Plenary, 11 Sep 2003

Meeting date: Thursday, September 11, 2003

Official Report 716KB pdf

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Obesity

The final item is a members' business debate on motion S2M-145, in the name of Elaine Smith, on obesity among the Scottish population. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes with concern the findings of the recent study carried out by Dr Andrew Walker of the University of Glasgow, The Cost of Doing Nothing – the economics of obesity in Scotland; recognises that an estimated 21% of adults are now obese and that the annual cost to the NHS of obesity and obesity-related illnesses has been estimated at £171 million; acknowledges the efforts of the Scottish Executive and health care providers in attempting to address this problem, in particular those of Coatbridge Local Healthcare Co-operative whose "Weigh-In Without Women" programme recently received the National Obesity Forum award for excellence in weight management, and considers that such examples of best practice could be rolled out across the country as part of a comprehensive multidisciplinary approach to tackling this problem.

I am pleased to open the debate on the motion in my name and I am grateful to colleagues who supported the motion and to those who are attending this evening. I also thank the Scottish Parliament information centre for the document that it produced, and my researcher Catherine Murphy for her work. It is a helpful debate to have ahead of next week's Executive debate on the challenge of improving Scottish health.

Obesity is a condition that is defined as

"an increase in body weight beyond the limitation of skeletal and physical requirements, as a result of excessive accumulation of body fat."

It is a complex condition that has serious social and psychological dimensions that affect all ages and socioeconomic groups, predisposing them—often unwittingly—to a number of serious and frequently life-threatening medical conditions.

The World Health Organisation now describes obesity as a global problem of epidemic proportions, with more than 1 billion adults overweight, at least 300 million of whom are clinically obese. Obesity is now considered to be one of the major contributors to the global burden of chronic disease and disability.

In Scotland, we face a situation that is considerably worse than that of our European neighbours and one that could lead to a crisis of potentially endemic proportions. The legacy of Scotland's poor record on dietary health is well known and documented.

Based on the Scottish health survey of 1998, it is estimated that more than 19 per cent of Scottish men and more than 22 per cent of Scottish women are now obese. Given that the condition is implicated as a predisposing factor for a considerable number of other diseases—including type 2 diabetes, high blood pressure, angina, heart attack, stroke, several types of cancer, osteoarthritis and gall bladder disease—obesity is now recognised as a disease that ranks second only to smoking as a burden upon society and the health service.

In June 2003, Dr Andrew Walker of the Robertson centre for biostatistics published a report entitled "The Cost of Doing Nothing – the economics of obesity in Scotland". That report provides the first authoritative estimate of the costs of obesity and obesity-related illness in Scotland. From his analysis, Dr Walker—a senior lecturer in health economics at the University of Glasgow—estimates that the cost to the national health service in Scotland of treating obesity and its consequences is £171 million. It is important to mention, however, that Dr Walker's report considers only 13 of the numerous diseases to which obesity can be linked. The actual cost to the NHS could therefore be significantly higher than the figure that Dr Walker arrived at.

Similarly, Dr Walker suggests that his report does not take significant societal costs into account. Additional factors such as days off work due to associated illness, increased morbidity and premature mortality are impacting on our society. In fact, the National Audit Office's report on obesity in England, which was published in 2001, estimated that health care costs make up only 18 per cent of the total societal costs of obesity and related diseases.

Perhaps the part of the report that gives most concern is its claim that only 2 per cent of the cost that I mentioned is used to treat obesity, while 98 per cent is consumed by treatment of associated diseases. The NHS in Scotland has been constrained by the legacy of decades of poor nutrition and bad eating habits among the population and it appears to be unable to reverse the deficit of focus on direct or preventive treatment of obesity.

Nevertheless, excellent examples of innovation and best practice are being developed. Indeed, in February, Coatbridge local health care co-operative's "Weigh in Without Women" initiative in my constituency received the National Obesity Forum award for excellence in weight management. The programme was conceived after attendees at a men's lifestyle clinic expressed a desire for a slimming clinic that was tailored to meet the needs of men in the area. If the minister has the time, perhaps he would like to visit that LHCC or speak to people about the programme.

The initiative's success makes clear the effectiveness of listening and responding to the needs and concerns of people within their communities. As "Weigh in Without Women" was developed, the LHCC sought consistently to foster an accessible and supportive environment in which men could enjoy losing weight. Indeed, recent research from Queen Margaret University College in Edinburgh that shows that Scottish men are just as unhappy with their weight as women are stands as testament to the sensitivity and initiative that has been shown by Coatbridge LHCC. I urge the Executive to consider how such examples of best practice can be identified and rolled out similarly throughout the country. However, it is not, of course, an absolute solution to the problem of obesity, the sheer extent of which necessitates a comprehensive multidisciplinary approach that would involve many agencies and the voluntary sector.

I commend the Scottish Executive's significant emphasis on food and healthy eating during the first four years of the Parliament. Welcome measures, such as the establishment of the physical activity task force, the introduction of the healthy living campaign and the increase in breakfast service funding have been designed to tackle the problem nationally.

