Childhood obesity in Scotland - Member's debate in Scottish Parliament
February 2006
Motion for debate: That the Parliament expresses concern at recent findings published by NHS Scotland which suggest that the proportion of Scottish children who are overweight, obese and severely obese is far higher than anticipated in all age groups and is twice that of the expected UK average; recognises this means that more than a third of our 12-year-olds were considered to be overweight last year, 19.4% were considered to be obese and 11.2% severely obese; accepts that these figures represent a potential time bomb for the NHS in terms of the future costs of the treatment of obesity and related illness; acknowledges the commitment by the Scottish Executive to tackle this problem; considers that more robust measures are needed, such as investing further in the promotion of breastfeeding as the healthiest start in life, removing unhealthy dietary choices from our school environments and increasing the focus and commitment to physical activity in our schools; acknowledges that examples of best practice exist, such as South Coatbridge’s Healthy Lifestyle Project, and believes that, in light of these findings, a national debate is needed to re-examine all possible options and means of making progress on this issue.
Introduction
Childhood health and nutrition are of great concern to the British Medical Association and we therefore welcome parliamentary debate on Childhood Obesity in Scotland.
The BMA released its report Preventing Childhood Obesity in 2005 [Go to reference 1]. Its recommendations call for nutrition-based standards for schools meals, the removal of unhealthy foods from vending machines, improved food education in schools and the banning of advertising and marketing to children of unhealthy foods. A further recommendation was that good quality drinking water should be freely available and accessible in all schools.
Placing the needs of children at the centre of our thinking is vital, as this period of their life is a crucial stage their development.
Latest statistics
Worldwide over 22 million children under five are severely overweight. In the UK there are around 1 million obese children under 16 years of age. In Scotland, some 20% of 12 year olds are classified as obese and 33% are overweight. These soaring rates in obesity have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers. UK estimates indicate that, if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020.
Nutrition
In general, children and adolescents are eating more salt, sugar and saturated fats than is recommended and not enough fruit and vegetables. Attention has also recently focused on adolescents’ high consumption of fast food and soft drinks. The problem is most acute for those who are born into low-income families, with inadequate income and inadequate access to healthy food making it much more difficult to improve the diet [Go to reference 2]. There is increasing evidence that adult susceptibility to disease is associated with nutrition in early childhood and adolescence, and therefore early intervention is vital [Go to reference 3].
The BMA recommends that the Scottish Executive should mount a sustained and consistent public education campaign to improve parents’ and children’s understanding of the benefits of healthy living.
- Schools should provide food that conforms to nutritional guidelines and use the curriculum to reinforce messages around healthy eating.
- Food education and the acquisition of related practical skills should be compulsory. There should also be special emphasis on how to provide healthy meals on a low income. In order to do this effectively, teachers should receive training on what constitutes a good, balanced diet and how to prepare food.
- There should be mandatory nutrient and compositional standards for school meals. Maximum/minimum levels should be set for fat, sugar, salt, vitamins and minerals. In order to ensure compliance, the profile of health in HMIE inspections should be raised.
- The sale of unhealthy food and drink products from school vending machines should be banned in secondary and upper schools to continue the healthy eating message given in primary schools.
- Primary and nursery schools should all provide free milk and all schools should make free water available from clean and hygienic sources.
- The free fruit and vegetable scheme should be extended to cover more school children on a more frequent basis. The Scottish Executive should subsidise the cost of fruit and vegetables to encourage health eating.
- All manufacturers should be legally obliged to reduce salt, sugar and fat in pre-prepared meals to an agreed level within a defined time frame. School food contractors should be encouraged to use different approaches to food preparation more frequently, such as boiling, grilling and baking.
It should be emphasised that much more must be done to help families adopt healthier eating habits, this will help to ensure that children make healthy choices outside of schools.
Exercise
The BMA recommends that the Scottish Executive should increase funding and improve access to sport and recreation facilities within school and communities.
- There should be increased access to subsidised sporting facilities for both children and their parents. Ready access for those from lower socio-economic groups is particularly important. ‘Exercise on prescription’ (e.g. reduced cost/free access to local authority sports centres) should be extended.
