Meeting of the Parliament

Meeting date: Thursday, October 26, 2017

Official Report 911KB pdf

---

Diet and Obesity Strategy

The next item of business is a statement by Aileen Campbell on developing a new diet and obesity strategy for Scotland.

I am delighted to update Parliament on our proposals for improving diet, activity and weight in Scotland and to announce the publication of our consultation document. It forms part of our wider efforts in public health to improve Scotland’s health and ensure the sustainability of the national health service.

As the nation’s waistline expands, so does the cost of dealing with the challenges that are posed by obesity, which include the cost to our NHS, the cost to our economy and, importantly, the human cost of poor health and wellbeing.

Over the past 15 years, progress towards meeting our national dietary goals has remained stubbornly challenging. Recent Scottish health survey figures show that two thirds of us in Scotland are overweight or obese. One in five children is at risk of being overweight or obese, and it is of great concern that that particular health problem is more marked in our most deprived areas, where the obesity rates for children are very substantially higher.

Poor diet is associated with 13 types of cancer, heightened risk of type 2 diabetes and a range of cardiovascular and other conditions that can be debilitating and can shorten life expectancy.

Although the statistics are important, we must also understand the implications for people’s day-to-day lived experience, their happiness and their sense of wellbeing. I heard about that lived experience today at the Heart of Midlothian football fans in training session, from people such as Wattie, who described how his life has been transformed through getting fit and losing weight. I thank Hearts for hosting us today.

What makes the obesity challenge all the more heart breaking is that we know that much of that poor health can be avoided and prevented. We know that, if we get the strategy’s approach correct by intervening early enough, appropriately and correctly, we can help people and communities avoid poor health, prolong life expectancy and enjoy life. That is a goal worth pursuing. The strategy outlines the way in which we believe that we can help shift the culture away from poor health and obesity being the norm and towards good health and positive choices being embraced. Scotland has an exciting opportunity to lead the way.

It is important that we recognise the progress that has been made and that, while acknowledging that some problems persist and remain, we are not embarking on this work from a standing start. The healthy living programme supports healthier options in grocery stores; the healthy living award recognises good practice in catering settings; the healthcare retail standard in the NHS shows how promotions can be rebalanced towards healthier food; and football fans in training and the daily mile are proof that regular physical activity is achievable, no matter a person’s age.

That work and commitment have helped slow the rate of weight increase. Just as we have done in relation to other major public health matters, however, we recognise the need to go a lot further. That is why I am publishing a bold plan for improving diet, weight and activity for Scotland. There is no simple solution and there is no quick fix. A growing body of evidence points to the action that we must take to make a real and tangible difference to people’s lives, to communities and to the country as a whole. I am grateful to Obesity Action Scotland, Cancer Research UK and others for their important work in this area.

There are three main pillars to our proposed approach and I will focus on them in turn.

I am clear that improving the food environment is the single biggest change that we need to see in Scotland. The reality is that many of us find it challenging to make healthy choices in an environment where food and drink that are high in fat, salt and sugar are cheap, widely available and heavily promoted.

I do not doubt for a minute the value of food labelling and other ways to help people make informed decisions. However, the odds are stacked against most shoppers. We have data that shows that 35 per cent of all food and drink purchased in Scotland is on price promotion—around double the figures for Germany, France and Spain. We know that food that is high in fat, salt and sugar is more likely to be bought on promotion, compared to healthier alternatives. Cancer Research UK’s recent survey found that 89 per cent of parents in Scotland believed that supermarket promotions influence what they buy, with more than half stating that multi-buy offers lead them to buy more junk food than they really want.

Therefore, consistent with our programme for government, the new strategy proposes action to restrict the promotion of food and drink that are high in fat, salt and sugar. During the consultation, we look forward to hearing people’s views, both within and beyond the parliamentary chamber, on how we can best approach that collectively. The first steps will be to consider what products that are high in fat, salt and sugar and what types of promotion should be targeted, such as multi-buy, or X for Y.

