Healthy Weight Strategy

– in the Scottish Parliament on 27th February 2018.

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Photo of Kenneth Macintosh Kenneth Macintosh Labour

The next item of business is a debate on motion S5M-10652, in the name of Aileen Campbell, on developing a Scottish healthy weight strategy. I call on the minister to speak to and move the motion.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

The closure of our recent consultation on creating a diet and obesity strategy for Scotland provides a real opportunity for Parliament to unite and consider how we collectively create the healthier Scotland that I know we all seek.

The consultation generated significant attention. There were nearly 400 responses from a range of contributors, from members of the public to academics, from health professionals to the food and drinks industry, and everything in between. It is clear that this most pressing issue has captured the imagination. We are grateful to everyone who took part, and we will reflect on the contributions and publish analysis soon. Of course, today’s debate gives parliamentarians their chance to add their views and opinions.

It should come as no surprise that the consultation generated such interest. That interest echoes the growing recognition of Scotland’s diet and obesity challenges, which require urgent attention. Although there will be differing views and opinions on the approach that we should take, it is clear that the scale of the challenge that we face and the need to act decisively were widely recognised.

That view is shared by the public more generally. Yesterday, Food Standards Scotland reported that 91 per cent of people think that obesity is a serious problem. Although the issue is by no means new, there is a new resolve to tackle it, which is galvanising professions, the public and politicians alike. Just as we have done in the past in relation to alcohol and tobacco, we will need to rise to the challenge and take decisive action to bring about long-needed change. Work to address the issue will not fit neatly into an electoral cycle, nor—as Miles Briggs’s amendment makes clear—will it fit into one ministerial portfolio or one discipline.

Over the past 17 years, it has remained stubbornly challenging for us as a nation to meet our dietary goals, and it has remained equally challenging to tackle the associated health inequalities. In its new situation report, Food Standards Scotland reported that two thirds of people who live in Scotland continue to be overweight or obese; that 29 per cent of children are still at risk of becoming overweight or obese; and that around 32 per cent of adults who live in the most deprived areas are obese compared with just 20 per cent in the least deprived areas. Separately, the primary 1 body mass index measurement shows that obesity rates in the most deprived areas are 14 percentage points higher than they are in the least deprived areas. Poor diet affects all of Scotland but, as is so often regrettably the case, the people who are most impacted by poor health outcomes are those who face the greatest inequalities in life. We are all familiar with those statistics, but if we can get our approach right, it is not an inevitable situation.

We all know that the health consequences of obesity are life changing and that they can sometimes be life threatening. Obesity is the second-biggest cause of preventable cancer, behind only smoking. Food Standards Scotland’s recent report also illustrated the stark reality of the common diseases in which diet is a contributory factor: there were 6,697 deaths from coronary heart disease, 2,181 deaths from stroke and 31 per cent of primary 1 children had obvious dental decay.

The cost of obesity and poor health is unsustainable. It is costly to our economy and our national health service but, more importantly, it is costly to individuals and their sense of health and wellbeing. The biggest frustration is that all of this is largely preventable. For those reasons, we require a new strategy for Scotland that benefits everyone but which has a steely focus on tackling inequalities and which also focuses on reversing the trend of childhood obesity to ensure that children get the best start in life and the chance to flourish.

Our consultation focused on three strategic priorities: transforming the food environment; encouraging and supporting the adoption of healthier, more active lives; and building strong leadership and exemplary practice in the public sector and the food and drink industry.

On promotions, we recognise that we need to be bold in tackling the overall environment that makes it difficult to make positive dietary choices and which instead incentivises the taking of less healthy options. The reality is that much of modern-day life makes it hard to maintain a healthy weight, whether that is because of the energy density of today’s food, our increasingly sedentary lifestyles or the constant stream of messaging that encourages us to consume more food and drink.

That is why, as part of our programme for government, we announced that we would progress world-leading measures to limit the marketing of products that are high in fat, sugar or salt, all of which contribute disproportionately to ill health and obesity. However, other measures on marketing are needed. The food environment is not made up only of shops where we buy food; it is all around us, from adverts on bus stops and billboards to the food outlets in our high streets and near our schools.

We are all susceptible to advertising, but children are especially impressionable. That is why we continue to urge the United Kingdom Government to take action to restrict all such advertising until after the 9 pm watershed. We have argued that, if it does not make headway on the issue, it should provide us with the powers to take such action. When it comes to the powers that we have, we must ensure that we make the maximum use of all our levers so that we can make the impact that all of us want and expect.

The places and spaces that we live in also need to be conducive to healthy lifestyles. That is why we will continue to build on the good work that is being taken forward through the place standard to explore what more we can do in developing healthy, sustainable communities. We will continue to promote innovative ways of keeping active in everyday life, including the daily mile initiative, which is a simple but effective way of ensuring that people become more active in their daily routines. We have increased the active travel budget to encourage more people to be more active, including when they travel to work or to school, and we support initiatives such as football fans in training, which since 2010 has helped change and transform lives to ensure that much healthier lifestyles are adopted.

There is much more that we can do to support people who are already overweight, however. In addition to the funding that we provide to health boards for weight management services, we will invest an extra £42 million over the next five years to reduce the rates of type 2 diabetes. We will also continue to have a focus on the early years, as we understand that early intervention is key to instilling healthy habits that last a lifetime. We must be alert to the opportunities that are present, such as the roll-out of 1,140 hours of early learning and childcare, and ensure that children get the opportunity to understand the importance of healthy food choices.

We will also build on the good work that is happening now. That was illustrated last week in our Scottish maternal and infant nutrition survey, which found that 43 per cent of mums are continuing to breastfeed up to six months after birth, compared to 32 per cent who did so in 2010. There has also been a welcome increase in breastfeeding in the most deprived areas and among younger women, but there are still significant inequalities. We want to ensure that everyone has the best start in life, recognising the importance of early nutrition. As part of our current programme for government commitment, we will invest more resources in supporting, protecting and promoting breastfeeding.

Businesses also have an important role to play. To help them do that, we will support businesses to innovate. The soft drinks industry has taken great strides in advance of the United Kingdom Government’s soft drinks levy. That shows what can be done, but we recognise that there will be significant challenges for small and medium-sized enterprises. We will therefore develop a package of support for them, investing an initial £200,000 to help them make their products healthier. We will also work with industry, the enterprise networks and universities to ensure that the considerable existing resources for innovation support that work. Similarly, the out-of-home sector has the potential to play a significant role in driving improvements in the Scottish diet. Food Standards Scotland is developing a strategy that will include calorie labelling and portion control; as part of that, it will consult later this year on the issue. I encourage all parliamentarians who have an active interest in the issue to promote the consultation and take part in it where they can.

I am determined to ensure that we deliver a bold, innovative and effective strategy that draws on the evidence that we have to enable more people to have healthier, happy lives and to help relieve pressures on our NHS. Consensus is growing that there is a serious diet and weight problem that needs to be tackled in a much more concerted way than previously. The consensus includes this Parliament but goes much wider. We are about to embark on a journey that we have to recognise will not be easy. There is clear consensus around the statistics and the work that Food Standards Scotland has been taking forward, but there will be challenges, sensitivity and many questions. We need to recognise that the issue will impact on many people’s lives; it is not an issue that will impact on some people somewhere but one that will impact on everyone in our communities. We need to recognise that there will be challenges and that we need to remain alert to them.

We need confidence in our ambition and a desire to succeed. In a country of just 5 million people, we need to work together. I have said that it will be a challenge, but I think that it will be one that we will all relish because the goal is a healthier Scotland. Our innovative plans to limit the marketing of products that are high in fat, sugar or salt will be an important part of our forthcoming strategy. I very much welcome the open letter from the four health spokespeople for parties in this Parliament, putting on record their support for our strategy and their call for us to be bold and ambitious in it.

I sincerely look forward to hearing members’ views. I shall, of course, reflect on them as we develop our new strategy on diet, activity and healthy weight, which we intend to publish in the summer. I appreciate the consensus that has been built around our strategy and look to continue that consensus as we build a strategy that I hope the whole country can ultimately be proud of.

I move,

That the Parliament supports the development of an ambitious new Scottish healthy weight strategy; believes that fresh action is necessary, as two thirds of the population are above a healthy weight and almost a third of children are in danger of being overweight or obese; recognises that obesity and the absence of a healthy diet are clearly linked to harms, including type 2 diabetes, heart disease, stroke and cancer; supports proposals that are anticipated to have the greatest effect, including restricting junk food price promotions, exploring the strengthening of current labelling arrangements and enhancing how nutrition information is communicated; acknowledges that the food environment in which people live must be addressed in this work as this has a significant impact on the choices that people make for their diet, and encourages the Scottish Government to examine where the current draft strategy can be strengthened as a result of feedback to the recent consultation.

The Presiding Officer:

I call Miles Briggs to open for the Conservative Party.

Photo of Miles Briggs Miles Briggs Conservative

I welcome today’s debate and I thank the organisations that have provided useful briefings, including Cancer Research UK, the British Medical Association, Diabetes Scotland, Which?, and Obesity Action Scotland.

I believe that there is a significant degree of consensus in the chamber. There is a recognition of the extent of the challenges that we face as a country and consensus on how we can move forward in tackling this public health crisis. As the minister outlined, it is a crisis that we have to deal with rapidly.

It is a huge concern to all members that two thirds of all Scots are overweight and that we have one of the worst obesity records in the Organisation for Economic Co-operation and Development countries, with 29 per cent of adults being classed as obese. Meanwhile, almost 30 per cent of our children are at risk of being overweight, with 14 per cent now at risk of obesity.

Most weight and obesity indicators have flatlined or indeed—as is the case with mean body mass index—worsened in recent years, despite many interventions and initiatives and substantial corresponding investment, so it is clear that we need to have a real look at how a more far-reaching, more effective and broader approach can help to change that. The negative health and financial impacts of obesity cannot be overstated. Quite simply, Scotland’s obesity crisis means that too many of our fellow Scots are dying prematurely and it is a massive driver of the sad reality that life expectancy in Scotland is lower than in the other nations of the UK and among the very lowest anywhere in western Europe.

As well as leading to hypertension and heart disease, obesity is the single biggest preventable cause of cancer after smoking and, as we have heard, it is linked to 13 types of cancer. Being overweight or obese is the most significant risk factor for developing type 2 diabetes—it accounts for 80 to 85 per cent of the overall risk of developing the condition.

