Katie Mackintosh examines Scotland's obesity problem
When First Minister, Alex Salmond, visited America last week to mark the 10th anniversary of the US Senate’s Tartan Day resolution he was keen to stress the deep-rooted historical links between the two countries. The occasion, which has this year been re-branded “Scotland week”, is a yearly opportunity to celebrate the cultural, economic and academic achievements of Scots and the shared sense of heritage that binds the two countries together.
However, America and Scotland also have something far less worthy of celebration in common. The US has the highest rate of obesity in the world with Scotland coming in a close second. While Salmond may be desperately keen to emulate Thomas Jefferson and the Declaration of Independence in Scotland, when it comes to our health, do we really want to be following so closely in America’s footsteps?
While the infamous Scottish diet of deep fried anything with a side of chips and a can of ‘ginger’ has long been the subject of affectionate ridicule, the toll that it is taking on our health is altogether more serious. There is now no denying that obesity has become a major public health concern for Scotland. According to a report published by ScotPHO in September last year, 22 per cent of men and 24 per cent of women in Scotland are now obese. This trend has also filtered down to the younger generations as one in five boys and one in ten girls aged between 2 and 15 are also obese, and the future outlook is even bleaker as 60 per cent of the Scottish population are expected to be severely overweight by 2050.
The link between health risks and obesity is stark, with Scottish estimates linking obesity to nearly 500,000 cases of high blood pressure, 30,000 cases of type 2 diabetes, 5,000 strokes and 30 per cent of all colon cancer cases each year. In addition, obese people in Scotland are an estimated 18 per cent more likely to be hospitalised than those of ‘normal’ weight.
The ScotPHO report states that “these figures provide little evidence that current approaches to obesity are having any impact”. So what more could and should we be doing? In a bid to reverse these trends, the Scottish Government has already announced an extra £40m for health improvement initiatives, including £15m that will be directly targeted at obesity. It is also in the process of compiling its action plan on healthy weight, physical activity and healthy eating, which is expected to be published later next month. Public Health Minister Shona Robison has already hinted that the plan will contain a number of “radical” proposals. Among the ideas mooted are proposals to ban sweets and fizzy drinks from school vending machines and limiting the number of times school canteens can serve chips; calls for councils to ban fast-food vans from near school premises and to stop children from leaving the premises at lunchtime in
a bid to prevent them buying junk food; calls for supermarkets to consider huge discounts on fruit and vegetables; and plans to extend the NHS-run adult slimming programme, Counterweight, which offers diet, lifestyle and exercise advice, to overweight children and their families.
The common thread in each of these approaches is the emphasis on preventing obesity, particularly in children, by establishing patterns of healthy eating and exercise in early life. Child obesity has more than trebled in the past twenty years, with projections predicting that if these trends continue more than half of British children will be obese by 2020. In response, the Scottish Government has pledged to make early intervention a key priority and has already agreed with COSLA a new indicator to reduce the rate of increase in the number of children outwith the healthy weight range by 2018, and a new NHS target to monitor the number of children successfully completing family-focused programmes that address the multiple cause of unhealthy weight. So is this focus on early years a step in the right direction?
Judith Manson, author of Child Obesity – a parent’s guide, agrees it is. She says that children are very vulnerable when it comes to eating as they often have no control over the kind of food that they are given, which is made all the more important because patterns of unhealthy eating choices that are established in childhood are likely to stay with them throughout their lives.
“In the first few years of life, a child’s body lays down cells to store fat,” she explains. “The more fat that is stored, the larger the number of cells created, in order to store more fat. It’s estimated that an obese child can have as many as three times the number of fat cells as a non-obese child, and when this process stops, the fat cells remain with the child for the rest of their life.
“The amount of fat the body wants to store is in proportion to the number of cells that have been created. So if you were overweight as a child, the theory goes that your body is programmed to carry more fat.”
Laura Stewart, who runs the Children’s Weight Clinic in Edinburgh, also places a strong emphasis on making sure children get the right messages about healthy eating and exercise earlier on so as to empower them to make healthy lifestyle choices. However, she also stresses the importance of bringing the family together for treatment, as she says no matter how determined they are to change their eating habits, the children will not succeed unless their parents are 100 per cent behind them. However, she says that many of the parents who she encounters at the clinic are nervous about attending for fear that they might be labelled “bad parents”.
“Some feel nervous because they genuinely didn’t realise that their child was overweight or obese, they just didn’t see it. The population in general is becoming more overweight so it is getting harder to recognise it.
“But some also worry about how they will be perceived by other parents and worried that they will be blamed for their child being overweight.”