There is more that we can and will do to improve the environment, particularly to protect children from exposure to junk food advertising. It is disappointing that the UK Government did not take the opportunity to extend current restrictions on broadcast advertising before the 9 pm watershed. Many credible commentators have identified that as a crucial measure in the fight against obesity. If a commitment to do so is not forthcoming, we will request that the relevant powers are devolved to the Scottish Parliament. We will not let the matter drop.

On the devolved powers that we can use, use them we will. We will seek to extend the current restrictions on non-broadcast advertising of junk food to places that are commonly used by children. Those could include streets and safer routes to schools, or locations such as visitor attractions. If we want to make good on our shared ambition to make Scotland the best place to grow up in, we must ensure that we provide our children with the best chance and environment to be healthy.

I said earlier that weight is a major contributory factor to serious disease. I also said that much of that disease is preventable. I will put that into perspective. More than a quarter of a million people in Scotland have been diagnosed with type 2 diabetes, and around 9 per cent of the health budget is used on their care. We know that 87 per cent of them are overweight. More worryingly, Diabetes UK estimates that a further half a million people are at risk of developing type 2 diabetes. Although this is at the extreme end, around 1,700 people have had a major lower limb amputation as a result of their diabetes. That is all preventable.

In a population of 5 million, the costs are significant: the cost to people and their families, the cost to our health services and the cost to our economy. Those costs give us a strong economic and health imperative to act.

Type 2 diabetes is an example of where we can have a significant impact. We know that losing weight and maintaining healthy weight can improve the health and lives of people who are affected by type 2 diabetes. Even more important, that can delay, prevent and even reverse the onset of the disease.

The strategy therefore signals our intention to establish supported weight management as a core part of treatment for people with, or who are at risk of, type 2 diabetes. That is entirely consistent with our aspiration to offer a world-class diabetes service. To support that work, we propose investing £42 million over the next five years to support the delivery of that ambitious, innovative and potentially transformative approach.

The consultation also proposes action in many other important areas. It proposes action in the early years, because we know that habits formed in childhood can last a lifetime; in leadership, where the scale and pace of change needed will require long-term commitment right across the public, private and voluntary sectors; and in physical activity, because we know that an active lifestyle, alongside a healthy food environment, will be to the lasting benefit of everyone in Scotland.

This Government and this Parliament have led the way on public health with our groundbreaking strategies on smoking and alcohol. We must now focus on the next great challenge—diet, weight, and activity—in the knowledge that we are at our best when we are bold. In doing so, we must keep people at the forefront of our minds. As Minister for Public Health, I have seen first hand how lives are transformed by healthier weight and diet. That happens when people are empowered, enabled and equipped to make positive decisions about what they eat. It is about ensuring that good habits are established in the early years and educating our teenagers with the knowledge that they need as they emerge into adulthood, enabling them to make choices that sustain good, healthy lives for themselves and as the potential parents of the future.

The consultation paper that I am publishing today sets out an ambitious and forward-thinking set of proposals. Over the coming months, I look forward to having many conversations around the country about our ideas and considering the many ideas that I know will come to us. If people think that there is a case for going further, we will certainly look at it.

This Parliament is at its best when we work together, across political boundaries, united by a desire to create a better Scotland for us all. Regardless of the bumps that we will no doubt encounter along the way on this journey, if we succeed, we stand to gain the biggest prize—a healthier, happier and fairer Scotland.

The minister will now take questions on the issues raised in her statement. I intend to allow around 20 minutes for questions, after which we must move on to the next item of business.

I thank the minister for prior sight of her statement and welcome the Scottish Government’s intentions in launching the consultation on a new diet and obesity strategy for Scotland. It cannot come soon enough, because we know that, as the minister outlined, two thirds of Scottish adults are overweight and nearly one third of children are now deemed at risk. Turning that around requires support from all Government departments, public institutions and businesses and from all sides of the chamber—I very much take that on board.