As we know, the prevalence of diabetes in Scotland has soared by 40 per cent in recent years. Average healthcare costs for people with a BMI of 40 are at least twice those for people with a BMI of 20 and the annual cost to our NHS of dealing with unhealthy weight and obesity is estimated to be around £600 million. The total economic costs of obesity to the nation, once wider economic impacts are taken into account, may be as high as £4.6 billion every year.

I commend Cancer Research UK for the excellent work that it has undertaken, through its scale down cancer campaign, to raise public awareness of how obesity is linked to so many cases of cancer and to so many different types of cancer, including breast, bowel, pancreatic and oesophageal cancers.

It is vital that that information is made available to the public so that people can understand fully the very real health risks of being overweight or obese. Until recently, only a quarter of Scottish adults were aware that being overweight could cause cancer, so the work of Cancer Research UK in the area is important and timely.

The Scottish Government’s consultation focused on seven key areas and although we cannot give our support to all of the policy proposals contained in the consultation, we are able to give our backing to a number of them, and to plans that we think can make a significant difference in relation to helping to change behaviours. We support moves to restrict multibuy promotions on junk foods that are high in fat, sugar and salt—a restriction that a number of supermarkets have already undertaken to do themselves.

Food Standards Scotland has identified that almost 40 per cent of all calories, 40 per cent of total sugar and 42 per cent of fats and saturated fats were purchased on price promotions in 2014-15. Consumer spending on price promotions in the UK is now the highest in Europe and 50 per cent of foods that are high in fat, sugar and salt are purchased on promotion. The potential reach and impact of restricting such promotions is therefore clear, and we support such restrictions.

As the minister mentioned, polling that was commissioned by Cancer Research UK demonstrates that nine in ten parents believe that supermarket promotions impact on what they buy. It also indicates broad public support for restrictions, with two thirds of Scots supporting the proposal and three in four people wanting the balance of promotions to be shifted towards healthier items. Recent polling by Which? also suggests that a substantial majority of the public want more supermarket promotions and offers to apply to healthier food choices. There are clearly market opportunities for supermarkets and retailers if they move towards that approach.

As well as restrictions on junk food multibuys, and as part of a vision where the consumer can have access to the most relevant and useful information about their food in order to be able to make the best-informed choices, we also support moves to explore how labelling can be strengthened and improved in this area. The Scottish Government must, of course, also work with the business community to ensure that its concerns and needs are addressed in any changes to labelling processes and in how they are implemented. I hope that retailers will step up to the mark to help the country to address and tackle this public health issue. We know that retailers have spent significant sums of money on mapping consumer behaviour in stores and I hope that they will help to provide a healthier retail environment in future, as that addresses the future health of their customers, after all.

Although the consultation includes a number of individual policies that we support and which are important and welcome, we believe that tackling obesity will involve even wider societal and cultural changes, which are needed to reduce overconsumption of unhealthy food. As our amendment makes clear, we believe that a cross-portfolio approach is vital. The health department and ministers must work hand in hand to embed preventative measures into cross-portfolio work and cross-policy areas—I welcome what the minister said on that. The Parliament’s Health and Sport Committee is often frustrated that many of the policy interventions that are advocated by health experts are the responsibility of education or planning ministers and sit outwith our remit and in other committees’ remits. I hope that we will see action on the issue across Parliament and Government. That cross-portfolio approach must also include the Scottish Government working constructively with local government and with all the third sector organisations that have a stake in the issue and an important role to play in our communities.

When we debate obesity, we cannot ever afford to forget that we need to focus on promoting healthier active lifestyles and exercise. My colleague Brian Whittle will have a lot more to say on that issue when he closes today’s debate for the Conservatives. We need to look at how calories are burned off by an individual as well as their calorie intake and look to ensure that everyone has access to the physical activities of their choice in their local community. We are a sporting nation. After the fantastic high-level sporting success that we witnessed at Murrayfield at the weekend, the question that we need to ask is how we can inspire Scots to undertake more physical activity in whatever form that may take.

Most people in Scotland, and indeed many members, will have woken up with a sore head on Sunday, and many may even have woken up with the previous night’s kebab—I am speaking for other members. We need to develop our national interest in sport from an observational to an active role, so I hope that that issue will be developed in the strategy. The way in which we plan our communities and community spaces has an important role in helping to achieve that. As the minister has outlined, many community sports clubs across Scotland are undertaking constructive community initiatives to open up facilities to their supporters and local communities and I pay tribute to them, especially those in my Lothian region.

However, much more still needs to be done to achieve that. On my way to work at the Parliament today, I noticed the new exercise bike that the council has located in Royal Terrace Gardens. I have noticed it a few times, but I have never seen anyone using the bike or seen where it is mapped so that people can have the opportunity for 15 or 20 minutes of exercise. On a recent visit to the Aviemore sports hub, members of the Health and Sport Committee were told that the hub has developed 15-minute staggered timetabling to allow parents and grandparents to drop off children and grandchildren in activity classes before going into classes themselves. We need to develop that joined-up approach across Government and across our sports facilities.

My Lothian colleague, Alison Johnstone, has highlighted on a number of occasions the fact that many people do not jump from low levels of activity to exercise classes, because they find that a challenge.

The Presiding Officer:

Please bring your remarks to a conclusion, Mr Briggs.

Photo of Miles Briggs Miles Briggs Conservative

We heard more about that point in Aviemore.

We hope that we will work constructively, as a Parliament and Government, to take forward a cross-portfolio approach. I support the Scottish Government motion and I hope that members across the chamber will support my amendment.

I move amendment S5M-10652.1, to insert after “their diet”:

“; believes that a cross-portfolio approach is required to achieve meaningful change and embed the ambitions set out in the draft strategy; recognises the crucial role that an active lifestyle plays in tackling obesity and related conditions”.

The Presiding Officer:

I apologise to everybody for shortening the time for the debate.

Photo of David Stewart David Stewart Labour

I welcome the debate. Labour will support the Government motion and the Conservative amendment.

Obesity is a modern-day public health crisis that would be unrecognisable to Scots who lived through rationing in the second world war or a century before that, when church parishes from Shetland to Selkirk had to set up poorhouses to look after the hungry and the dispossessed. I share the view of Martin Cohen of the University of Hertfordshire, who has stated:

“Obesity is not just a matter for the nutritionist; rather, it is a product of social inequality and requires a collective social response.”

As we have heard, obesity has been on the rise for decades. Changes to our lifestyle have had inescapable repercussions for our diet: the increasingly fast pace of life means that we are more likely to buy quick and easy meals, and frequently to trade nutritious food for efficiency. We are also more prone to eating on the go, grabbing a meal deal from the supermarket or—maybe even and—getting a takeaway for dinner.

That shift in our eating habits means inevitably that we are taking in more sugar, salt and fat than we need. To compound the problem, as the minister said, the busyness of life means that fewer and fewer of us are active enough to burn off the calories. It is estimated that, in 2016, only 64 per cent of people over 16 reached the recommended amount of physical activity each week. The result is a country that has one of the worst records in the Organisation for Economic Co-operation and Development.

The consequences of endemic obesity are severe. The issue is less a ticking time bomb than it is a grenade with its pin already pulled. For individuals, being overweight comes with numerous increased chronic health risks and reduces life expectancy by an average of at least three years.

Like Miles Briggs, I commend the work of Cancer Research UK and obesity action Scotland, which are working extremely hard in Parliament and with the public to raise awareness of the link between being overweight and development of various cancers.

As a former diabetes champion of the Parliament, I am also encouraged by the focus in the Government’s consultation document on Scotland’s growing type 2 diabetes epidemic. Being obese or overweight is a significant contributing factor to a person’s developing type 2 diabetes. With our obesity crisis it is, unfortunately, no surprise that figures for type 2 diabetes make for bleak reading. More than 257,000 people in Scotland have been diagnosed with type 2 diabetes, and a further 500,000 are at risk of developing the disease. With type 2 diabetes can come serious complications, including the risk of blindness and amputation, besides the clear and grave implications for the individual’s quality of life.

Growth in that condition is just one example of the strain that obesity places on our national health service resources. The NHS spends almost £1 billion on tackling diabetes, but about 80 per cent of that goes on managing avoidable complications. The Government’s proposal to invest in weight-management programmes with long-term goals is, therefore, welcome. Diabetes Scotland has raised with me concerns that budget cuts to teams that are currently collecting clinical data could significantly undermine assessment of the programmes. Therefore, I urge the Government to consider seriously how it will support those existing resources. Talk of precise targets and desired outcomes is useful only if evaluation is possible.

When we are faced with the complexity of our obesity problem, it is easy to feel overwhelmed. Some people might longingly hark back to the good old days—I am sure that Stewart Stevenson could relate to that—when our food was less processed and children played outside rather than sitting indoors playing “Football Manager”. However, nostalgia is not the solution. The Government’s consultation proposals recognise that in order for it to be successful, a strategy must help people to make better choices by changing the environment within which we operate.

It is good to see the Government seriously considering how advertising and promotion of food that is high in fat, sugar and salt could be restricted. Key to that approach will not only be negative restriction of unhealthy foods, but making the option of a balanced diet more practical. Furthermore, the growth in out-of-home eating means that a strategy needs to have a consistently strong approach to labelling and marketing of foods by restaurants and takeaways.

However, the environmental shift needs to encompass more than just our food culture. Although the nature of the public health challenge might look modern, under the surface the root causes are the same old story: poverty, social deprivation and inequality are significant contributors to a person’s being overweight, and the least well-off are most at risk. For example, a quarter of children who live in the most-deprived areas are at risk of obesity, compared with only 17 per cent in the least-deprived areas.

The problem is captured in a Health and Sport Committee report from 2015, which stated:

“A boy born today in Lenzie, East Dunbartonshire, can expect to live until he is 82. Yet for a boy born only eight miles away in Carlton, in the east end of Glasgow, life expectancy may be as low as 54 years, a difference of 28 years or almost half as long again as his whole life.”

Therefore, our health inequalities are, in fact, just inequalities; they cannot be explained away purely as the food choices that individuals make.

As food prices have risen, it has become harder for families who are on a tight budget to buy meals that are both filling and nutritious. Evidence shows that consumers want to buy healthier food, but think that it is more expensive to do so. Therefore, the aim of regulation of product promotions needs to be more ambitious than merely to reduce the number of unhealthy foods that are on offer; it should also involve making healthy products more affordable.

