I want to start by echoing the sentiments of the Obesity Health Alliance; in this debate, weight stigma does not help people lose weight. The right support, evidence-based weight management, and fundamental changes to our obesogenic environment and food systems are all required to tackle this.
The health harms caused by obesity are well known, but I initially wish to mention one particular aspect that does not get the attention it deserves: liver disease. On average 40 people die of liver disease every day. The Foundation for Liver Research and the British Liver Trust have sent a helpful briefing, but in truth I had already committed to mentioning it in this debate. My husband, Joe, was diagnosed with stage 2 non-alcohol related fatty liver disease in 2019, after wandering around complaining of a wee pain under his ribs for five years. Since his diagnosis, he has made difficult but necessary changes to his lifestyle; he has lost 22 kg, taken up hillwalking, and has been carefully monitoring his weight, and I am very proud of him.
Some 90% of liver disease is preventable and, luckily for Joe, at stage 2 it can be reversed; however, as it can remain asymptomatic for up to 20 years, three quarters of people are diagnosed at a late stage when it is too late for lifestyle changes or interventions. Liver disease is the third leading cause of premature death in the UK, with deaths increasing by 400% over the past two generations; this is in stark contrast to other major diseases, such as heart disease and cancer, so I urge the UK Government, who have acknowledged liver disease in their obesity plan, to come up with actions, including doing all they can to spread information about this disease and the ways of preventing it.
The disproportionate harm caused by covid 19 to older people, minority ethnic groups, the people living in greatest deprivation, and those with obesity, diabetes and respiratory and cardiovascular disease has highlighted new vulnerabilities and underscored existing health inequalities. While much focus has been put on the direct health impacts of covid, the SNP recognises that we must also work to shift our focus towards reducing those inequalities and preventing ill health. We want everyone to eat well, be a healthy weight and have equal access to care.
The ambitious and wide-ranging actions to address this challenge are set out in the Scottish Government’s diet and healthy weight delivery plan. The plan, which has over 60 broad-ranging actions, has a strong focus on prevention, including population-level measures to make it easier for people to make healthier choices, as well as more targeted interventions. Alongside this, the SNP Scottish Government also published “A More Active Scotland: Scotland’s Physical Activity Delivery Plan”. This recognises the importance of physical activity in promoting and maintaining healthy weight. Progress towards the outcomes set out in this delivery plan is being monitored through a dedicated set of indicators linked to the active Scotland outcomes framework”. The SNP Scottish Government are continuing to provide £1.7 million in 2020-21 for improvements to weight management services for children and young people. Earlier this year, the SNP Scottish Government also published the refresh of their diabetes improvement plan, which strengthens the actions in the original plan to improve the prevention and treatment of diabetes and the care of all people in Scotland affected by it.
The SNP has consistently pressed the UK Government to ban junk food advertising on television and online before the 9 pm watershed, and we welcome that this is finally coming to fruition. Online adverts on social media are an area the UK Government must tackle strongly, as other Members have mentioned, because they are pervasive. In our recent manifesto, the SNP renewed its commitment to halve childhood obesity by 2030 and to significantly reduce diet-related health inequalities by pledging to provide free school breakfasts and lunches to every primary school pupil in Scotland, all year round, and to all children in state-funded special schools in Scotland; and to pilot the provision of free nutritious school breakfasts in secondary schools and explore the feasibility of universal breakfast provision in secondary schools.
We also want to make Active Schools programmes free for all children by the end of the Parliament, continue to improve nutritional standards of food and drink in schools, and bring forward legislation over the next Parliament to restrict the use of promotions on food and drink that is high in fat, sugar and salt. We will also aim to enshrine the fundamental right to food in law, as the cornerstone of being a good food nation. That will form part of the commitment to incorporate UN human rights charters into Scots law.