One of the key priorities of which the Health and Sport Committee has become acutely aware is the need for a cross-portfolio approach to the issue. I hope that the minister will look at how that will be taken forward across all local authorities and all ministerial portfolios in the Government. I hope that today will mark a point to which we can look back to see how the Parliament has made a real difference. Today we will also need to make sure that we see an end to the potential Scottish National Party swim tax and the proposed extra charges for some of our leisure facilities. How would that fit into the strategy? How will the Government measure the progress of the strategy?

I thank Miles Briggs for his question and acknowledge his interest and his suggestion that there is a willingness to work across political parties to make sure that we can make good on the aspirations that I have set out today. Of course, he is absolutely right that public health demands the attention of not just the health department but all departments across Government and beyond, and of our local authorities as well as other public and private bodies.

The strategy that I am setting out in the consultation document also indicates where there can be cross-portfolio working, whether that is in education or in the planning world, in relation to how we plan and shape the spaces and places that we live in to make sure that they are conducive to healthier, happier lives and also nudge us in the direction of making active travel choices.

The programme for government also articulates that desire for us to work across portfolios to make sure that we can create the healthier country that I think we all seek to create. I hope that that gives some reassurance that there is a desire right across Government to work collaboratively—to work together—and to disregard the boundaries that are set by ministerial portfolios, because life does not fit into one single, neat ministerial portfolio.

On how we will measure success, we have focused on diabetes and on promotion in the early years so that we can measure some of the impacts through the primary 1 weight chart. When we take the weight of primary 1 children, we can chart improvement. We can also track purchasing through our endeavours to tackle the promotion of unhealthy foods. The SCI-Diabetes database can also evidence the improvement that we seek to make in that area.

I hope that that provides reassurance that the strategy is not designed simply to be warm words. There are clear ways in which we want to measure success because we are determined to take an evidence-based approach to tackling this great health challenge that we face in Scotland.

I thank the minister for prior sight of her statement. The obesity crisis is the single biggest public health challenge facing Scotland today and one that, sadly, too often impacts on our most deprived communities. Two thirds of adults and over a quarter of children are overweight. Those are the worst rates in the UK and among the worst anywhere in the world.

It is clear that the current obesity route map has not reached its milestones and bold, radical action is very much needed. Labour therefore very much welcomes the publication of this long overdue strategy and in particular the commitment to restrict the promotion of food that is high in fat, salt and sugar.

I pay tribute to organisations such as Cancer Research UK and Obesity Action Scotland, which have campaigned so effectively to ensure that, at last, the Government has recognised the importance of regulation in making the healthy choice the cheaper choice for families.

At this eleventh hour, will the minister give a clear commitment that the consultation exercise will not be used in any way to water down a commitment to tough regulation, whatever pressure she may come under?

Will the minister also accept that one of the reasons for the lack of effectiveness of the existing obesity route map was the failure to have regular, comprehensive measures of success? Will she therefore ensure that the new strategy is underpinned by clear, enforceable targets, not just for diabetes, and that the targets will be monitored and evaluated regularly by this Parliament so that we do not have to wait another six years should we need to change course again?

I thank Colin Smyth and acknowledge his support for and his welcome of the consultation document and for his particular welcome of our intentions to put restrictions on high fat, sugar and salt foods.

I agree with what he says about the work that has been carried out by Cancer Research UK and Obesity Action Scotland as well as a whole host of other organisations out there that represent many of the illnesses and conditions that are associated with obesity. That has set the tone for us to be able to move forward with momentum on this journey of tackling obesity and the challenges that it poses for us.

I cannot be more straightforward—we want to restrict the marketing and promotion of high fat, sugar and salt foods. There is no intention for us to do what I think happened with the UK Government’s proposals: it set out a consultation that indicated a direction of travel and then unfortunately, when its strategy was published, it fell short of some of the aspirations that had been built up. That is not our intention. We will be bold, imaginative, innovative and we are determined to make a difference on the issue.

We will, of course, listen to what others have to say on the matter. I noticed that some of what Colin Smyth said had a grudging tone—I am not sure whether that was what he intended. I hope that the 12-week-plus consultation process will give Colin Smyth and his colleagues time to formulate some ideas of their own, rather than coming to the Parliament and asking us to do more without always being specific on what action we need to take.