However, I am equally encouraged by the emphasis that parliamentary parties and the back benches have placed on the issue. In that respect, I want briefly to mention the School Meals (Scotland) Bill. Although I realise that not every member agreed with the bill's purpose, I think that it merited consideration beyond stage 1; the introduction of pilot schemes might also be merited.

Attention has continued to be drawn to the fact that in order to promote optimum dietary health we must focus on the very beginning of life. I would be expected to cite a study carried out in June 2002 by the University of Glasgow's department of human nutrition, which found that breastfeeding one's baby could reduce the risk of childhood obesity by almost a third. Moreover, scientists have suggested that such benefits could continue into adulthood. Given its potential as a useful component in any population-based strategy for obesity prevention, it is in everyone's interests to ensure that breastfeeding is encouraged, promoted and welcomed in this country.

It is clear that there is no absolute solution to the problem. Many factors have conspired to create the health time bomb that faces us. However, we must continue to develop an effective local and national multidisciplinary approach that focuses on preventive measures and on how we empower Scottish people and communities to make healthier lifestyle choices. Dr Ian Campbell, who is the chair of the National Obesity Forum, said recently that the obesity epidemic is already with us and that we need to meet it head on and quickly.

I draw members' attention to the reception for the National Obesity Forum, which I will host in committee room 1 on 9 October, and which will feature a number of speakers including Dr Ian Campbell and Dr Andrew Walker. I urge all members and interested parties to come along and discuss this important issue.

As most members in the chamber wish to speak in the debate, I will limit speeches to four minutes.

I sometimes alarm my more serious religious friends by telling them that I stay moderately slim through hatred. They think that that is very bad until I explain that I do not actually hate people, who are quite good value on the whole—indeed, even the worst of them have some redeeming features. Instead, I hate systems and I like keeping on at them. I am a sort of Don Quixote chap—he is always depicted as being slim.

To be serious, having something worth while to do in life helps to keep people slim but, unfortunately, many people do not have that great privilege. We can best approach the matter by starting with young children. If we get children sorted out, they will not carry the problem into adulthood. We should tackle the problem on a number of fronts. Issues of diet are difficult to tackle because, as with drinking alcohol, an unhealthy diet is almost inbuilt in the system in Scotland. We must tackle that issue seriously both through incentives and penalties, although I have not yet thought out that matter.

It is vital that people take exercise, but we have couch potatoes who do not take exercise. My oldest grandchildren are good at games and enjoy sporting activities but will, when they are given the choice, sit in front of a GameBoy and twiddle it about, or whatever one does to GameBoys—I do not understand those things. When they use such machines, children are sedentary. They gain finger skills, but nothing more. I know how difficult it is, but we must make a serious effort to make sport attractive and available.

If I remember correctly, in a question to the First Minister today, Tommy Sheridan produced the shocking statistic that 17 sporting facilities in Glasgow have been closed in a number of years. I am sure that that pattern has been replicated in other areas, although perhaps not at such a high rate. We must deliver facilities and encouragement. When I was a Westminster member of Parliament for Edinburgh, a nice all-weather pitch was built, but people did not use it because in that part of the city people were not well organised in teams and clubs. An administrative and coaching structure is required as well as facilities.

We should spend a small fraction of the health, police, prison and education budgets on encouraging young people to take up more active activities, whether they are competitive or non-competitive, such as walking up hills or even walking to school. Some people do not like competition, although members must do, otherwise they would not be here. We can, through road-safety measures, encourage activities such as walking to school.

We must attack the issue on all fronts with children as young as possible and with teenagers. I urge the minister to get a grip on his ministerial colleagues and to produce a worthwhile budget to encourage sport among young people, which would save a lot of money in a few years.

I congratulate Elaine Smith on securing the debate. I am sure that we will discuss the subject more in next week's debate on health improvement. I pay tribute to Dr Andrew Walker's work, which has been important in informing this debate and others.

As Elaine Smith said, 21 per cent of adults are now obese, which has an immense cost to the NHS. One of the main issues that follows the rise in obesity is the rise in diabetes. More young people are becoming obese and more young people are getting diabetes, which contributes to Scotland's ill health and to the cost to the NHS.

We must consider our poor diet along with the other health issues in Scotland. Those issues require a range of solutions and although some health improvement initiatives are worthy, they are not on their own enough. We must look beyond them. Elaine Smith outlined a project in her area that is worthy of further exploration. We must look across the issues of education, dealing with poverty and other issues for which the Executive is responsible. We need also to look into the areas for which the Executive is not responsible. In order to tackle poverty, which is one of the underlying causes of poor diet, we need to have control over other mechanisms.

We need joined-up government in order to effect health improvement. Too often, we get the feeling that for everything that we try to achieve with one hand, there is another hand pushing against it, which can be rather frustrating. For example, there is the issue of vending machines in schools, which has been raised in Parliament on a number of occasions. I am aware that action is being taken to deal with that matter, but the message that has been sent out to children is that crisps and fizzy drinks must be okay, because if they were not, people would not be selling them and encouraging schoolchildren to buy them. That runs counter to all the messages that the Executive has been trying to put out.