Placing restrictions on the formulation, sale and advertising of food products is beneficial, but it is also complex and tricky. The minister might want to respond on controlling the number of food outlets near schools, in particular with regard to local authority licensing of mobile traders. Further, the planning system should consider how community spaces can encourage physical activity by being welcoming and safe.

Overall, the Government’s proposals for a fresh approach to tackling obesity are positive. The hope is that the proposals will now be turned into a strong and practical strategy that has clear targets and systems of evaluation. The key to tackling obesity lies in seeing it not only as a problem for individuals and families, but as a social problem that is similar to those around educational underachievement or criminality.

Poverty, not individual choices, is the driver of the problem. Thus, only fundamental societal change that fights inequality will cut the Gordian knot of widespread overindulgence.

I move, as an amendment to motion S5M-10652, to insert at end:

“; notes the importance of an active lifestyle for maintaining good physical and mental health and wellbeing and calls on the Scottish Government to ensure that resources are made available to support increased physical activity programmes for all ages and backgrounds; believes that the case for action is clear, and therefore calls on the Scottish Government to consider bringing forward the timescale for the publication and implementation of its strategy as a matter of urgency.”

The Presiding Officer:

We move to the open debate, in which speeches should be of five minutes, please.

Photo of Sandra White Sandra White Scottish National Party

I do not mean to be too harsh or sensational, but we need to tell the truth about what is happening at this moment in time, and we really need to educate people that being overweight can literally kill them. That has to be said. It can lead to high blood pressure, strokes and all the complications around type 2 diabetes that David Stewart mentioned, and which other members will discuss later.

We have to be quite harsh: we have to educate people so that they realise that being overweight has many implications for their future health. That message must be sent not only to young people, but to people of my age and older. It is never too late to change our diet and become healthier.

I welcome the debate and look forward to listening to members’ speeches.

According to the latest Scottish health survey, two thirds of Scots are obese or overweight, only a fifth of adults eat enough fresh fruit and vegetables—I am probably one of those who do not, so I will take that lesson—and only 31 per cent of men and 24 per cent of women meet the recommended levels of physical activity that are needed to prevent health risks in later life. Those are quite startling facts.

The Health and Sport Committee, which I have only recently become a member of, published a paper that said that Scotland has a policy framework that could enable the Scottish Government to make decisions

“ that may initially be unpopular

”— that part is published in italics—when introducing new initiatives. I am glad that the Scottish Government has decided to follow policies that might be unpopular, because as other members including the minister have said, we need to introduce such policies.

I am pleased that the Scottish Government has taken on board ideas on restriction of discounts on junk food, on minimum alcohol pricing, on restriction of car use, on encouragement of more active travel, and on action on fat and salt in food. If being unpopular brings us a Scotland that is healthy, and it improves the lives of our children, I am quite happy to be more unpopular than I sometimes already am in my constituency, and I certainly support everything that is in the Scottish Government’s strategy.

Various strategies are going on throughout the country, but I want to concentrate on some in my area. NHS Greater Glasgow and Clyde was mentioned by the minister. People in the area can ask their general practitioner or health visitor for a referral to the health board’s “live active” exercise scheme, which helps to build the confidence that is required to enable people to make positive lifestyle changes. It offers one-to-one catch-ups that help people to understand the sort of activities that can make their lives much better. Access to the scheme is generally free and, in my constituency, participants can attend classes at North Woodside leisure centre and Kelvin Hall. There is also a weight-management service that is linked with the scheme.

There are various other initiatives in my constituency—for example, Woodlands Community Development Trust. For people who live in areas like Glasgow city centre, the west end of Glasgow or Partick, where it is all tenemental properties, it is really important to have access to green spaces. We are very lucky in Glasgow because we have parks, but it is difficult for people who live in tenements to access to community gardens. Woodlands Community Development Trust runs a community garden, which is a fantastic project. There are 50 raised beds, local people grow and cook their own food, and people who cannot cook are taught how to cook. Perhaps we should look at providing more money for allotments: I will throw that open to the minister. The garden is a fantastic therapeutic space that is attended by school-age and nursery-age kids. There is a community cafe that is open to everyone, which the First Minister visited a couple of weeks ago. Refugees come along there and are fed. The real strength of the project is that everyone joins in; there are no distinctions between people.

Even if it means being unpopular, we have to ensure that people embrace a healthy lifestyle. However, there are other things on the ground that we can do, as well.

I am getting a look from the Presiding Officer, so I will finish there.

Photo of Christine Grahame Christine Grahame Scottish National Party

Thank you for betraying what I am doing here with my looks.

Photo of Annie Wells Annie Wells Conservative

We can no longer ignore Scotland’s obesity epidemic.

Individually, many of us worry daily about our weight—two thirds of Scots are concerned about their weight or the weight of someone in their family. Whether we are made to feel ashamed of our bodies by images in the media, or confused by ever-changing guidelines on what we should and should not be doing to maintain a healthy weight, it is clear that, as a country, we have become lost along the way.

Two thirds of adults in Scotland aged 16 and over are overweight and almost a third of children are at risk of being overweight. The repercussions of that are great, in terms of health and cost to the NHS. It is therefore vital that we set out an ambitious national strategy that embeds across all Government portfolios a focus on healthy eating and physical activity. That is why the Scottish Conservatives support the Scottish Government on the issue—in particular, in relation to the following areas.

It is estimated that 110 tonnes of sugar are purchased on price promotion every day in Scotland—the equivalent of 4.3 million chocolate bars—and that 50 per cent of high fat, sugar and salt products are bought that way. It is right, therefore, that the strategy seeks to restrict price promotions. Looking beyond the food that we consume at home and the fact that eating out can contribute up to 25 per cent of calorie intake, we also support improvements to labelling. We support, too, exploration of how changes to planning could have a positive impact on our food choices, and we agree with support for small businesses to adapt to new healthy food manufacturing opportunities, as they become apparent.

The biggest challenge is to create long-term cultural change—to address our relationship with food and to encourage people to make active healthy decisions. That should not always happen because the choices have been limited; it should also happen because we understand and appreciate the value of healthy eating from an early age. Key to that, as Miles touched on, is education and a cross-portfolio approach that embeds that ethos in our everyday thinking. To supplement that, we should improve physical activity rates from an early age—something that our “Healthy Lifestyle Strategy” paper detailed last year.

At present, 24 per cent of children are not meeting the current moderate to vigorous physical activity guidelines—a statistic that increases to 36 per cent among adults. Not only is physical activity one of the best things that we can do to improve our physical health, but it is proven to improve our mental wellbeing, mood and self-esteem, all of which are surely conducive to making healthy eating choices.

Linked to that idea is something that we are not talking about enough when it comes to maintaining a healthy weight, which is that we should take into consideration the psychological factors that are linked to our eating habits. It is really easy to forget, among the statistics and strategies, that bad food choices are often made knowingly.

Many of us desperately want to lose weight and we know roughly how to do so, but it is a real struggle. Among serious cases, as leading expert Dr David Blane recently pointed out in a newspaper article, there is quite a large number of adults for whom obesity has large psychological components. Often, there have been situations of adversity in childhood, or other stresses that people have been under that have led to overeating as a coping mechanism.

Furthermore, as I alluded to in my introduction, many of us are crumbling under the pressure of a society that bombards us with images of the perfect body, which distorts our perception of what is healthy and makes it difficult to motivate ourselves to achieve long-term and sustainable lifestyle changes. I ask the Scottish Government how it seeks to widen the focus of the strategy to take into account the psychological factors that influence our eating habits.

The final point that I will make is on the need to focus on how socioeconomic factors affect weight, and how awareness of that can be embedded in the strategy. Adults from deprived areas are more likely to be overweight or obese, and children in the most deprived areas are 8 per cent more likely to be so than are children from the least-deprived areas. I ask the minister for further detail on how the strategy will prioritise work with families who are in poverty and on low incomes, in order to ensure that we do not have such disparities.

In finishing, I repeat my support for a national strategy that seeks to address one of the greatest health challenges that face Scotland at the moment. Only by working together and embedding healthy eating and physical activity in our nation’s ethos can we achieve the long-term cultural change that is required to make Scotland a healthy-weight nation.

The Deputy Presiding Officer:

I remind members that they should use other members’ full names in the chamber. It is easily forgotten, but do so, please.

Photo of Kenneth Gibson Kenneth Gibson Scottish National Party

Paradoxically, although Scotland is renowned worldwide for its quality food and produce, obesity is now one of the major causes of ill health here. Our diets often leave much to be desired, earning us the unenviable position of being one of the heaviest nations in Europe. People of a healthy weight are now in the minority. They represent only 35 per cent of Scottish adults—and, sadly, I am not one of them.

There is no quick fix, and no single piece of legislation can change that. Instead, significant effort is now required on all sides—from policy change to a shift in societal behaviour—to ensure a healthier future for Scotland.

For millennia, people in most countries around the world struggled to have enough to eat. Indeed, a century or more ago, corpulence was seen as a sign of health and wealth. Now, the opposite is true. Rises in obesity have largely been driven by the increased availability of affordable and accessible food and drink that is high in salt, saturated fats and sugar, combined with increasingly sedentary and time-stressed lifestyles. Therefore, in addition to individual effort, cultural and environmental changes that determine what people buy and eat are needed to deter excess weight gain, to support individuals to maintain a healthy weight, to encourage people of all ages to exercise more—even if it is just by walking—and to promote active travel.

Obesity can reduce the average lifespan by a decade or more and can have serious and debilitating consequences on physical and mental health, such as cancer, type 2 diabetes, strokes and depression. It also results in an astonishing economic burden, costing NHS Scotland £600 million a year and significantly reducing productivity in the Scottish economy.

Obesity is now one of the biggest public health challenges that we face as a nation, with significant yet preventable impacts on every aspect of society. To tackle it successfully, we must be fully aware of the risks that come with being overweight or obese and be prepared to combat them with tough action and a commitment to change. Some measures are already in place. The Scottish Government has invested £12 million over the past five years on programmes to support and encourage healthy eating, with campaigns such as supporting healthy choices and eat better feel better.

The next step towards a healthier Scotland is the new Scottish Government diet and obesity strategy document, “A Healthier Future—Action and Ambitions on Diet, Activity and Healthy Weight”, which includes bold measures that are designed to deliver a new approach to diet and healthy weight management, to empower change and to help people to make healthier choices.

The programme for government aims to provide more weight-loss support for the 300,000 people in Scotland with type 2 diabetes—a figure that has doubled in just two decades. I commend David Stewart for all the hard work that he has done in that area over a number of years. The programme also aims to progress measures that limit the marketing of products that are high in fat, sugar and salt.