I have 10 members who want to ask questions, but we have only 15 minutes left, so I want short, sharp questions and quite brief answers, minister.

I welcome the boldness and ambition in the statement. Environmental factors may play a role in determining both nutrition and physical activity. Will the minister expand on how the Scottish Government intends to work to change the obesogenic environment in order to change behaviours?

I recognise the real interest in the issue that Maree Todd has expressed in her committee role and in the chamber.

In the strategy, we have set out a number of actions that we want to take to challenge and change the obesogenic environment—it is unfortunately so conducive to obesity. That is why we have outlined actions to restrict price promotions on high fat, salt and sugar food and drinks, and action to extend the current restriction on broadcast and non-broadcast advertising of junk food to reduce exposure, especially that of children, to those foods. We also have plans to develop an eating out of home strategy, which will include action on better labelling, calorie caps and portion control. We also want to ensure that we are in a position to support our small and medium-sized enterprises to allow them to reformulate recipes to increase the range of healthier options available.

I hope that that package of measures will go a long way towards changing the obesogenic culture.

I, too, welcome the minister’s statement. As she has highlighted, obesity is linked to many other complications and conditions. Driving behavioural change will be crucial to the success of any obesity strategy and will be most effective for the younger age group. What focus will the consultation have on early intervention, both in terms of our relationship with food and access to physical activity, irrespective of background or personal circumstance? Will malnutrition be addressed as—

I am sorry, but I can allow only one question.

It was a really good question as well. [Laughter.]

I thank Brian Whittle in the spirit of recognising that there is cross-party support for some of the approaches that we are taking. I also recognise his keen interest in the subject.

Early intervention will be the focus of what we do. We do not want to wait until a problem presents itself before we tackle it. Early years intervention is a big part of the ideas that we have put forward in the strategy, using opportunities around the expansion of childcare, the fact that we have a range of different things going on around the food that is given to children in a school setting and ensuring that we use opportunities in the classroom to instil good habits early on.

However, early intervention must not just be associated with action in the early years. There are a range of measures and prevention is the hallmark of our approach.

Obesity used to be a condition of the wealthy and is now a condition of the poor. What is being done to address the key issue that contributes to obesity, which is poverty and food poverty?

There are a range of actions. My colleague Angela Constance has set out a number of actions that she and Jeane Freeman are planning around creating a fairer country by ensuring that the powers over social security that are coming to the Scottish Parliament are delivered in a fair and equitable way, with dignity being the hallmark of their approach. We are ensuring that we tackle child poverty and a range of other issues to challenge the inequalities that too often persist. We recognise that obesity has the most impact on our most vulnerable communities.

To go back to what Miles Briggs said, it is not just about me taking forward a strategy on my own—the issue has cross-portfolio interest across Government to ensure that we have a whole-country approach to tackling the problem.

Will the minister outline how the Scottish Government’s obesity plan will link with curriculum for excellence and does she agree that the plan offers an opportunity for schools in ensuring the health and wellbeing of their pupils? I should declare an interest as the education parliamentary liaison officer.

As Jenny Gilruth suggests, the curriculum for excellence provides us with opportunities to ensure that pupils develop a full understanding of food issues in the widest sense, for example learning how to cook, choosing food and the influence of advertising and culture.

Our proposals in the strategy will look to ensure that such work begins in those important early years, including with parents, and continues through pre-school facilities, ensuring a natural progression of advice and engagement. It is also important that we recognise that that work does not stop outside the primary school, because we also need to work hard to target and support adolescents. If we intervene in the early years, that work can potentially unravel if we do not have support for our adolescents as they emerge into adulthood. We need to ensure that there is age-appropriate advice and support at every part of a young person’s life journey.

Along with Cancer Research UK and Obesity Action Scotland, the Greens firmly support restricting price promotions. I hope that the consultation is about how we restrict them, rather than whether we restrict them. How will the strategy make healthier food more affordable? How will it directly support producers of that healthy food?