- Choice in the style of exercise offered to children is desirable, as not all children want to play competitive or mixed sports. The needs of disabled children should also be reflected in the choice available.
- The BMA remains deeply concerned by the sale of school playing fields, even when this is regarded as the last resort. The protection offered to school playing fields should be strengthened.
Although a matter largely reserved to the Westminster Parliament, the role of advertising cannot be underplayed in relation to its impact on children’s behaviour. The BMA is concerned that children receive a huge amount of attention from food advertisers, with a marked discrepancy between the foods marketed at children and the nutritional quality of that food [Go to reference 4]. The media has an important role to play in forming attitudes to nutrition and there is scope to harness this potential and further regulate its more harmful impact [Go to reference 5].
- There should be a ban on the advertising of unhealthy foodstuffs, including inappropriate sponsorship of programmes targeted at school children.
- Celebrities and children’s television characters should only endorse healthy products that meet nutritional criteria laid down by the Food Standards Agency (FSA). The media has a role to play in encouraging improvements in children’s diet and exercise.
The National Consumer Council found that logos on food labels are more likely to confuse and mislead consumers, than help them make informed choices [Go to reference 6]. Research into the dietary knowledge of adolescents aged 14 to 16 years found that they did not tend to check nutritional labelling or weigh up the nutritional content of food that they chose [Go to reference 7].
- The BMA believes that accurate food labelling and clear information is imperative to encourage the public to make informed choices about their diet. Nutritional labelling must be clear, simple and easy to understand. Health claims made on food must also be addressed. Both nutritional and content claims on labels, and functional claims on packaging and in advertising, must be accurate and verifiable.
- We welcome the government’s initiative to make nutrition labelling on all foods mandatory, and for the labelling to indicate whether the product is high, medium or low in fat, sugar and salt [Go to reference 8]. The Food Standards Agency is developing a model of nutrient profiling to help define healthy and unhealthy foods, which is welcomed by the BMA. We hope that a model such as this will be used to set new standards in nutritional content, food labelling, and food marketing and promotion for mandatory adoption by the food industry.
- The BMA strongly advocates that nutritional labelling and health claims should be regulated. Regulations must apply to all traders, suppliers, manufacturers, caterers, agencies, retailers and importers of foods. They must be adequately policed and monitored by a board such as the FSA.
Existing primary care health professionals are not well placed to meet the needs of obese children [Go to reference 9].
gives very specific recommendations that need to be addressed when planning services. Staff with time and motivational skills are urgently needed.
- There needs to be funding to establish and sustain training programmes for those who are involved in the care of children with obesity. This includes specialist school nurses, health visitors and GPs.
- This should be complemented by resources to allow children from any region within the UK to gain access to specialist regional obesity services.
- There needs to be clearer guidance and advice as to the most effective ways of losing weight and maintaining weight loss.
Families should be educated and empowered through guidance that recognises the impact they have on their children’s development of life-long habits of eating and activity. Information and advice should appeal to ‘positives’ where possible.
- The BMA strongly supports and calls for a ‘National Obesity Institute’ or ‘Nutrition Council’ to improve collaboration between stakeholder groups.
- There should be UK-wide surveillance of factors that lead to childhood obesity, developed by the public health observatories.
- British Medical Association Preventing Childhood Obesity London: BMA 2005 [available online ]
- British Medical Association. Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books 1999.
- Public Health Nutrition 4 (6A) 1335-6 Early nutrition and risk of disease in the adult .
- British Medical Association. Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books 1999 [available online ]
- British Medical Association. Adolescent health. London: BMA 2003 [available online ]
- NCC annual_review 2001
- Food Standards Agency (2003) Food Standards Agency role in school based initiatives. London: Consumer Committee Meeting 18 June 2003. In Adolescent Health (2003).
- HL Deb 1 April 2004 c182WA
- The International Consensus document Speiser P, Rudolf MCJ et al (2005) Consensus statement: childhood obesity. Journal of Clinical Endocrinology and Metabolism 90(3): 1871-87.