In 2016, food and drink that was bought on price promotion represented 36 per cent of all calories purchased in Scotland, and UK consumer spending on price promotions is the highest in Europe. Consumers often make decisions automatically. I am sure that the majority of us have fallen victim to that and have returned from a shopping trip with unhealthy foods that we had not intended to buy, simply because they were on offer. The strategy represents a unique opportunity to reduce the wide-reaching influence that price promotions have on consumer behaviour.

By welcoming the views of a wide range of stakeholders on current proposals, priorities and implementation methods, this ambitious strategy seeks to revolutionise the food environment in Scotland. I heard many such views at first hand while I was co-convening last week’s Scottish policy conference keynote seminar on policy priorities for tackling obesity in Scotland with Brian Whittle at the Royal Society of Edinburgh, which we chaired in our capacity as co-conveners of the cross-party group on improving Scotland’s health: 2021 and beyond. David Stewart is the other co-convener of that group. I look forward to seeing many of the ideas from the seminar taken forward.

The development of the much-needed strategy is testament to the fact that we are reassessing diet. By utilising knowledge gained from tackling other public health challenges such as alcohol misuse and smoking, and by utilising the growing body of evidence on actions that are necessary to improve the health of the whole population, the measures will ease the process of making healthier choices each day by empowering change at national and personal levels.

As we develop the new strategy, it is important that we continue to promote community health projects that support people around Scotland in making healthy, affordable choices as well as promoting the vital role of an active lifestyle. That support, such as that which is provided by community food networks, delivers dignified services to individuals and communities through activities that are designed around cooking, growing and food education.

The programme for government outlined our ambition to make Scotland the best place in the world to grow up, be cared for and be healthy in. By committing to the delivery of the new strategy over the next five years and by offering advice and support to parents, we will get closer to ensuring the healthier future that Scotland desperately needs. After all, an obese child is around five times more likely to become an obese adult, and we cannot afford to let obesity become the new normal in Scotland, regardless of location or circumstance. I am sure that this progressive plan will be exactly what our society needs to kick-start a positive change in attitude and positive action towards diet, weight and healthy living.

Photo of Johann Lamont Johann Lamont Labour

I welcome the opportunity to contribute to the debate. I confess to feeling a little unease about the whole debate around obesity and weight, not because I am obliged to think it through in order to make a speech, but because there is a broader question here.

I cannot be the only person who is alive to the fact that, as well as today’s debate on healthy weight, there is a members’ debate tomorrow on eating disorders. Many eating disorders have developed out of body shaming or cruel comments about somebody’s size. I taught at a school that Lena Zavaroni attended, and she lost her life to an eating disorder. As I have got older and gained more awareness about eating disorders, I have realised that we must be very careful about the language that we use to talk about healthy eating and weight. We must fully understand the consequences for all too many of our young people, in particular, of the language that is used around that question.

For a lot of people—I am certainly one of them—the question of weight is personal. There could be a whole debate on why women, in particular, worry about their weight. As for many women, that has been a part of my personal life. From my childhood and from my time as a teacher, I know about the way in which a child’s weight can become a vehicle for bullying that is deeply ingrained among other children in the classroom. We have to understand the impact of that when we talk about the issue.

I do not in any way pretend to be an expert. I have perhaps been on as many diets as others. However, I will make a number of observations about what is important in the debate. I understand the public health impact of the issue and the importance of understanding the need to tackle the question of obesity at that level. There are good health messages on healthy eating and being active—on exercise and sport—to get across to our population, and it is important that we take the time to ensure that people are aware that those messages are for them and not just for other people.

It is also important that we move beyond a one-dimensional, if worthy, debate that is decontextualised—taken out of the context of Government policy choices on spending on health, on education and elsewhere. It is important that we mainstream the debate into the general question of the wellbeing of our communities and that we understand what is happening out there. Some of it is about choice, and we need to understand what shapes those choices. People are not simply malleable to the supermarkets’ wishes. Somehow, we need to combat that view.

We also need to understand that there have been many important health initiatives over many years, which are now being rolled back. In the early years of this Parliament, important measures were put in place at a local community level to encourage healthy eating and to ensure that people understood about cooking and sport. Work was also done through after-school activities in our most deprived communities. However, much of that work has gone because of the financial constraints of the recent past—we must recognise that those things go hand in hand.

It is not always easy to take on board many of the sports messages. I never regarded myself as a sporty person. While Brian Whittle was off winning gold medals, some of us simply watched. Nevertheless, in the 1980s, in particular, there was the development of the fun run movement. People like me put on running shoes and ended up running marathons because it was seen as something that all of us could do. It was easy, affordable and supported in our local communities by local authorities and others. We should learn from that.

It is also important that we understand health inequalities in the context of disadvantage. Why are people in deprived communities more likely to be obese? Why are women in deprived communities more likely to be obese than men in deprived communities? As a school teacher, I used to help to run attendance groups—we helped those who had a problem with coming to school. We realised that, often, the only thing that those children had in common with each other was that they did not come to school. That is also true of obesity, as not everyone who is obese is obese for the same reason. Therefore, the same solutions will not necessarily address people’s problems.

We need to think about how young people access sports. Does that need facilitating parents or are there ways in which community initiatives can support talented young people to access sports without relying on a parent with a car? Too often, that is the division that develops early doors in our communities.

We need to address those issues gently and understand their importance. We cannot back away from the importance of resources. I make a particular plea to the minister to ensure that local government is allowed to support those issues as well as the other things for which it has responsibility.

The Deputy Presiding Officer:

I have been quite tolerant but I cannot allow members to overrun by 20 seconds or so. That takes time away from other members, and we have no time in hand.

Photo of Ash Denham Ash Denham Scottish National Party

The food environment that we live in today is very challenging. We apparently need to make up to 200 food decisions every day. That is sometimes summarised in the moment when I look at an orange and think that peeling it is just too much effort—which is obviously wrong. Even something as simple as buying a coffee can be fraught with risk, because we know that we will have to spend five minutes in a queue, looking at the cake display. Having to make 200 decisions can test even those with the strongest willpower.

I have come a long way from the typical diet that I had as a 14-year-old—lunch was usually a portion of chips, and then I would leave school, go to the local shop and buy some sweets. Most people know that chips and sweets for lunch is not a great choice and that they need to eat more fruit and vegetables and get some exercise. The problem is that, although we often know what to do, we do not seem able to do it. Therefore, the strategy is timely in helping people to achieve that change in lifestyle.

The food environment is hugely important and is possibly one of the missing links in converting that knowledge into action. If people have junk food pushed at them constantly, it will be very difficult to resist. Extending the restrictions on junk food advertising to children is, therefore, very important and welcome. From my experience, I know that, if someone does not buy things as multibuys from the supermarket and they are in their kitchen cupboards, rarely, if ever, will they go out to the shops to buy them later.

The strategy also commits £200 million for small and medium-sized enterprises to reformulate their products to make them healthier, which is welcome. However, I raise a note of concern about that in relation to fizzy drinks. To avoid the sugar tax, manufacturers have reformulated their recipes but have replaced the sugar in those products with artificial sweeteners. I am concerned about the long-term damage that those sweeteners might turn out to do, especially to children.

We also need to be able to easily understand what we are eating—that, if something is marketed as healthy, it is actually healthy. Food labelling is key and is perhaps the other piece of the jigsaw. It must be easy for people to judge what the nutritional content of a product is. We also need to carefully regulate the additives and ingredients that go into our food.

Are we holding the food industry accountable for the products that it is producing? We know that some food products are deliberately designed to be as addictive as drugs. Should we force the industry to become more accountable and to label food properly so that people know what they are really eating? I think that we should.

I heard one scientist describe our food environment as containing, in many cases, not food but a food-like substance that our bodies do not recognise. That observation stayed with me. These products are not just making us fat; they are making us sick, too. I will illustrate why that is important using the example of bread. It is something that we might think of as quite simple but, similar to other food products, it is now a complicated tale of processing, maximising shelf life, reducing costs and using ingredients that probably should not be there.

In 1961, the British Baking Industries Research Association in Chorleywood devised a fast bread-making method using lower-protein wheat and an assortment of different additives and high-speed mixing. Until the 1990s, anyone eating commercial bread was also ingesting potassium bromate, which was found to be potentially carcinogenic and was banned in the European Union in 1994. It was replaced by enzymes that are used to make bread huge, soft, squishy and cheap. Those enzymes, which modern baking relies on, are designated as processing aids and, as such, do not have to be listed as ingredients. They are proteins that speed up a metabolic reaction and can be derived from bacterial, fungal, animal or plant sources. Many of them are derived from substances that are not part of a normal human diet and are known to cause occupational asthma in bakers.

Those processing aids are currently used either as ingredients or additives, and bread manufacturers are able to disguise their presence from the buying public legally. I think that the public deserve to know what is in the products that they are eating, especially when those ingredients could pose a risk to their health—and there is a cost to public health from products of that type. For example, there has been a recent rise in coeliac disease, and there may be a link between the two.

The strategy is a strong package of measures and I am pleased to support it.

The Deputy Presiding Officer:

I will not look at toast in the same way again.

Photo of Alison Johnstone Alison Johnstone Green

I will pick up on the points that Ash Denham has made. As someone who is just about to finish sugar-free February, the Cancer Research initiative, I have been encouraged to look at hidden sugars, which are not always obvious. I have a picture on my phone of a loaf of bread that contains caramelised sugar. I will not name the offending seller, but it just goes to show that it is a challenging area.

The Government is asking for cross-party support for action to tackle obesity, and I am happy to provide that support. As the Greens’ health spokesperson, I signed up to the joint letter from all Opposition parties to the cabinet secretary earlier this month, and I have previously written to the minister about the need to regulate price promotions. The 2016 Green manifesto supported policies that would make supermarkets healthier places to shop, proposing action on price promotions, advertising and product placement. It also suggested help for local authorities to create safe and exciting outdoor spaces, more green spaces, more walking and cycling routes and affordable and accessible sports centres.

I know that the minister attended the national cross-country championships at the weekend, where she will have seen thousands of people of all ages taking part in an activity that is probably about as affordable as it gets and can be enjoyed in many locations. However, she will also be aware, from her recent meeting with Hutchison Vale Football Club, of the challenge that some of our young people have in accessing the places that they need to access in order to train for specific sports, whether football or athletics.

