Associate feature: The time for action on obesity is now

Obesity - Image credit: Holyrood

Scotland’s population has a big problem – with its weight. Scotland’s levels of overweight and obesity are the worst in the UK. 

Around a third of children in Scotland are overweight or obese and there hasn’t been any decrease over the last decade. Meanwhile the rates of severe obesity in Scotland are going up.

The Scottish Government recognises it needs to act on this. Its ‘A Healthier Future: Scotland’s Diet & Healthy Weight Delivery Plan’, published in July, outlines the measures it intends to take to halve childhood obesity by 2030. But there is no time to lose.

Obesity is currently the second biggest preventable cause of cancer in Scotland, responsible for 2,200 cases each year, and with links to 13 different kinds of cancer.

However, Cancer Research UK believes that obesity will actually overtake smoking as the leading preventable cause of cancer sometime within the next couple of decades.

“We’ve been very complacent, I think, for a very long time and we’ve stored up these problems which we’re now seeing,” says Cancer Research UK’s Linda Bauld.

Cancer Research UK’s Scale Down Cancer campaign asks the Scottish Government to tackle this issue head on, calling on MSPs to enact legislation restricting price promotions on junk food, particularly multibuys such as buy-one-get-one-free and three for two.

Bauld says the organisation wants to act early, because “we’re not just interested in helping adults lose weight – although hugely important – we’re interested in policy actions that will help prevent obesity.”

The key, she says, is changing the food environment.

“We’ve been trying to highlight the importance of achieving changes at the population level. That is really about changing the food environment, so our Scale Down Cancer campaign is about changing the food environment to improve the Scottish diet and to address obesity.

“I often talk about the four Ps – price, promotion, products and place – and we’re focusing on two of those Ps: price and promotion. So, although we welcome all the recommendations that are in the Scottish Government’s heathy weight action plan, we’re particularly calling for restrictions on price promotions of foods that are high in fat, salt and sugar – so junk food.”

This is something the Scottish Government has indicated it intends to do, with the action plan detailing plans to consult on a ban on junk food promotions, but – given that it has already consulted on this once – there has been disappointment that it did not commit to just doing it.

Cancer Research UK has carried out research on a ban, and found it would be supported by around two-thirds of the Scottish public, who recognise that restricting price promotions on these type of foods is something that the government can do and they would welcome.

The reason for focusing on price promotions is because largely they’re used to promote unhealthy rather than healthy food.

Foods Standards Scotland has found that 43 per cent of junk foods are bought on any promotion compared to 27 per cent of healthier products. And over a third of calories brought into the home are purchased on promotion.

Multibuy promotions mean that those unhealthy products are the cheapest, the quickest and the easiest to access.

But what does Bauld say to the argument that banning cheap deals is regressive and hits the poor the hardest?

“We do get that criticism of any pricing measure. We had it on minimum unit pricing, we had it on tobacco taxation,” she answers, before explaining some of the reasons this is inaccurate in this case.

“Public Health England did some work and estimated that promotions lead to a 20 per cent increase in what we all buy. And that is independent of social class, so it affects everybody.

“But for the most disadvantaged, it probably has the biggest impact because if you don’t have a lot of money, spending 20 per cent more than you need to on excess calories rather than staple foods isn’t obviously a great outcome. So that’s the first thing.”

The second one is that promotions actually cause people to eat more.

“When you buy those… packets of crisps with five little packets within them – and in my local Asda I can get three of those for the price of two.

“Now if I buy those of a week... they disappear within that week, they don’t get eked out over time. So what tends to happen with junk food is we do eat it if it’s in the cupboard.”

The third issue is that it is only unhealthy foods that are being promoted.

“And the third one is the fact that it’s unfair, because the restrictions are just targeting primarily the unhealthiest foods.

“So what’s being marketed to people who don’t have much income are things that have a really limited nutritional content rather than family staples.

“Just to give you an example, around half of crisps and snacks are bought on promotion and that compares to less than a fifth of bread, for example.

“And we think that retailers would still be able to offer multibuy promotions, but on healthier goods, so it could be vegetables, it could be staple goods that are lower in calories and if they want to compete with other retailers, that gives them an opportunity to do that on that front.”

Although Cancer Research UK has been focusing on price promotions, it has also been campaigning on TV advertising, which is reserved at a UK level, and welcomes the recent news that the UK Government is to ban junk food advertising before the watershed across the UK.

“It’s not like a silver bullet, but I think we’re pleased that that decision has been taken and I think it will definitely have an impact and we support the introduction of that policy.

“The question for us now is that we need that implemented and… all they’ve said is that they’ll consult,” says Bauld.

Which brings us on to the Scottish Government’s ‘Healthier Future’ plan and its intention to consult on a junk food promotion ban. What did Bauld think of the measures outlined in the plan?

She says: “We were delighted overall. Some of the other measures that are in there, like weight management services, look great.

“We need to do more in primary care to help people engage around their weight and then have adequate support and referral if they want an option for support to lose weight.

“We were delighted around the measures on physical activity, but primarily we were just pleased to see that the government recognised that changing the food environment was key to reducing Scotland’s obesity problem.

“So overall, we really welcome the strategy, but the devil is in the detail, and a lot of the detail is still to be worked out, for example, how they’ll classify the products that they might restrict on price promotion.

“So we want that to be ironed out and we want that to be implemented as soon as possible. All our work has indicated that it is entirely possible, that it can be done.”

What is her opinion of the decision that instead of promising legislation on price promotions, the Scottish Government will consult again, even though it has already consulted on this?

“Basically, it’s a bit like the plan in England: we’d like these changes just to be implemented,” says Bauld. “…Because we already had a consultation, remember… The government has consulted. They should just do it.”

Given that seven per cent of cancer cases in Scotland are thought to be due to weight, that’s a lot more people going to get cancer for every year that there is a delay, which underlines the urgency.

Bauld is blunt about the need for action now, and that simply educating people about healthy food choices is not the answer.

She says: “People are affected by these things every day and people are dying from obesity-related cancers in Scotland every week. So I think we can’t really afford [to wait].

“We’ve talked about this issue for 15 years, to be perfectly frank, in terms of the price of junk food, its availability and its marketing… We really think that now is the time to do it and we shouldn’t wait.

“I think it’s not fair. Everybody recognises that Scotland has a huge problem with people being overweight and obese, there’s wide public understanding now of the fact that it’s an issue.

“Instead of just giving more information, you know, education and information approaches, which a lot of people feel if you just teach kids how to cook that will solve the problem, and it’s bollocks. That’s not going to do it.”

She concludes: “If we change the environment to shift it in a different direction so the healthier products are cheaper, the unhealthy products aren’t promoted so much, I think that can change it.

“Actually, the reason I am confident about that is because I have spent 20 years working on tobacco control and that’s exactly what we did.”