There is no intention to shy away from the big things that we need to do, particularly around restricting the marketing and promotion of foods that are high in fat, sugar and salt. There is the opportunity for Alison Johnstone to contribute over the lifetime of the consultation to ensure that that message is heard loudly and clearly, and it is one that we are determined to continue with. I put on the record that we intend to continue to work with industry on that issue, particularly with our small and medium-sized enterprises with regard to the reformulation that they need to do to adapt. That is why we have set out £200,000 to support small and medium-sized enterprises to respond to the challenges that they will face.

Does the Scottish Government agree that all health boards and local authorities should develop strategies and performance indicators for striving to reduce obesity in children?

We certainly encourage the use of the health visiting pathway, for instance, which presents opportunities to ensure greater measurement for children and their own indicators. We certainly encourage local authorities to use that information to take action in partnership with others. Our intention is also to maintain and expand the existing child healthy weight work, which is happening right across the country. However, I acknowledge the point that Gail Ross makes, and we expect our boards and authorities to take forward appropriate work in that regard.

Does the minister agree that physical activity in the early years has to be more than just the provision of the daily mile in our schools? In recent years, there has been a quiet erosion of unstructured sessional activity for young people in our communities. Will the minister commit to putting increased access to both youth work and play at the heart of the obesity strategy?

There is a real progression for children in the early years in terms of their co-ordination skills, their ability to throw and catch, and all those things that they learn from play. The play strategy was so important because it gave play the serious emphasis that it required in order to ensure that children had the best start in life. That allows some young people to do what we have seen in the case of Judy Murray’s children. She played simple games with her children and we can see what that led to for them. Play creates the firm foundations that allow young people to proceed to elite sport, if they want to, but it also instils good habits for children to be active and enjoy their childhood and to be active and enjoy sport later on in their lives.

Scotland has a thriving food and drink sector, and the Food and Drink Federation Scotland estimates that 97 per cent of that sector is composed of micro to medium-sized businesses. Can the minister outline what support will be provided to SMEs to enable them to reformulate their products to support the delivery of the Scottish Government’s ambition?

We have set out in the consultation document that we will set up a fund of £200,000 to help support those small and medium-sized enterprises, because they will perhaps require a bit of support in responding to the strategy that we will take forward. There will be not only a financial offering, but advice and support from, for example, our agency Food Standards Scotland, which will provide the expertise and knowledge to support those businesses in that transition. There will be both financial support, and advice and information support. That will be crucial for our very important SMEs, which are the lifeblood of our economies across the country.

What plans does the Government have for health checks for 40 and 50-year-olds, given that it has scrapped those checks during its time in office? How will the diet and obesity strategy help to address diet, activity and healthy weight for older Scots?

I have set out in the consultation document a lot of detail on the proposals that we are taking forward for type 2 diabetes, which I think will impact really positively on the age group that Annie Wells speaks about. There are a range of issues. It is also important to recognise that, unlike the UK Government’s strategy, which just focuses on children, our approach is for the whole population. It is designed to try to shift at every age and stage so that it is impactful for everybody across the country should they require support.

I see that Annie Wells is shaking her head, but those are the facts. This approach is very different from the one that the UK Government has taken forward. It would be helpful if the Conservative Party members here applied the same pressure to their colleagues down south to get them to stop shying away from going forward with a 9 pm watershed for junk food advertising for the most vulnerable people in our society: our children.

The last question is from Clare Haughey.

Obesity plays a significant role in the development of type 2 diabetes, amongst other conditions. Will the minister outline what steps will be taken to assist those who are most at risk of developing type 2 diabetes?

The diabetes prevention framework, which has been developed by an expert group, complements our strategy and proposals and considers the identification of high-risk groups. It supports early diagnosis, addresses the important questions of referral pathways to treatment, education and lifestyle management and is a fundamental pillar of our approach to how we effectively prevent the escalation of type 2 diabetes across the country.