The strategy addresses a multifaceted area, and I support the amendments from Miles Briggs and David Stewart in that regard. When we are seeking to make a big change, there will always be those whose interests are challenged. We should not just ignore their concerns, but we should ask why Asda might oppose restrictions on promotions in its stores. The protests of food manufacturers and big retailers are often framed as a valiant defence of consumers, which is why it was helpful that the consumer organisation Which? sent a briefing ahead of the debate with the results of consumer research that was recently conducted in Scotland. Only about 30 per cent of people thought that food manufacturers and supermarkets were doing enough to encourage people to eat better. Cheaper healthy food is what consumers really want.

Just over a month ago, I hosted an event with the Royal College of Paediatrics and Child Health on its state of child health scorecard for Scotland. Its report noted:

“Child health in Scotland ranks among the worse in Western Europe”.

It highlighted the strong relationship between deprivation and weight, which colleagues have touched on. For children in Scotland, overweight and obesity prevalence in the most deprived areas was 25 per cent, whereas its prevalence among those who lived in the least deprived areas was 8 percentage points lower, at 17 per cent. As Kenny Gibson noted, that pattern is in complete contrast to the pattern in the early 1970s, when obesity prevalence was the other way round: it was greater in children from the most affluent areas than in children from the most deprived areas. That relatively new pattern needs new actions.

The Government’s strategy talks about the need for a broad range of actions to address a complex problem. That is true and welcome. Good health means tackling income inequality, discrimination and prejudice; it is not only about having more nurses and hospitals.

The consultation also recognises that interventions need to rely less on individual choice and more on changes to the wider environment. Everyone wants to eat food that is tasty and nutritious; let us make that the affordable and easy choice.

A spokesperson from Coca-Cola was in the news recently, claiming that restrictions on price promotions have

“little evidence to support their efficacy”.

In 2015, a Public Health England study on evidence for action on sugar reduction identified price promotions as having the most robust evidence base of all actions. It said:

“Food retail price promotions are more widespread in Britain than anywhere else in Europe. Foods on promotion account for around 40% of all expenditure on food and drinks consumed at home. Higher sugar products are promoted more than other foods. Price promotions increase the amount of food and drink people buy by around one-fifth.”

Therefore, they clearly work. It also said:

“These are purchases people would not make without the in-store promotions.”

Annie Wells was quite right. We have to do another difficult thing: we need to consider the emotional and psychological dimension of food. Can we develop a more psychologically informed approach to weight management? That means working with people to address damaging patterns without stigmatising their weight—a point that was well made by Johann Lamont. We know that stigmatising behaviours and conditions only damages people’s health, making them more psychologically vulnerable and less likely to seek the support that they need.

I touched on that topic in a debate on world cancer day, because there is research that links obesity to adverse childhood experiences. The Parliament should explore that matter further.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I thank the Scottish Government for lodging the motion and for seeking to build consensus by reaching out to Opposition members in advance of the debate. I welcome the Government’s efforts to maximise the public response to the consultation.

Whenever we have debates like this in the chamber, I am reminded of the words of Thomas Jefferson, who said:

“The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.”

I think that he would be astonished and dismayed to learn that, some 200 years later, in a developed country such as Scotland, obesity and associated health conditions are at their current levels. Some 200 years later, our diet is worse in many ways, our engagement with physical activity is poorer, and our relationship with alcohol is far more extreme.

I do not doubt for a minute the sincerity of the Scottish Government’s commitment in that regard, but that commitment has been shared by every First Minister and health secretary and their Opposition counterparts since devolution began. Therefore, something is not working.

We have deployed a significant body of scientific evidence, innumerable publicity campaigns and a hope that the industry will respond and reformulate, but our collective response to the human cost and the reality that obesity is the second biggest cause of cancer after smoking has been found wanting.

Our nation’s waistline has proven to be utterly immovable. I have been struck by the fact that, as we have heard, almost two thirds—65 per cent—of adults in Scotland are still overweight or obese. That figure is largely unchanged since 2008. That a third of children are overweight is a national scandal. That correlates to the fact that children in Scotland who live in the two most deprived quintiles are least likely to have a healthy weight and delineates the link between social deprivation and obesity, which we have also heard about in the debate. I saw that at first hand in a detached youth work shift in Govan in 2012. I was astonished to learn then that there were no shops selling fresh fruit or vegetables within walking distance.

It is not just about diet, but about alcohol. We have again heard a lot about that issue today.

Although diet is disproportionately a symptom of poverty and relates to deprivation in our society, that is not exclusively the case. This morning, I was interested to hear, as I am sure that other colleagues in the Health and Sport Committee were, the chief medical officer, Catherine Calderwood, reveal that the highest rates of childhood obesity are to be found in the Shetlands and in Dumfries and Galloway.

We must be bold, comprehensive and look at a whole-systems and whole-country response. The chair of BMA Scotland, Dr Peter Bennie, is right to state that the Government has got some really good proposals here, but that we still “need to go further.” He reaffirmed his view in his response to the committee that voluntary measures have failed and that a heavier hand might be needed. As a Liberal, I instinctively find that approach uncomfortable, but in this case it is absolutely right.

We support measures such as the further restriction on sales and price promotions and on sponsorship and marketing, particularly when it is directed at children. We want the provision of calorific information for food purchased in shops and restaurants to be a requirement, along with, as the BMA has called for, the provision of readily accessible, specialist multidisciplinary weight management units.

I welcome today’s motion—I really do—but it refers only to part of the battle. My amendment, had it been accepted, would have covered the other aspects. A healthy diet is only part of the answer to Thomas Jefferson’s challenge. He talked about

“the care of the human frame”.

That very much relies on the pursuance of physical activity. In the Parliament, we are all very conversant about the many barriers to people using or having access to local leisure facilities, but there is another lens through which to look at the issue.

Social isolation, poor self-esteem linked to mental health issues and infirmity—issues that came to the fore and which I was struck by as part of the Health and Sport Committee’s sport for everyone inquiry—all contribute to poor levels of activity.

Basic anxiety is a principal barrier to strenuous activity—embarrassment gets in the way—but it manifests in other forms, too. I go on about fear of falling, but with good reason: it has a severely limiting effect on social orbit. If someone does not have confidence in the integrity of the pavements and the paths around them, they do not have as much physical activity at their disposal as they would otherwise have.

Two hundred years after Thomas Jefferson issued his prophesy, we have, in this country at least, stalled in our efforts to realise it. The cost of that can be measured by the strain on our NHS and in the life outcomes for those suffering from obesity.

I thank the Government for its motion and I assure it of our support for it tonight.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I remind members that I am the parliamentary liaison officer to the Cabinet Secretary for Health and Sport.

I welcome the Scottish Government’s ambitious new healthy weight strategy, which is a good foundation for tackling Scotland’s obesity problem. As others have said, healthy weight adults are in the minority in Scotland and almost a third of our children are in danger of being overweight or obese. Those figures are alarming, and without proper action our population will undoubtedly see an increase in health problems.

As Obesity Action Scotland has pointed out, we live in an obesogenic environment that promotes weight gain. To pick up on a point that was made by Annie Wells, I support body positivity, especially in our young people. However, there is a clear link between obesity and health issues such as type 2 diabetes, cancer and other chronic conditions. We must ensure that we have early intervention and that children have a healthy and positive relationship with diet and exercise from a young age, so that making informed and healthy choices is second nature to them. The new strategy empowers personal change and contributes towards the cultural change that is needed, too.

We need to tackle the link between poverty and obesity. Child poverty is a massive issue facing my constituency and Scotland more generally. My area of Coatbridge and Chryston is an old industrial heartland, which is recovering from the deindustrialisation and chronic unemployment of the 1980s and has been hit with a second whammy of UK austerity. Although I welcome the very pleasant Miles Briggs, his support for the strategy and, indeed, his amendment, I strongly believe, politically speaking, that those of us of a progressive nature must always be aware of the context of Tory policy when we are implementing actions at a local level and elsewhere.

There is clear evidence that healthy eating and steering clear of processed foods are difficult for people who are on a tighter budget. It is great to see that the strategy takes that into account and will support families who are on low incomes to help them make more informed choices about calories, sugar, salt and fat.

We perhaps talk about fat less than we talk about sugar, and we need to get that balance right. I would like part of the strategy to focus on making the public more aware of the types of fat. I do not have time in the debate to go into this, but there is strong and compelling evidence that we got it wrong many years ago when we lumped all fats together. Some fatty foods, such as nuts, avocado and oils, might bring significant health and weight benefits. I encourage members to watch the BBC documentary “Fat v Carbs with Jamie Owen”, which is very interesting and can still be seen on the iPlayer—I checked that.

I praise North Lanarkshire Council for its recent implementation of a 365-days free school meal policy. The Scottish National Party group on the council has supported such a policy and fought for it for a long time—indeed, it was doing so when I was a councillor—but we should give credit where it is due; the Labour Party has brought forward the policy for implementation, with a pilot in Coatbridge.

I agree with the British Psychological Society that children and families need not just information but practical, skills-based education if we are to increase the likelihood of information being translated into action. Such education could include more concrete skills training, to provide all school leavers with the ability to cook basic, balanced meals.

I have a wee bit of personal experience of the kind of education that I am talking about. Just last week, we had a health visitor appointment for our youngest boy, who is eight months old. I was impressed that the health visitor took time to talk about the sugar content in various foods and about hidden sugar. At the end of her visit, I told her that I am the local member of the Scottish Parliament. I said that I would bring up the issue in this week’s debate if I had the opportunity to do so—I think that she was quite happy with that. It is important to praise NHS Lanarkshire staff and others who promote healthy eating.

I also want to praise North Lanarkshire Council’s community learning and development Coatbridge locality team, which has been running a weaning workshop for about five years, in partnership with the health board, midwives and health visitors. The team runs a four-week course, which offers parents knowledge about diet and nutrition for their baby and their family. The course includes a practical cookery workshop. I have spoken to a number of participants, who commended the course for enabling them to gain knowledge about sugars, hidden sugars, fats and food labelling, which is especially useful when they are shopping in the supermarket. I think that a lot of them were quite surprised by what they had learned.

We need to get people’s approach to physical activity right from a young age. I welcome the Government’s approach to building an active nation and making our towns safer places to walk and cycle in, and I welcome initiatives such as the national play strategy, the daily mile project and the commitment to outdoor learning. Just yesterday, my older boy came home with a note from his nursery that said that he will participate in the Forestry Commission’s forest kindergarten, which will

“offer children the unique opportunity to play and learn outdoors, helping them connect with their natural heritage.”