The encouragement of children to take physical exercise can also be undermined. At a debate that was held on Monday evening and which David Davidson and Malcolm Chisholm attended, we heard from a woman about the physical education programme in her children's school being severely cut back because of curriculum and other pressures. That runs counter to any strategy that is being promoted or encouraged by the Executive. Unless such strategies are to be followed through at local level, and unless schools are resourced sufficiently to ensure that children have adequate physical education—and that there are enough physical education teachers, which is an issue that Margo MacDonald highlighted during question time—none of them will fit together in such a way as to improve our children's health. Other worthwhile initiatives include encouraging children to eat healthily right from the start and the provision of free fruit, which I would like to be extended to all primary school children.

We also have to hold the corporate sector to account. Far too often, that sector promotes unhealthy foods, especially to children. We need to tackle the issue across the board and we must tackle the lack of self-esteem and lack of confidence that underlie so many of our health problems. People need to be motivated to eat more healthily, and that needs to start at a young age.

I congratulate Elaine Smith on securing the debate, which is on a serious subject. She has encapsulated the Andrew Walker report pretty well, so there is no need to reiterate what she said on that. We will have a lot of consensus this evening on many key issues, so I suspect that the Deputy Minister for Health and Community Care, who is winding up the debate, will probably have a fairly easy ride.

However, we need to do more than just discuss the figures that are contained in the Walker report. The issue is not just about money; it is about quality of life and attitudes. For too long, the NHS has been picking up problems, so we need to think a bit more about how we can slide the emphasis towards people helping themselves. In order to do that, they need education. Donald Gorrie was right to discuss getting young people involved, but the answer is not just about educating children; it has to start with parents-to-be. Their behaviour and the style of living of a mother-to-be when she is carrying a child present potential difficulties with regard to weight control. The matter is also about the messages that are conveyed about how best to deal with that. There are issues around how to buy well for those who do not have the appropriate education, especially if they are on a poor income. The Parliament must address those things.

There is huge underestimation of costs, especially in relation to co-morbidity, in which an initial condition can lead to another. That is where the financial costs and the human costs come in. We must take into account in particular those who are deprived of education or of work. As Elaine Smith pointed out, early death can deprive children of a parent. Those are really serious matters, which we have to start considering holistically—something that I think we do not do very well.

On statistics, those who call most on general practice services because of obesity tend to be from among two groups: women aged between 25 and 44 and men aged between 45 and 64. The first of those groups largely comprises those in the child-bearing group, which is where parental input comes in. The second group, of 45 to 64-year-old males, comprises people who, for one reason or another, become less active.

I am sure that much will be said about how people gain access to decent recreation of a type that suits them, but there is a cost to providing those services. Many old-age pensioners and young people cannot afford entry fees. One or two councils are addressing that issue, but others are not—they see entry fees as a form of revenue. In central Buchan, when people raised about three quarters of the money that was required to build a community swimming pool—backed by the medics and for use by people of all ages—Aberdeenshire Council deprived them of revenue support on a stand-by basis, because it said that it could not support the project. The way forward is to get communities involved. We should seek ways in which to help people to help themselves, where they can. That would make a difference.

We are paying a price for doing away with team sports in schools some years ago; people have got out of the habit of sport. Young people like team games and they want to be involved, even as the reserve who comes on and off a football pitch. We must encourage such activities for the future.

There are compulsive-addictive disorders associated with food and eating; I refer not only to eating disorders of the sort that my family has suffered. There are other problems, such as snacking, bingeing and so on. GPs do not always have the resources or understanding to identify the mental health aspects of eating disorders and to step in at an early stage. Some magazines are obsessed with the shape that people should be and the clothes that they should wear. That often results in excessive dieting, which leads in turn to excessive snacking. People bounce around and experience mental health problems. We must get such issues into the public domain, so that they may be understood.

I congratulate Elaine Smith on securing this debate. I agree with Shona Robison that we must examine how obesity affects all levels of society, regardless of where people come from, regardless of opportunity and regardless of wealth. I look forward to hearing what the minister has to say.

I, too, welcome this debate. Obesity is an important health issue and I am glad that it has been highlighted. I am pleased, first, that there has been much consensus on the matter—I am sure that that will continue—and secondly, that many members have focused on the need to start with children. I want to do the same and to develop some of the points that Donald Gorrie made.

Donald Gorrie said that he hates systems. I hate barriers that prevent people from doing things that they would otherwise do and that would be good for them. Members have spoken about the fact that our children now engage in far less physical activity than was the case previously. They have focused on organised sports and physical leisure activities that would be healthy. That is fine, but we must also deal with the issue of how active people's lives are generally. Previous generations were not more active because they were playing team sports or visiting leisure centres, but because they had a more active lifestyle—they walked or cycled to places, rather than driving—and because their play was physical, spontaneous, active play outside. Many children would still like to play actively outside, at least when the weather is decent, but often they cannot. That is what I mean by barriers.

