accept if we are to avoid the stark consequences for our health and our economy set out in section 2.