She says we also need to look at the reasons that may be acting as a barrier to children.
“I was with one wee girl the other day and I was asking her how active she was and she said, well, I go to PE now and again.’ I asked her if she got excused from going for some reason and she said she regularly skipped class because she felt embarrassed about getting changed in front of the other girls.
“So low self-confidence is a real issue and we need to think really carefully about how we can create safe environments for these young people.”
The same applies for the grown-ups, she says, arguing that as well as the focus on preventing obesity, there is a need for governments and service providers to make sure they are prepared for the here and now. Reflecting on reports about doctors having to ask vets to scan their human patients in machines normally used to weigh cattle because the hospital scanners are not big enough for their obese patients, she says:
“I remember years ago working in a hospital where the larger patients had to be taken to the loading bay to be weighed because the scales didn’t go above 30 stone. How embarrassing is that for someone!”
This is the sort of finer detailing that she says might not get noticed by those who hold the purse strings, “but it is certainly noticed by the patients.”
Like Stewart, Manson argues that if healthy lifestyles are to be successfully established and bad habits broken, then it is important not to make
individuals feel guilty or ashamed about being overweight. She points out that of the World Health Organisation’s top ten facts about obesity; number six is that “nobody is responsible for being overweight or obese”
the World Health Organisation’s top ten facts about obesity; number six is that “nobody is responsible for being overweight or obese” 
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“There’s no single reason why obesity rates are so high,” says Manson, “but a number of factors around food and lifestyle have combined to cause the current situation.”
In particular she highlights the ‘obesogenic environment’ that we live in, which, she says, increases the risk of becoming obese.
“Over a generation our lives have changed dramatically with fewer people doing heavy manual work and more people sitting in front of computers all day. At home we sit in front of screens watching a wide choice of TV channels or using a home computer.
“We have more money to spend on more types of food than ever before and although there is a huge interest in sport, it tends to be of the armchair
variety.
“We generally travel by car and have houses packed full of gadgets and devices, which means we don’t have to use much energy.”
In this kind of environment, she says, it is wrong to hold individuals responsible for their size and condition.
And yet we frequently do. The media in particular must hold its hands up for being key. Manson argues that there is almost a “media epidemic about the obesity epidemic”, with the topic of obesity rarely out of the news and frequently reported with increasingly incredulous tones and obvious disgust.
“JCB needed for 52-stone man’s funeral,” shouts one headline. “UK firefighters sent to Move fat man’s TV,” screams another, while another cries, “World’s fattest man leaves house.”
Much of the coverage is alarming, says Manson, and leaves people confused about the facts behind the booming headlines and statistics.
In America, similarly aggressive press coverage has led to the evolution of a fat rights movement, led by organisations such as the National Association to Advance Fat Acceptance, with campaigners dubbing ‘fatism’ the new racism and calling for legislation to be introduced that would make it illegal to discriminate against someone on grounds of shape. And the anti-fat movement is beginning to gather pace.
When in 2000 a San Franciso gym put up posters featuring an alien and the slogan, “When they come, they’ll eat the fat ones first”, protestors held an aerobic demonstration outside the gym, waving “Eat me!” placards in response. The city has since brought in legislation making it illegal to discriminate on grounds of weight.
Elsewhere, others are also starting to fight back. The Russian Big Ballet company, which is currently touring the UK, describes itself as a “comedy ballet of weighty elegance”. Because of fierce competition to join the troupe, a minimum weight restriction was set at 17 stone, although the average weight of the dancers is 20 stone.
While the dancers readily poke fun about their weight – the lead dancer was recently “suspended” for losing too much weight, while another quipped that it is “easier to do the splits with a 120k down force” – they also have a serious point to make. The dancers aim to challenge stereotypes about fat people – they prefer the term fat to obese or overweight as it is more direct and the latter suggests that there is a normal weight to aspire to – and show that being overweight is not a barrier to keeping fit and healthy and following your dreams.
In the UK, 17-year-old Chloe Marshall is also challenging stereotypes by becoming the first size 16 beauty queen to reach the finals of the Miss England contest. Dubbing herself an “ambassador for curves” she plans to take on the competition’s “skinny minnies” in a bid to prove that it is ok for women to buck the size zero trend.
These examples from both sides of the Atlantic show us that it is important not to forget the ‘other’ side of the obesity debate. If individuals are to be encouraged to make healthy choices, then it is essential to ensure the key facts and messages do not become blurred
by prejudice; and if a way can be found to strike that balance then America and Scotland could have something else to celebrate after all.
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