I will tell members a little story that a Green party member who is a GP in Glasgow told me a few years ago. The story is about a community in an area in Glasgow that was fairly poor, although not really deprived, and that did not have many facilities. However, the community had a playing field, with a grass football pitch and next to it a red blaes pitch. The kids in the area used to go out on to the field to do the things that kids do—to play football, to run about and so on. That was the place where they played, as it was safe and off the road. The playing field was at the centre of the community.

Then someone had the idea of building a leisure centre on the grass football pitch. The kids were very sad, because there are barriers to visiting a leisure centre. Even if someone has a free card, they cannot spontaneously kick a ball around there in the 20 minutes before tea or take their dog or wee sister with them. Children's access to places for physical play must be immediate and spontaneous, or they will not go. Instead, they will sit in front of the television.

However, the kids were still able to play on the red blaes pitch. Then better-off people from wealthier suburbs came to use the leisure centre. They planned their visits and drove to the centre, creating a car-parking problem. The council decided that a car park was needed. Members can see where the story is going—that was the end of the red blaes pitch as well. The kids now had a beautiful leisure centre that other people from outwith their area used, but they had nowhere to play.

That takes us back to what Elaine Smith said about the need to take a genuine multi-agency approach to the problem—not just by involving health and education services, but by involving councils' planning departments in considering communities and seeing whether they are unwittingly putting up barriers to children's being active. Children should be enabled to walk to school through further initiatives such as those that we have already in safer routes to school, home zones and traffic-calming measures. We must construct our communities in a way that is not obeseogenic—I am not sure whether that is a word, but it should be—and ensure that children can be active and do not have to sit in front of the television until they get up to go somewhere else in the car. How we view our society and our communities is important, and we must not put up unintentional barriers.

Obesity is a huge problem, and tackling it must start in childhood—otherwise people will end up like me. I have promised to work my butt off for the people who elected me to the Parliament, so members may see a new me in a year or two. However, there are problems when people who have not been particularly active as children become inactive and obese as adults. We all recognise that. The solution is not just to provide facilities that may or may not be used; it is to allow kids to be what kids should be naturally, which is active beings who go out and play.

I, too, congratulate Elaine Smith on bringing to the chamber a subject that is important and will become even more important.

As has been said, the Health Education Board for Scotland has told us that childhood obesity has doubled over the past 10 years. HEBS predicts that the figure will double again in the next seven to 10 years. However, the document that was prepared for this debate by the Scottish Parliament information centre quotes an answer by Malcolm Chisholm to a parliamentary question on the number of Scottish citizens who are diagnosed as clinically obese, which shows that the figure rose between 2000 and 2001 from 22,500 to 32,000. That is an increase of almost 50 per cent in one year. Therefore, a doubling of the present figure in seven to 10 years seems to be very much an underestimate.

That has serious implications. The points that Andrew Walker makes in his document, about the costs of doing nothing, have to be addressed. He estimates that it now costs us £171 million a year to deal with obesity and related illnesses. If there is just a doubling of the number of cases of clinical obesity in the next seven to 10 years, the pressure on the NHS budget will be considerable. However, if an even worse situation develops as a result of clinical obesity, the strain on our health service budgets will, frankly, become almost intolerable. That is why it is important that the issue is raised. The debate highlights the need for us to take measures, but there is no use in our having such debates and just talking about the problem if we are not going to take measures.

Elaine Smith referred to the School Meals (Scotland) Bill. It may have been controversial, but one of the important reasons why the British Medical Association, the health economists at the University of St Andrews and others supported the bill was that they saw it as a way of tackling—as early as possible—the issue of providing nutritious food for children. They were not prepared to support just the idea of providing free school meals, because they would not support giving every kid some of the rubbish that kids are getting now. However, they were prepared to support the bill if it would ensure that nutritious school meals were provided. That is why the bill was drafted in the way that it was. We will have another debate on that issue, to which I urge all members to give serious consideration.

The problems of obesity should also inspire support for Elaine Smith's proposed bill on breastfeeding. The Parliament should not only allow breastfeeding in public places; we should encourage the take-up of breastfeeding, especially in deprived areas where far too little breastfeeding takes place.

Another issue that arises, and which I hope we get round to addressing, is the restricting of advertising during children's TV viewing times. The food industry's global advertising budget is $40 billion. For every $1 that is spent by the World Health Organisation on the prevention of diseases that are caused by bad diets, the food industry spends $500 on promoting those diets. That is the serious imbalance that we face and which we must try to address. Other European countries have taken concrete steps to ban the advertising of particular foodstuffs on children's television. Perhaps we should consider doing that, because bad food, which contains high sugar and high salt, is ruining the lives of far too many Scots, particularly young Scots.

Obviously, such an approach must be linked to Donald Gorrie's points about physical activity. It is not enough to address only diet. We must address physical activity as well. I hope that, rather than just having this debate then forgetting it, we will consider practical measures during the rest of the parliamentary session to address the problem of obesity.