That seems like a good place to end my speech, Presiding Officer.

The Deputy Presiding Officer:

It is an excellent place to end. Thank you.

Photo of Maurice Corry Maurice Corry Conservative

I welcome the opportunity to speak in today’s debate.

It is important that we get our response right on this country’s health. The statistics show the breadth and scale of the issues that we face in Scotland and are worth emphasising. Scotland has the lowest life expectancy in western Europe—and it has been that way for more than 30 years. The Royal College of Paediatrics and Child Health has found that the health of children in Scotland is among the worst in Europe.

When I was posted to Croatia with my job and lived there with my wife and children, we learned to live a healthy life, which was based on healthy food, tennis, swimming and great sunshine. When we returned to Scotland we had to adapt to having little sunshine and freezing seas, but we kept up with the fresh food, the olive oil and the exercise that have stood us well so far.

Obesity is a problem that looks set to continue over generations. A recent report from health experts showed that millennials are on track to be the most overweight generation since records began. That is a statistic; the real-world impact on individuals is immense. Poor diet has been associated with 13 types of cancer and is linked with a higher risk of type 2 diabetes and a large range of cardiovascular conditions that shorten life expectancy. The cost on society cannot be discounted, either.

I think that the public expect us to resolve the issue. A poll that was conducted on behalf of Cancer Research UK showed that 83 per cent of the public think that Scotland has a problem with obesity. It is clear that the current state of our nation’s health is one of the greatest challenges that faces Scotland.

I want to take a moment to note the excellent work of my colleague Brian Whittle in producing the Scottish Conservatives’ healthy lifestyle strategy in 2016. The document, “Healthy Lifestyle Strategy: Setting out a long term alternative strategy for Health, Wellbeing and Sport” is great and includes input and insights from a number of well-respected sources. As Brian Whittle hoped that it would do, it sets out a long-term alternative strategy for health, wellbeing and sport. In particular, it looks at the connection between having an active lifestyle and making healthy choices, and the barriers to inclusion and participation that lead to increasing health inequality and contribute to a widening attainment gap. I recommend reading that document, if anyone has not already done so.

It is important to highlight that obesity is not a problem that we can fix through the legislative process alone or by regulating what people can or cannot eat. It is most important that we ensure that the Scottish Government focuses on educating the public and providing the information that is required for people to make healthy choices, without removing their element of choice. Removing completely the element of individual choice would, in my opinion, inhibit and discourage the real cultural, nationwide changes that we need.

I welcome the introduction of domestic science into our schools in Scotland. That is a good step forward and has taught my son to cook healthy food.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

Some of the evidence is that the higher prevalence of food being purchased on promotion suggests that there is not a level playing field and that our choice is not as straightforward as I think the member has articulated.

Photo of Maurice Corry Maurice Corry Conservative

Yes, and offers—such as buy one, get one free—are one of the issues that are being addressed by the retail industry, and in particular the Scottish Grocers Federation. It is also being looked at very clearly in the soft drinks industry. The minister makes a fair point.

I want to take a moment to speak about the soft drinks industry, which I know very well from my past. The Scottish health survey data show that 35 per cent of children drink non-diet soft drinks at least once a day. The Scientific Advisory Committee on Nutrition recommended in 2015 that soft drink consumption should be minimised.

In the 1960s—believe it or not—there were 54 soft drinks manufacturers in Scotland; now there are only three. It is hardly surprising that we know ourselves to have a sweet tooth. We consume three times the recommended amount of sugar. An average adult’s daily limit should be 30g. A typical can of cola contains about 33g, which means that by drinking just one can, an average adult exceeds their daily limit.

I will not say that people should never drink a can of Irn-Bru or Coca-Cola, but, as with everything else, it should be done in moderation. To be fair, I add that to that end soft drinks manufacturers have sought very hard over the past few years to promote responsible consumption. Nevertheless, we in Scotland love our soft drinks. That is why I support the UK Government’s soft drinks industry levy, and I would like Scotland’s share of the levy to be spent on tackling childhood obesity. I think that that approach, in tandem with educating the consumer, would have the largest long-term effect.

Tackling our nation’s issues with health will not be easy and I doubt that those issues will be resolved in a single generation, but it is a fight that we need to have. We cannot keep kicking the issue into the long grass. We have to tackle it now, take it head on, and win.

Photo of Emma Harper Emma Harper Scottish National Party

I am pleased to speak in the debate. As the motion highlights, the food environment in which people live is one of the biggest challenges that faces us. Making healthy choices is difficult when food that is high in fat, salt and sugar is cheap, widely available and heavily promoted.

Colleagues have spoken about a range of issues—diabetes, heart disease, body image and diet. Johann Lamont mentioned tomorrow’ debate on eating disorders, in which I will participate. I am sponsoring the post-debate event in Parliament, which I encourage members to attend.

As a member of the Health and Sport Committee, I am delighted that the Scottish Government’s forthcoming strategy, which is backed by a £42 million investment over five years, will include world-leading proposals to restrict the promotion of junk foods as well as provide targeted services for those who have, or are at risk of developing, type 2 diabetes.

In November 2017, the cross-party group in the Scottish Parliament on diabetes, which I co-convene with Dave Stewart MSP, heard from filmmaker Anthony Whittington. He introduced us to his documentary, “Fixing Dad”, which focuses on the topic of type 2 diabetes. The documentary, which was aired on the BBC, is about Anthony’s faither Geoff. In November 2013, Geoff’s doctor suggested that a foot amputation might be necessary in the near future, because of Geoff’s type 2 diabetes and obesity. The arch of one foot had already collapsed as a result of Charcot’s foot, which is a complication associated with diabetes. His other foot was developing ulcers due to poor circulation, which is another type 2 complication.

Geoff’s sons, Anthony and Ian, embarked on a mission to overhaul their dad’s lifestyle and prevent the premature death that his doctors had forecast. Over the course of the year’s filming, we see Geoff’s transformation from an obese night-time security guard to an endurance cyclist and health activist. Geoff lost 7 stones in weight—almost 100 pounds—and he no longer requires any of his diabetes medications.

Following the success of “Fixing Dad”, the brothers are making new episodes using the same format and have had a big response from across the UK. I spoke to Anthony and his faither Geoff at the cross-party group and have since been in contact with him. I am impressed by his plans and his passion to effect real societal change.

The film’s message is that real change might not be easy, but it is achievable. Changing the habits of a lifetime is not easy, so it is important that the right support is in place, and the Scottish Government’s ambitious new strategy will empower everyone to make the right personal choices for themselves.

The prescription for Geoff by his two sons and the evidence of sustained weight loss—aye, it took a year—indicate that a model of social prescribing can work. Social prescribing is defined as

“a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of”—

Photo of Jamie Greene Jamie Greene Conservative

Type 2 diabetes is an issue that is very close to my heart, because my mother has it. One of the problems that she faces is understanding the sheer complexity of all the various diets that are out there that claim to cure the condition. Does Emma Harper have any views on how we could standardise the advice that is given to people with type 2 diabetes on what would be the best diet for them?

The Deputy Presiding Officer:

I do not know whether you are supposed to give a diagnosis, Ms Harper.

Photo of Emma Harper Emma Harper Scottish National Party

I am not a dietician or a diet expert, but I recommend that anyone who is having difficulty with dietary advice should seek specialist information from a dietetic specialist in diabetes management.

I see evidence of the benefits of social prescribing in Dumfries, where constituents Scott Manson and Karli Scambler, who are both veterans of the armed forces and are qualified in exercise referral, have established their own gym, which is called Rebuild Body and Mind. Scott and Karli’s aim is to provide exercise, recovery and rehabilitation in their gym as part of social prescribing. I support their goals and have encouraged constituents to engage with them so that they can share their knowledge and skills to help to improve the health and wellbeing of many people who have said that, for whatever reason, they do not feel comfortable going to a gym.

I encourage the Scottish Government, as it examines how the draft strategy could be strengthened, to consider as part its fresh action the need to gather evidence on how social prescribing is helping to improve the lives of people in Scotland.

The Deputy Presiding Officer:

I call Alex Rowley, who will be followed by Stewart Stevenson. Mr Stevenson will be the last speaker in the open debate.

Photo of Alex Rowley Alex Rowley Labour

Because I am always watching what I am eating in an effort to lose some weight, I know how difficult that can be and how difficult it can be to know what to buy, what to eat and what is good for you. Despite the efforts of successive Administrations, we still have issues with the level of information that is available to people.

For today’s debate, we have received some excellent informative and concerning briefs from many experts and organisations. Cancer Research UK has said:

“Obesity is the single biggest preventable cause of cancer after smoking and is linked to 13 types of cancer.”

Diabetes Scotland tells us that people in Scotland need to understand the risks of being overweight because, as it points out, the prevalence of diabetes has increased by 40 per cent over the past 10 years. I take the point that Johann Lamont made, but there is a need for us to be more informative with the public. I was certainly taken aback by some of the information that has been provided over the past few days. Obesity Action Scotland has said that obesity rates in Scotland are among the highest in the world.

I would say that, from the levels of information in those briefs, the debate today is one of the most important that we have had of late in terms of the future health and wellbeing of the Scottish population. Indeed, Cancer Research UK says that the Scottish Government’s diet and obesity strategy presents a once-in-a-generation chance to scale down the prevalence of cancer in Scotland. I therefore want to focus on what might be necessary to ensure that the final strategy is not just wishful thinking but an action plan for doing something to address the issues.

There seems to be consensus among most professionals and organisations that we need action and regulation to tackle price promotions for unhealthy food across the retail sector. Cancer Research UK says that Food Standards Scotland identified that nearly 40 per cent of all calories, 40 per cent of total sugar and 42 per cent of fats and saturated fats were purchased on price promotions in 2014-15. Consumer spending on price promotions in the UK is the highest in Europe and double that of Germany, France and Spain. As the minister knows, times are hard out there for many individuals and families and it is easy to see why people will be attracted to price promotions. It is therefore also easy to see why that is an area that the Government must take action on.

Fulton Macgregor made the point about the growing levels of poverty in Scotland. Much of that is not happening by accident but as a direct result of UK Government policy. Again, we need not just warm words from the members of the Tory party in this chamber but action to stop the attacks on the poorest and most vulnerable in our communities.

The Government must do more to curb the numbers of fast-food outlets. It is not a coincidence that there are more and more of those in areas where there are schools and, indeed, areas of long-term disadvantage and poverty. Overprovision is a material consideration for a licensing committee for a liquor license application. With the Planning (Scotland) Bill, which is making its way through Parliament, we have the chance to look at the overprovision of fast-food shops. That is an area that we should look at.

