The current consultation on a diet and obesity strategy for Scotland, A Healthier Future, has the potential to be truly world leading in its scope and ambition, and AHPs need to ensure they are at the heart of it.
When it comes to the challenge the strategy is seeking to meet, Scotland is already world-leading in a much less positive sense. We have the worst weight outcomes of the United Kingdom nations and among the worst of any Organisation for Economic Cooperation and Development (OECD) nation[1]. In 2015, 65% of those aged 16+ were overweight, including 29% who were obese. According to 2016 ISD figures, 12% of Primary 1 children are at risk of becoming overweight and a further 10% at risk of obesity.
It is therefore really positive to see a comprehensive and far reaching range of proposals put forward. We are particularly pleased that the government has recognised that encouraging healthy retail environments is important. Research indicates that retail promotions are used extensively on goods which are high in fat, sugar and salt (HFSS), and there is also considerable evidence of their effectiveness, especially to children. Buy-one-get-one-free offers, discounts and marketing around checkouts need to be regulated to help the public make healthier food choices.
Of course promotion and advertising in shops is just one element, and stricter rules in the out of home sector on calorie labelling, portion sizes and promotions and marketing are to be welcomed. Improving front of pack labelling more generally would also be a positive step, but we recognise the limitations the Scottish Government has in that regard.
We also agree that the Scottish Government should build upon and support the sugar reformulation work being undertaken by Public Health England, as well as future work which on calories and saturated fat. Dietitians can support Small and Medium Enterprises in Scotland to translate these recommendations (and others) into practice.
Taking steps to transform the food environment, like those mentioned above, will underpin everything else the Government does to tackle obesity. Weight management interventions, or active lifestyle programmes led by AHPs to help people reach and maintain a healthy weight, will be less effective if people are contending with shops, restaurants and even advertising on the bus that encourage them to eat unhealthily.
This consultation contains a lot of proposals we can get excited about, but there are certainly ways it could go further. It must ensure it builds upon existing successes, including the Child Healthy Weight (CHW) Programmes that are delivered in every NHS Board. Dietitians have played a key role in developing and leading CHW programmes across Scotland, and we believe this work has to continue and requires continued, long term investment.
Indeed thinking long term is important more generally. For this strategy to be a real game changer, it must think beyond the next electoral cycle. Obesity is a complex problem, and while we see the merit in targeting shorter term gains, such as interventions for those at risk of developing diabetes, the overall target must be a reduction in obesity and overweight figures in the population as a whole over the next 20 years or more.
Note to readers:
There is still time for you to comment on this consultation (it closes on Jan 31st 2018) and we the BDA Scotland Board would urge you to get involved. Our initial position statement may also be of interest to you and give you some points to consider when responding.
References
[1] 1 OECD (2017), “Non-medical determinants of health”, OECD Health Statistics (database). DOI: http://dx.doi.org/10.1787/data-00546-en
AHPs across health and social care. 