I thank Elaine Smith for the opportunity to debate obesity. WeightWatchers thanks her as well. I reckon that I am about the best qualified in the chamber to talk about obesity.

A long time ago, when I qualified as a physical education teacher, I did not have the problems with my weight that I now have. That was because I was so active. I did not know it then, but I was a fat person waiting to get outside a thin athlete. However, because I was so active my weight was kept down. My weight started to go up only after a period of illness and it took me a long time afterwards to get back into the habit of regular exercise. It does not say much for my priorities when the choice tonight was between going to the golf course with my husband and two granddaughters and coming here to sit and talk about exercise. However, I continue to do it because old habits die hard.

I inform the minister that I have seen a huge change in attitudes towards exercise and physical education. In Scottish education, PE was always regarded as a frill. A terrible snobbery surrounded PE; people regarded it as just drill and thought that all that was needed for it were gym shoes or sannies. PE was not taken seriously. However, I think that not only health economists, but real economists are beginning to realise that an unfit population means a poorer population. Therefore, PE should by now have become central to policy making and all cross-cutting measures. If that is not the case, I sincerely hope that it will be. Physical education should be central to how we think now and should not be used just to alleviate poverty, make for a better quality of lifestyle, keep kids occupied and out of trouble, or keep people thin.

I appreciate the moves that have been made to reclassify physical education as a degree subject in universities and to bump it up the academic ladder. However, that is not enough if we want to get teachers into schools quickly enough to meet what is now an epidemic. Extraordinary measures must be taken—for example, measures to get more PE teachers into schools and to provide more coaches at community level to get kids out exercising.

For the older age group to which David Davidson referred, prescription exercise could be a possibility. That would cost much less than lots of the pills and potions that are prescribed for women of my age. It would be better, for example, if older women were given a free ticket for an aquafitness session at the local baths, or were allowed to try out a pulse centre. I believe that prescription exercise is a practical solution that could happen right now.

Tommy Sheridan is right about free school meals. The reason for suggesting the provision of universal free school meals was not to prevent poor children from feeling stigmatised for getting free school meals, but to ensure that what children ate at school could be controlled. We could tell parents that they did not need to give their children lunch money because they would get a free school meal. That was the rationale behind the proposal to provide universal free school meals and that is why I continue to support that proposal.

I also support the free fruit in schools scheme, even though some kids throw away the fruit. We must persist with that scheme and extend it to all schools. We must get role models and sporting icons into schools to say, "Look at me munching an apple. This is what it does for you—you can sign for Man United and get paid a fortune." We must meet the advertising giants on their own ground. The scale of the advertising to which Tommy Sheridan referred is undermining all the sensible foodstuffs and eating plans that we are discussing.

The issue affects not only poor wee Scotland with its bad dietary habits; it is an international problem. Just a few months ago in Portugal, I saw evidence of that. Portuguese kids, too, are getting fatter because they are watching the same advertising on television and eating the same gloop as our kids are. Similarly, their mothers are out working and do not have time to cook, so they use microwaves as well. In closing, therefore, I suggest that, as well as tackling advertising, the Government takes action that would hurt the companies and puts tax on foods that have high salt and fat contents. Think about it: if we can tax cigarettes because they are bad for people, we can do the same thing with food.

I have more requests to speak than it is possible for me to accommodate in the time allocated. I would therefore be willing to accept a motion without notice to extend the debate by up to 15 minutes.

Motion moved,

That the Parliament agrees that Members' Business on 11 September 2003 be extended until 6.10 pm.—[Mr David Davidson.]

Motion agreed to.

The fact that we have had to extend the debate shows that there is a great deal of interest in the subject. We are all grateful to Elaine Smith for raising the issue.

It might come as a surprise to people to hear that I have never suffered from obesity. I do not think that I have ever been on a diet, except that I am now under medical instruction to follow what I can only describe as a Billy Bunter diet—all the nasty foods that we are talking about tonight, such as pizzas, are an automatic part of my diet. When I go shopping at the weekend, some people look at me as if I were a very strange person.

I hope that, in this short debate, we can consider all the related aspects of health, diet and education. Underpinning my contribution to the debate is my view that we need to establish why some people are prone to obesity while, at the same time, six-year-old girls are being treated for anorexia. A variety of issues are involved and additional work has to be done.

We know that some people's obesity is due to psychological problems—people might be going through a relationship break-up or have problems with self-esteem. Other people put on weight due to illness or because they take steroids or some other medication. We have to deal with eating disorders in the round rather than dealing with only one issue. It is easy to say that people should eat less, eat better or eat more, but it is not easy for people to face such choices—changing the habits of a lifetime takes time.

I look forward to a certain debate that we will have next week, because the real issue for the Government is the assistance and treatment that we give to people who are vulnerable. Elaine Smith highlighted the fact that, of the money that was spent on dealing with obesity, only 2 per cent was spent on trying to assist people with obesity while the rest was spent on the treatment of conditions arising from obesity.

I am not a clinician, but I think that the educational aspect is important. We need to know how our bodies work and what they need in order to operate. Since other Ewings have been quoting Latin in the chamber, I will say

"mens sana in corpore sano".