In the time that I have left, I want to focus on something that I have spoken to the minister about previously: the projects that have been run in Fife between Fife Sports and Leisure Trust and Fife Council that involve social prescribing, which Emma Harper mentioned. I am sure that there are good projects right across Scotland, but they are struggling for funding because of pressure on local government budgets. If we are serious about tackling obesity, we need to ensure that exercise is part of that. Social prescribing is an excellent way forward. As I said, there are brilliant projects, but they need funding.

The Deputy Presiding Officer:

I call Stewart Stevenson, who is the last speaker in the open debate.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

David Stewart made a sideways reference to what we should call my seniority in this debate. Indeed, looking round, I see that I am the only member—apart from someone in front of me, perhaps—who might remember rationing. Indeed, I was six years old—[

Laughter

.]

The Deputy Presiding Officer:

The ground is gradually opening up under your feet, Mr Stevenson.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

When I wrote this speech, someone else was in the Presiding Officer’s chair, of course.

Anyway, the bottom line is that I was six when sugar rationing ended, so as a youngster my palate was not used to having sweet things. There is an important point in the rather amusing comment that I made, which is that how we eat in the very early days of our lives will influence our preferences throughout our lives. I have survived to the point where my blood pressure is 120 over 60, my heart rate is 72 and my respiration is running at about 20. More critically, I have been sworn in to the Parliament on five occasions and on each occasion I have worn the same suit. However, now for the bad news: I am 30 per cent heavier than I was when I got married nearly 50 years ago. So, it is not all good news; it is merely not as bad as it might be.

I am afraid that I must say that most of that weight gain is probably fat rather than muscle. Brian Whittle—the most accomplished athlete in our number this afternoon—would no doubt agree that of course muscle weighs more than fat so perhaps there is a modest advantage.

I want to talk a little bit about the psychology of being overweight. We heard about tomorrow’s debate on eating disorders; of course, such disorders can cause people to be underweight or overweight. Being in possession of an eating disorder is linked to stress and low self-esteem; it might even be linked to some degree of mental ill health. Some of the language that is used does not help. We have used the expression “junk food” quite frequently in this debate and I think that when we suggest to people that they are eating junk food, we demean them and we disincentivise them; we make them feel bad about themselves, because the word “junk” is not a nice word. I do not think that it is the kind of word that we should use too much.

We have heard a little bit about labelling—from Ash Denham, for example. We need vigorous rules on labelling. It is sometimes really quite difficult to work things out. I pick things up and I look at how many calories they have. Then I notice that in tiny, tiny print, it says that the number of calories is what is in half the contents of the packet. In some cases, it is even a fifth of the packet. I want to see, in 20-point print on the front of everything that is prepackaged, how many calories are in the packet. Then I can start to do some meaningful estimation.

Members have talked about the outdoors and exercise. It is worth saying that we can extend the eating habits of the young by encouraging them to just walk around. There is hedgerow food—we normally pick enough brambles to last for most of the year. They go in the freezer. There has been a huge crop of wild raspberries in our area, and there are mushrooms out there. If I want something sweet when I am in the country, I pick up a clover flower and just stick it in my mouth and suck it; it is lovely. There is seaweed not far away, there is tree resin, and there are nettles, which are an excellent thing to add to mince, stews and so on. Of course, when they are cooked, they have no adverse effect whatsoever on one’s palate.

We have talked a bit about salt, which is, of course, sodium chloride. It is possible to buy formulations of salt that have potassium chloride, which is much less harmful to the metabolism, but gives exactly the same flavour benefits.

We have heard a little bit about alcohol. I must confess to members here and now that I reckon that the amount of calories in my alcohol consumption is probably equivalent to a meal a week, and for a lot of members it might be something similar. People should think of their alcohol consumption in those terms when they are thinking of its benefits.

In my lifetime—and I think that this goes to the heart of it—there has been a shift. At the beginning of my life, people were eating to live; now, alas, too many of us are living to eat.

The Deputy Presiding Officer:

That was entertaining as usual, Mr Stevenson, as well as informative. I call Anas Sarwar to close for Labour.

Photo of Anas Sarwar Anas Sarwar Labour

How do you follow that? It has been a really good debate and it is good that there has been so much consensus, because this is a hugely important subject. This Parliament has previously made it a priority to tackle smoking, tobacco and alcohol and I genuinely believe that the next big public health challenge is to tackle obesity and all the related health issues that follow from it.

As others have said, the health implications linked to obesity are truly horrifying. Alex Cole-Hamilton quoted some of the statistics and I want to repeat them. Obesity is the single biggest preventable cause of cancer after smoking and is linked to 13 different types of cancer. Obesity represents almost 85 per cent of the overall risk factor of developing type 2 diabetes. Obesity is a significant cause of ill health and premature mortality.

Those health implications are put into real perspective when we consider that Scotland has the highest number of people who are overweight or obese in the UK and has among the worst levels in the OECD countries—65 per cent of adults and 29 per cent of children in Scotland are overweight or obese.

As the minister said in her opening remarks, there is wide consensus on the issue—she mentioned the letter that has been signed by all cross-party health spokespeople—and that consensus can be built on so that we have an ambitious strategy that leads by example for the rest of the UK and globally.

Miles Briggs put on record his thanks to organisations, and I repeat those thanks to all the organisations and stakeholders that have provided briefings on this issue and which have regularly campaigned on it. I pay particular tribute to Cancer Research UK for its fantastic public health awareness campaign and for lobbying parliamentarians heavily.

David Stewart and Alison Johnstone spoke about the link between diet and health outcomes and their links to inequality and poverty. Those factors need to be looked at in the round in the obesity strategy, because they impact on life expectancy, life chances and life outcomes. Tackling obesity and its challenges is a matter of not only human interest but financial interest. We have seen the increasing pressures on the capacity and finances of the national health service, for which the cost of obesity and its outcomes are a huge issue.

Sandra White, Kenneth Gibson and others mentioned local community projects. We should put on record our thanks to not just our NHS and third sector organisations but the community organisations for their efforts to do so much important work through local interventions, particular in the hardest to reach areas. I will come back to the impact of local government budgets on that work.

The active lives project was mentioned by Annie Wells and other members. That is important, as we cannot look at diet in isolation. We have to look at active participation—sports participation or active travel—and ensure that alternative forms of travel are safe so that people can help to protect the environment and help to promote good health.

Johann Lamont made a very important point about body shaming and bullying and the pressures that come from popular culture. That hugely significant issue goes beyond putting restrictions on what people can eat or access to the resources that are available for educating young people and giving them confidence in their appearance and what they can achieve. Shaming individuals into action could be a negative approach; we have to encourage better behaviour and a change in culture through working with communities rather than looking like we are victimising communities or individuals.

Maurice Corry talked at length about sugar and the sugar tax. All that anger towards sugar and its impact made the dentist in me very happy, so more action on sugar is, of course, welcome.

A number of individual strategies are important. We need to look at advertising and its impact on shaping the mindsets of young people, including the timing of those adverts, which the minister mentioned. We need to look at the impact of portion sizes. There is a perception that healthy food is more expensive and less affordable than unhealthy food, and we need to work closely with retailers to make sure that affordable food is healthy and to encourage people to buy that more affordable healthy food. We need to take action on multibuys—it was mentioned that 40 per cent of the intakes of sugar, saturated fat and calories is from multibuys. It is important that we clamp down on multibuys, encourage better labelling and use our planning and licensing legislation to make sure that we have appropriate distances between schools and people who want to sell unhealthy foods.

I will close by touching on local government funding. We cannot look at active participation and active travel in isolation from local government finance. There is a direct link between the budgets of local authorities and their ability to invest in their local communities and in quality local facilities that can be affordable, safe and accessible for people from all backgrounds. This issue has broad cross-party support and I want us to be ambitious on it. I look forward to working closely with the Government to deliver an obesity strategy that will be historic and make real changes to people’s lifestyles.

Photo of Brian Whittle Brian Whittle Conservative

I assure Mr Stevenson that muscle is heavier than fat, but that makes no difference to me these days. I remember the day, but now it is night.

The debate has been interesting and consensual, which highlights the cross-party recognition that obesity is a serious issue that needs us all to park any political axe that we might wish to grind. The issue is not just about maintaining a healthy weight; it is also about eating a healthy diet to tackle modern-day malnutrition, because it is entirely possible to be overweight and malnourished, which is a growing problem not just in Scotland but in developed countries more widely.

From listening to the debate and reading the Government’s motion, I think that there is a danger that the healthy weight strategy will be considered in isolation. By that, I mean that we will discuss measures to tackle obesity as an individual health condition within only one portfolio, as Miles Briggs mentioned. I agree with Kenny Gibson that our relationship with food, drink and physical activity must be taken over a lifetime and that that is how we should frame the debate. When we decide what steps to take and what rhetoric to use, as Stewart Stevenson said, it is paramount that we do not stigmatise any condition or person, which Johann Lamont articulated well in discussing eating disorders.

In many cases, obesity, smoking and a poor relationship with alcohol have a real connection to poor mental health. Annie Wells took the time to bring that point to the chamber in a thoughtful speech. Successfully tackling those issues will, in turn, help to tackle the rising incidence of other preventable conditions such as type 2 diabetes, which was mentioned many times in the debate, musculoskeletal conditions, many cancers and chest, heart and stroke conditions. The two key pillars of a healthy lifestyle are physical activity and nutrition. There is a symbiotic relationship between them in that behaviour in one drives behaviour in the other. To consider one without the other offers limited scope for success.

When it comes to nutrition, Scotland has food producers who are recognised for producing some of the highest-quality food in the world, but it remains the unhealthiest country in Europe and the unhealthiest small country in the world. That suggests that locally grown produce is not getting to Scottish tables as it should. Our farmers produce the highest-quality food, are charged with custodianship of the countryside, pay the living wage and ensure the highest animal welfare standards but, when it comes to public procurement, a high proportion of our food for schools and hospitals—much of which can be sourced locally—comes from cheaper imports. I hold up East Ayrshire Council as showing the way and invite other councils to follow.

I mentioned poor nutrition and lack of physical activity as contributory factors in poor mental health. Good mental health is the starting point for maintaining or achieving a healthy weight. Therefore, although it is all well and good for politicians to provide advice on healthy eating, tax unhealthy food or ban multibuys for unhealthy products, that will be relevant only if the people whom we are trying to reach are in a mindset that will enable them to accept and act on that advice.