Scotland has one of the world’s best natural larders, but we know that so many people do not eat well and that obesity remains a significant problem. Evidence shows that in less well-off communities it is more difficult to obtain good-quality, fresh food at a price people can afford. Community larder projects, such as the Govanhill People’s Pantry in my constituency, have been springing up all over the place and working hard to try to redress the balance, in this case by working with FareShare to provide access to food in the community.
The overriding issue of poverty is, of course, key to tackling a lot of the issues; access to sufficient healthy food and the means to cook it is not there for everyone, not least because of policies such as the two-child limit, the upcoming removal of the £20 uplift to universal credit and tax credits, the UK Government’s neglect of people on legacy benefits, and the pretendy living wage. They all contribute to a situation where people cannot afford to eat healthily. If the UK Government want to tackle obesity, they cannot continue to ignore this reality.
Investment in regenerating neighbourhoods, increasing access to walking and cycling, and improving parks is also significant in getting people out and about and moving. Just last night, alongside local councillors, I met mums and grans from the Calton Community Association, who are desperate to access the newly announced Scottish Government fund for parks so that their kids can benefit from outdoor play. An obesogenic environment, coupled with a culture that allows the insidious influence of food giants and their ultra-processed foods to be advertised not just to us but to our children, has proven to be a recipe for disaster. I am looking forward to watching the latest programme by campaigner Dr Chris van Tulleken, “What Are We Feeding Our Kids?” and urge the UK Government to tune in tonight. The supermarket aisles are heaving with unnecessary infant snack foods, and the new report by the First Steps Nutrition Trust should be essential reading for the Minister.
One significant point of difference in the UK and Scottish strategies concerns our youngest citizens. Scotland’s healthy weight strategy specifically mentions the significance of breastfeeding, which can of course have a positive effect on maternal weight, as well as that of babies. The UK Government are committed to consulting
“on our proposals to help parents of young children to make healthier choices through more honest marketing and labelling of infant foods.”
Ministers could start by doing more to protect babies and pregnant mothers from the rapacious global formula industry, and, in this the 40th year of the World Health Organisation’s international code of marketing of breast milk substitutes, fully adopt the code. That used to be something the UK Government would blame the EU for their inability to do, but they have lost that excuse and must now act. The code sets out to protect all babies, however they are fed. As the chair of the all-party group on infant feeding and inequalities, I do not set this up as any kind of false pro-breastfeeding/anti-formula battle, because I know that for many formula is essential. Many mums want to breastfeed, but are failed by a UK Government who do not see breastfeeding as a priority and do not invest in support. Some years ago, Norway changed its approach and it now has one of the highest rates in the world. Norwegian mums do not have different breasts from us, but they do have a Government who made their needs a priority.
The Minister said that if adverts did not influence people, they would not be used, and she is correct. Formula companies spend astronomical figures on marketing, a cost that gets passed on to consumers at the tills and makes it challenging for many families to afford formula, and on the promotion of follow-on and specialist formulas, which are not necessary, but exist largely as a means of cross-promotion. I hope the UK Government will also act on that, as they claim they intend to look at honest marketing and labelling. As an example of that marketing, I share the concerns raised by the UK’s Baby Feeding Law Group that the National Trust has formed a partnership with HiPP Organic, a company with many documented violations of the code over the years. We should be under no illusions: these kinds of partnerships exist to benefit the company and boost their brand, and I urge the National Trust to reconsider.
I wish to touch briefly on the issue of calories on menus, on which I have received many emails, as I am sure other Members have. I can see what the UK Government intend, and I appreciate that for some people having calories listed on menus may be useful—I have certainly eaten fewer Danish pastries since coffee shops started to put calories on the display—but the policy is not about anecdotes and headlines and must be based on evidence. For those with a history of disordered eating, this is a deeply serious issue and such triggers can be very harmful indeed, so I urge Ministers to be cautious in what they are doing and to listen to and learn from the evidence from expert organisations such as Beat and from those affected.
I commend the Government for taking action on a range of issues to do with obesity but urge them to look more widely at the factors that cause obesity and to follow the Scottish Government’s approach with a healthy weight strategy.