I endorse what Margo MacDonald and others have said about the need for more in the way of facilities.

Obesity starts in the early years. Having read the contents of jars of baby food in the supermarket, I think that those foods must be addictive. They probably whet the appetite of the youngsters who eat them, with the result that, by the time the children get to school, they are already addicted to sugar, salt and all the things that David Davidson mentioned.

I know that, when parents are weaning their children, nurses and doctors in local health clinics encourage them to consider using home-made baby food. Most of us in the chamber will not remember eating baby food, but we all probably ate a mashed-up version of whatever mum and dad were having. That meant that there was not as great a quantity of addictive substances in our food as there is in modern baby food.

In school years, it is important that the physical education system is emphasised. In the 1970s, following the teachers' dispute, we lost a lot of the volunteers—the other teachers who were not PE-trained. We lost teachers such as me—I coached in netball, badminton, baseball, orienteering and swimming. We have to address that problem within our education system, because those skills have to be maintained.

I congratulate Elaine Smith on lodging the motion and bringing an important debate to the chamber. I probably ought to declare an interest as the United Kingdom parliamentary WeightWatcher of the year, something of which I am extremely proud. The new members would not have recognised me this time last year, when I weighed 17 stone 8 pounds. I had to wear clothes that now resemble potato sacks and I knew the meaning of obesity for the first time in my life. I am reminded that I was always a big so-and-so, but my former farming lifestyle prevented me from becoming obese.

What happened to me was a lifestyle thing. When I became a member of the Parliament, I carried on eating like the farmer that I was. Most meals came out of the frying pan—especially if I was cooking—and the lifestyle was not healthy. When I walked up the Mound one day and had to stop for a rest halfway up, I decided that I had to do something, because I was becoming very unhealthy.

David Davidson referred to the other costs of obesity. I can say from experience that one such cost is the loss of self-esteem. A loss of self-esteem leads to a loss of drive and a loss of drive leads to a loss of effort and generally pulls down someone's whole performance as a human being.

I will touch briefly on two aspects that have not been specifically referred to, although they have been hinted at. One is the great difficulty of healthy eating. I will use as an example low-fat crisps—a very humble little product. Those crisps exist and they are perfectly good, but they are hard to obtain. I challenge anyone who does not believe me to try to get a packet of them next time they are out shopping. The chances are that the crisps, if they are to be found at all, will be found only in a multipack of 10 or 12, so people will end up eating four packets instead of the one that they would have had otherwise, which undoes all the good. It is nearly always difficult to obtain healthy food products.

On top of that is the expense of eating healthily. I give no other example than the breakfast options in our parliamentary canteen. Until a year ago, when I joined the Parliament WeightWatchers scheme, I thought that the best part of being an MSP was the offer of five fried items on a plate for £1.10, which we can get in the canteen. That is incredibly good value and I had it every day—it was fabulous. However, it is a heart attack on a plate, unless one is following the Atkins diet. Now when I have breakfast in the Parliament's canteen, I have a bowl of fruit salad and two slices of toast and marmalade, which costs me £1.33. Neither cost is a big hole in my pocket, given my MSP salary, and I am not complaining, but there is something wrong when the healthy option that I now eat costs considerably more than the heart attack on a plate that I would still love to eat but have managed to get over.

If that example is taken out into the big wide world, it shows that eating healthily is expensive. That should not be the case, because fitness should not be the preserve of those who can afford it and fatness should not be the preserve of those who cannot. That is the dilemma that we face. Until we as a nation and the Executive grasp that and attack it, obesity will continue to be too big a problem in our society.

I, too, offer my congratulations to Elaine Smith on securing this debate. I am fortunate in that I have never been afflicted by obesity. In fact, my mother says to this day that when I was a child my legs were like two pipe-cleaners hanging out of my shorts. That is why members will not see me in shorts an awful lot.

We have to be grateful for small mercies.

Yes, I am grateful. I am naturally skinny, which is lucky.

I would like to make two points, both of which arise from Eleanor Scott's thoughtful contribution. I am sure that we all appreciated the story of the leisure centre, but we do not all have leisure centres. For reasons of local government history—and Eleanor will know this—the county of Caithness does not have any leisure centres whatever, despite the fact that many people live in the two towns of Wick and Thurso. Other councils, such as Ross and Cromarty District Council, which Rob Gibson and I served on, forged ahead and built leisure centres. Ross-shire has good provision but Caithness has no provision. I appreciate the points that were made about whether people should pay or not, but some people simply do not have leisure centres to use. I have made the point before—to ministers and to sportscotland—that we have to tackle the problem and ensure that there is equality of provision throughout Scotland. People should not be disadvantaged simply because they happen to live in the very far north. I can assure members that that is a huge issue up there.