In its presentation “Food for thought: Mental health and nutrition briefing”, the Mental Health Foundation stated:

“One of the most obvious yet under recognised factors in the development of mental health is nutrition … There is a growing body of evidence indicating that nutrition may play an important role in the prevention, development and management of diagnosed mental health problems including depression, anxiety, schizophrenia, Attention Deficit Hyperactivity Disorder ... and dementia.”

The Scottish Association for Mental Health’s document “Scotland’s Mental Health Charter for Physical Activity & Sport” suggests:

Physical activity through sport or recreation has been proven to have a positive impact on physical and mental health and wellbeing.

Research suggests the less physical activity a person does, the more likely they are to experience low mood, depression, tension and worry.”

As quite a few speakers have highlighted, education must play a pivotal role in tackling long-term health issues. As SAMH suggests,

“There are lots of people who would like to get active but don’t know how.”

I have often said in the Parliament that education is a major solution to health and welfare issues.

We have not discussed the delivery mechanism for any strategy that we might introduce. Without that, the strategy might join others that are gathering dust on the shelf. The third sector is a key deliverer, and I will give three different examples where the same outcomes are being produced.

The cardiac physiotherapy department at Crosshouse hospital in NHS Ayrshire and Arran has been running an extended community rehabilitation programme that not only helps sufferers of chest and heart problems and strokes but welcomes people with other conditions, such as obesity and musculoskeletal problems. The comorbidity exercise and education classes have not only been successful in reducing further readmissions to hospital or doctors appointments but been instrumental in increasing the quality of life for people suffering with the conditions that I mentioned.

Last night, I again visited Doon Valley boxing club to watch Sam Mullen, who has had a massive impact on the community in Dalmellington. Having brought the community into his facility, he has developed a boxing club and a gym and has trained trainers. Parents now bring their kids to the boxing club, and the kids take part in boxing while the parents use the gym before picking the kids up and going home.

I want to mention the Centrestage catalyst programme, which uses music and art to draw people in and does good work in relation to mental health and how people deal with food.

The key word in relation to all of the above is “community”. Everything that I have mentioned happens locally, in communities. All of those programmes have a hook that engages people and brings them in so that other conversations can be enabled. It is not just about the money in people’s pockets; it is about how much things cost and access to opportunities in communities where there are few amenities and where people have little in the way of resource to travel. That speaks very much to the point that David Stewart makes in the Labour amendment, which we will support.

Sandra White and Emma Harper mentioned social prescribing in relation to third sector services. Our doctors, nurses, midwives, physiotherapists, health visitors, teachers and nursery workers must be the very first step in that strategy. However, who is looking after our healthcare professionals and teachers? They need the tools and the room to breathe that will enable them to have the healthy and active lifestyle that they are encouraging others to adopt.

We must consider the tension between a child’s right to be protected from health-harming products and their freedom to choose, and we have some difficult decisions to make in that regard. For example, what is the point of restricting junk food promotions if children can leave school at lunch time and buy junk food from a van that is parked outside the school? If the law does not allow the banning of such enterprises, we should change the law.

I see that I am at seven minutes. Do I have to close now, Presiding Officer?

Photo of Brian Whittle Brian Whittle Conservative

There are some very big decisions to be made but I say to the Government that, even if they are unpopular to start with, it will find that it has support across the chamber.

The Presiding Officer:

I call Aileen Campbell to wind up the debate.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

David Stewart described the challenges that Scotland faces around our diet as being like a Gordian knot. Indeed, when we consider the statistics and the cultural, societal and marketing changes that we need to make to ensure success, we could all be forgiven for feeling that the issue is impossible. However, the debate has underlined the understanding that there is a need to take action and a consensus that poor health need not simply be inevitable.

Of course, that consensus does not involve an agreement whereby we simply pat each other on the back and congratulate each other on having great ideas. The contributions that I have heard today have been constructive, informed and reflective, and, where necessary, challenging of the Government. That is absolutely correct because, if I, as the minister who is ultimately responsible for the policy, want to have a consensus and the backing of the Parliament, and if we all agree that a step change and a culture change are needed, we need space to contribute in a way that ensures that we collectively feel ownership of Scotland’s eventual diet and obesity strategy.

Food is one of life’s great pleasures. Others have reflected on their experiences, and my experience is one of growing up on a farm. From that, I got a sense of seasonality, of how food is grown and of its connection to the land. I was incredibly lucky. As Kenneth Gibson noted, it is regrettable that our global reputation as a country of fantastic produce, renowned the world over, is at odds with our obesity levels and our current relationship with food—that is a paradox. It is also at odds with the stark reality of the lives of people who rely on food banks and who experience the inequalities that drive Scotland’s public health challenges.

Therefore, I sincerely agree with the colleagues who have said that we cannot view the issue purely through a siloed health lens. The issue is relevant to all of my colleagues across Government, in transport, planning, social security, equalities, education and, undoubtedly, a lot of other areas. That is because obesity is costly to our national health service and impacts on its sustainability, costly to our economy and, as all members have recognised, costly in terms of health and wellbeing, particularly for those who are most disadvantaged.

The facts that many members spoke to this afternoon are stark: 65 per cent of adults are overweight and 29 per cent are obese; 29 per cent of children are at risk of becoming overweight; and 87 per cent of people with type 2 diabetes are overweight or obese. Sugar consumption in children and adults is above recommended levels. As Kenny Gibson said, our country is known for its produce yet, in 2016, only 20 per cent of adults had the recommended five a day of fruit and vegetables. Fifty per cent of the sugar that we consume comes from discretionary products, and food that is high in fat, sugar and salt is more likely to be purchased on promotion. That stark list of statistics illustrates the clear need for action.

However, it is important to acknowledge that we are not starting from scratch and that there are encouraging signs of progress. The percentage of inactive children decreased from 10 per cent in 2015 to 8 per cent in 2016 and the percentage of children meeting guidelines on physical activity has increased. Walking participation has helped to encourage a slight upward trend in general activity levels in the country, and 2,000 convenience stores in the Scottish Government healthy living programme—most of which are in our most deprived areas—are providing local access to fruit and veg. That relates to a point raised by Alex Cole-Hamilton.

Our healthcare retail standard is altering the offer of food and drink in our NHS. As Brian Whittle said, we need to ensure that we support our health staff, too, and the healthcare retail standard is an important way of allowing them to choose healthier options. In addition, as I mentioned in my opening remarks, breastfeeding rates have shown an encouraging upward trend.

Although that is all positive, as Kenny Gibson, Annie Wells and Alison Johnstone said, it is clear that there is a need for significant culture change. That is why boldness, imagination and innovation are required.

A big theme in the debate has been about empowerment, community-led initiatives and social prescribing. Those issues were raised by Annie Wells, Sandra White, Alex Rowley, Alex Cole-Hamilton and Emma Harper, and that was a key theme in the responses to the consultation—contributors acknowledged that the area needs to be strengthened. That illustrates the need to work beyond the health world. Members mentioned allotments and other community-led initiatives, the social connectedness that comes from such initiatives and the knowledge transfer and support that are the result of people working alongside one another in their communities. Alex Rowley mentioned projects in his Fife constituency. I know that he is keen on allotments and growing one’s own food. In Edinburgh, I met people who were getting knowledge transfer and support on what to cook and how to cook it. Those are very basic things, but they were much needed by people in those communities. Sandra White mentioned similar initiatives in her constituency.

There were some laughs at Stewart Stevenson’s comments, but he made an important point about the seasonality of food, and the ability to go out and forage for food. There is also an important point there about our lack of connection with the land and with food production. Stewart Stevenson talked about something that is the antithesis of processed foods, the increasing accessibility of which Ash Denham mentioned.

Annie Wells, Alex Cole-Hamilton and Alison Johnstone rightly raised the psychological issues associated with food—the body images, the stresses of modern living, the distorted perspective of what healthy looks like and, of course, the associated eating disorders. A recurring theme in many parliamentary debates of late has been adverse childhood experiences and their impact on people’s ability to cope. We could add to that the reliance on poor food choices in order to cope with past traumas. Our challenge is to understand, help and support people. I will continue to work with Maureen Watt as she takes forward her mental health strategy and we will ensure that there are adequate connections across portfolios to maximise the impact of our strategies.

That is why it is also important to demand more responsible marketing. Better promotions will be important in tackling the urge to buy and the bombardment of images that is so prevalent. Many members mentioned the empowerment that is an important part of community-led initiatives. That empowerment also needs to be felt in the arenas where we buy our food. We need to empower people and help them to make positive choices.

Johann Lamont made a really important contribution. Some of it was challenging to Government, but the key was her personal testimony and what she has seen in her professional life as a teacher. She was right to urge caution in our language, to avoid bullying, body shaming and all the things that can go along with them in our discussion of diet and obesity. She is absolutely right that we need to be bold and imaginative, but we need to temper that with caution in how we articulate the issue.

David Stewart made a good point about how we evaluate the work that we are progressing. He specifically mentioned issues around SCI-Diabetes, which is the most complete and comprehensive national disease register and database of a major long-term condition in the world. It is recognised the world over. Mr Stewart was right to make that point, because it will be a fundamental plank in how we manage, monitor and evaluate what we are doing in the strategy. To give him some comfort, I say that Scottish Government officials continue to work closely with the SCI-Diabetes team to look towards the long-term sustainability of that valued and world-renowned system.

Brian Whittle was right to point to young people. We have mentioned early years, but the danger is that, in talking about early intervention, we simply equate that with action only in the early years. We need to recognise that our adolescents require support as well, to enable them to continue to make positive choices. This year of young people gives us an extra imperative to make sure that we get our actions right.

It is clear that Scotland now has an appetite for a bold, innovative and effective strategy that draws on the evidence to enable more people to have healthier, happier lives and to relieve pressure on our NHS. I think that we all agree that the plans need to limit the marketing of products that are high in fat, sugar or salt, which will be important for our forthcoming strategy. As David Stewart and Stewart Stevenson mentioned, clearer labelling on our food and the clarity of the information that is imparted to members of the public on what we buy and eat will also be important.

Cancer Research UK, Obesity Action Scotland, Food Standards Scotland and a whole host of others have provided an authoritative and evidence-based voice on the issue, and they deserve the thanks that members have given them. They have very much set the tone and the scene to enable us, as politicians, to land what I hope will be an effective strategy that will create the healthier Scotland that we need.