My second point is a simple one. I am not skinny because I did a lot of sport; I am skinny because I was fortunate enough to be born that way. There are kids who do not like sport and who do not like exercise. Let me give members an example that is right up to date. I met the children from Ross-shire who came to be with us this afternoon. When they came out of the gallery and went into the Lawnmarket, they were cross-questioning me and asking, "What was that about two hours of gym?" I said that that was the kind of decision that could be made in the chamber and they said, "Oh please, Mr Stone, we don't want two hours of gym." That might tell us something about the sorry pass that we have come to, I do not know. Members may put their own interpretation on the story. Nevertheless, it reminded me that some people will not enjoy gym or team games no matter what we do—I was one of them. I was always the last to be picked when the class was divided into teams for football. They knew I was absolutely hopeless.

I hear what Jamie Stone says about antipathy towards physical exercise, and I agree with him. Among young teenage girls, it is all to do with looking good and not getting their hair messed up. However, we must be serious about persuading people of the health benefits of exercise. I am sure that children do not like doing two periods of maths either, but if they are going to get a job, they are going to have to get through their maths higher. If they are going to stay healthy, they are going to have to take exercise.

Indeed. Margo MacDonald's point is well made and my conclusion, which I am now coming to, does not disagree with her at all.

We have to have the broadest possible approach to exercise. That might mean offering children activities such as gardening in the school grounds, or orienteering, or hillwalking, or time in adventure playgrounds—activities that will make them move, make them use their muscles, make them sweat and make them take deep breaths. Those activities would have the same effect as sports. A many-fronted approach is required, including what Margo MacDonald suggests. Our ideas could be broadened out along the lines that I have just described.

I, too, welcome Elaine Smith's motion, which highlights the serious problems that affect Scotland as a result of the high and increasing incidence of obesity. One in five adults is now classified as obese. Many of those people are now rearing their own children on diets and lifestyles that will result, unless the cycle is somehow broken, in a further steep rise in the incidence of obesity as those youngsters grow up.

Type 2 diabetes is a complication of obesity. It is commonly found in older adults but, sadly, as we have heard, there are now cases of young teenagers in Scotland developing that kind of diabetes. Let us be in no doubt: diabetes of either type is a very serious condition. If not dealt with properly, it can result in blindness, coronary heart disease and renal failure.

Obesity is also a causal factor in many other serious diseases. The high incidence of the condition—it is almost at epidemic proportions—is already exacting major costs, not only in terms of morbidity and mortality but in terms of health care and resources. Those costs will escalate as obesity becomes more prevalent. We are sitting on a health time bomb. We must tackle the problem head on.

As the motion states, the Executive and local health care providers are already attempting to address the problem. Many local initiatives are under way across the country. The allocations of cash from the New Opportunities Fund that were announced yesterday cover healthy-diet and lifestyle projects, from Orkney, Shetland and the Western Isles, right through the Highlands and the north-east of Scotland, into the central belt and down to Dumfries and Galloway. They go well beyond the successful Coatbridge initiative, which Elaine Smith mentions in her motion.

All those projects are to be commended and I agree that successful ventures should be rolled out as part of a comprehensive effort to tackle the problem of obesity. However, they are only the beginning of a battle to educate and change the habits of the whole population of Scotland.

Over time, concerted efforts have largely convinced people, especially young people, of the dangers of drink driving. The instance of smoking has significantly reduced—except among young women—since people have been made aware of the serious health consequences of that activity. The dangers of obesity are no less severe. We should lose no time in campaigning to make the population at large thoroughly aware of the life-threatening risks that they face when they allow themselves and their children to become overweight to the point of obesity. We need to convince them of the benefits of a healthy lifestyle and a healthy diet.

Obesity is a condition that is certainly much easier to prevent than to cure—all those of us who have put on weight know how much easier it is to gain it than to lose it—but failure to curb the increasing prevalence of obesity will have an enormous impact on our already overstretched health services.

I am happy to support the motion.

I offer my congratulations to Elaine Smith and thank the Presiding Officer for letting me speak late in this debate.

I want to add some observations taken from general practice over the years. It was patently obvious from my practice in the inner city that, over the years, people ceased to be able to cook. Generation after generation did not know how to cook because they did not see their mother and grandmother cooking. From the mid-1980s onwards, our practice ran healthy-eating and healthy-lifestyle clinics, and a great part of those was often about encouraging people to know how to cook—and how to cook food not just by shoving it in a microwave. I have heard the debate and agree with absolutely everything that has been said. However, we always had a shortage of dieticians—we never had enough of them—and that made it exceedingly time consuming to provide the advice and keep encouraging people.

I also want to comment on a small group of people who are perhaps forgotten about. Many of those who are perhaps a little overweight when they begin to need an operation for their knee or hip become very much overweight because they have to wait such a long time for the operation. Sometimes those people become so overweight that they can never have the operation because it would be unsafe to do so.

I wanted to comment just briefly on those two things, but there is one positive and, I hope, brighter aspect. When I was in the constituency the other day, I saw that one of the supermarkets has latched on to the fact that people have been shoving things in microwaves. I look forward to seeing how well it does this, but the supermarket is going to organise focus groups on how to encourage people to eat healthily and cook fresh foods rather than just use the microwave.

Like other members, I begin by congratulating Elaine Smith and expressing my gratitude to her for raising such an important issue as the action to tackle obesity levels in Scotland. I am happy to confirm that I would be more than happy to speak to her local health care co-operative. I am sure that we can make arrangements for that later.

The topic of tonight's debate is important, but it is also important to remember that Scotland is not alone in experiencing a rapid rise in obesity. In developed industrialised countries, virtually all population surveys have shown an increase in obesity levels over the past two decades. The recent study by Dr Andrew Walker, which has been referred to on a number of occasions, highlights the fact that we cannot sit back and do nothing to stop what can rightly be described as a health time bomb.

I freely agree that the statistics are, indeed, frightening. The increasing level of obesity among Scottish children has huge health implications for later life, as well as for our health service, for our productivity as a nation and, not least, for people's quality of life. I assure Mr Sheridan—who has left, but who explained to me why he had to do so—and others that the Executive is determined to tackle the issue with some vigour.

Some of today's discussion has focused on the need to treat obesity. Of course, that is extremely important, and Scotland's health communities are not sleepwalking when it comes to tackling that growing need. However, the specialist skills and capacities are not limitless, so in considering the scale and potential impact of this growing problem, we in the Executive believe that the focus of wider action must be on prevention and treatment.

While there is much to learn from international experience and current best practice in the UK and throughout Scotland, it is right to point out that, as yet, no confirmed models can be drawn from other countries that have successfully tackled the problem. There is, as yet, no blueprint. However, I ask the chamber to be in no doubt whatever that we are taking the problem seriously. It is no coincidence that obesity is emphasised as a priority in its own right in the document "Improving Health in Scotland: The Challenge", which was launched in March.

The World Health Organisation has stressed the importance of preventing obesity through combined action to tackle the problems of lack of physical activity and poor diet. Scotland is responding to that by driving forward integrated multisectoral implementation of our national physical activity strategy and the Scottish diet action plan. The WHO has strongly commended Scotland for adopting a preventive approach to this growing, global chronic disease.

The Executive is taking a renewed and unprecedented approach to health improvement in Scotland. We are no longer tackling each contributor to ill health as a separate entity. Problems such as smoking, diet, substance misuse, poverty, lack of physical activity and social exclusion are often interlinked, and we are taking an integrated approach to delivering improvement. That approach is outlined in "Improving Health in Scotland". Members will have seen evidence of the work to tackle poor diet through the healthy-living campaign, the new nutritional standards for school meals, and free fruit for primary 1 and 2 children. In fact, we have committed £63.5 million over the next three years to implementing those improvements to school meals.

Much has been made today of the advertising of large companies. I am happy to point out that the Food Standards Agency is currently engaged in research on the impact of such advertising. We await the outcome of that research with some interest.

Will the minister comment on fast-food companies going into schools to promote competitions, which I find is increasing in my constituency?

The research by the Food Standards Agency to which I referred will examine some of the issues and the impact of that activity. As I said, we will be interested to see the outcome of the research. Anecdotally, I do not doubt that that is a negative issue that we need to address.

The physical activity strategy aims to get Scots more active. Everyone in Scotland—men and women of every age—needs to build more activity into their daily lives at home, at school, at work and through play and leisure. A huge amount of work is already under way to put that strategy into practice. The Executive's physical activity co-ordinator is working in partnership across Executive departments and agencies to develop five-year action plans for active homes, active communities, active schools and active workplaces. We have already committed £24 million over three years to the expansion of the active primary school programme, and we are carrying out a review of physical education in schools.

Of course, we still have much to do. The Royal College of Physicians and Surgeons of Glasgow held a conference in January that focused on tackling our nation's obesity, at which the Deputy First Minister, Jim Wallace, delivered the closing speech. In doing so, I hope that we highlighted the fact that action on obesity is the responsibility of the Scottish Executive as a whole, not just the Health Department. We are developing a cross-cutting, integrated approach that requires novel partnerships and inputs at both a national and local level, and involving, consulting and collaborating with key stakeholders. The conference highlighted many important issues and brought together many key people to inspire and impress upon them their role in tackling obesity. We have since been working with the Royal College of Physicians and Surgeons of Glasgow to pull together further evidence that will inform future work and partnerships to turn the tide of obesity in Scotland.

Here in Scotland we are well placed to tackle obesity. We have strategies that are aimed at changing established patterns of diet and physical activity. With co-ordinated action to implement the Scottish diet action plan and to boost levels of physical activity, we can introduce a cultural change for the better.

Such a change will mean that, when we tackle obesity, we reverse the worrying level of diabetes and reduce the misery of coronary heart disease and the devastation that strokes cause. It will mean that, as people live longer in our increasingly sophisticated world, they have an improved life journey and a better quality of life.

Nothing that I have said represents a short-term fix—no such thing exists. We are talking about a long-term commitment to improving the health of our nation. We are serious about making the long-term changes that will lead to success and, as I have said, we will continue to pursue those changes with vigour.

Meeting closed at 18:10.