Priorities for Health: Promoting a healthy diet
November 2006
Introduction
In August 2006, BMA Scotland conducted a survey of members to identify their priorities for health. Around 600 doctors from all branches of the profession responded to the survey and their priorities for tackling Scotland’s poor diet are reflected in this policy briefing.
Background
The rates of obesity in Scottish women are among the highest in comparable European countries and almost two thirds of men and over half of women are either obese or overweight [reference 1].
Childhood obesity in the UK has increased significantly since 1995. One in three children is overweight by 12 years of age and in 2002, 22% of boys and 28% of girls aged 2 to 15 were either overweight or obese [reference 2].
There are many physical and mental health risks associated with being obese and inactive. Globally, obesity is estimated to cause about 10-16% of cases of breast cancer, colon cancers, diabetes and about 22% of ischaemic heart disease. The psychological and social effects include low self esteem, depression and body dissatisfaction.2
There is increasing evidence that adult susceptibility to disease is associated with nutrition in early childhood and adolescence [reference 3]. Childhood obesity is a risk factor for a number of chronic diseases in adult life including heart disease, some cancers and osteoarthritis. Some diseases, such as type 2 diabetes, however, can manifest during childhood. UK-wide, it is thought that treating ill heath caused by poor diet (in adults) costs the NHS at least £2 billion each year, rising to an estimated £3.6 billion by 2010 [reference 4].
There is a well established target that seeks to encourage people to eat five pieces of fruit or vegetables every day. However, on average, children aged between 5 and 15 consume only half the recommended amount and just over one in 10 children consume the recommended five-a-day, while the same proportion has none at all [reference 5]. Recent statistics show that the number of pupils eating school meals in Scotland has fallen to its lowest level for nearly a decade following the introduction of healthier menus [reference 6].
In general, people in Scotland eat more salt, sugar and saturated fats than is recommended and not enough fruit and vegetables. The problem is most acute for low-income families, with inadequate income and inadequate access to healthy food making it much more difficult to improve diet [reference 7]. 98% of doctors who took part in the BMA survey said that affordable, accessible and appetising healthy food is important if Scots are to improve their diet.
Interventions:
Improve Access
We all have responsibility for improving what we, and our children, eat. Access to healthy meals, information on what constitutes a healthy diet and encouragement to take part in physical activities will help halt the obesity epidemic in Scotland. Ensuring access to healthy food both at home and school and improving the understanding of why it is important will equip children with the ability to make healthy choices as they grow and develop. Ensuring that healthy food is affordable, accessible and appetising is important to help improve the diet of Scots.
Public Education
A sustained and consistent public education campaign should be introduced to help improve the understanding of the benefits of healthy living. As the problem is greater in deprived areas in Scotland, special emphasis is needed on how to provide healthy meals on a low income. Nine out of ten of doctors who responded to the BMA survey believe that subsidies on fresh fruit and vegetables should be introduced in deprived communities.
Nutritional content of foods
Manufacturers should be legally obliged to reduce salt, sugar and fat in pre-prepared meals to an agreed level within a defined time frame. Approximately 95% of doctors surveyed by the BMA agreed that mandatory standards for meals provided by the public sector (i.e. school and hospital meals) should be introduced which include maximum/minimum levels for fat, sugar, salt vitamins and minerals. Many schools and hospitals offer vending machines that provide snacks that are high in sugar, fat and salt. The BMA believes that all food available in public sector buildings should reach defined nutrient standards.
Clear indications of the nutritional content of the food people are buying would help them to have a clearer understanding what they and their families are eating. Above all, coordinated working should be encouraged with the medical community, parents, teachers, retailers, caterers, politicians and food producers to improve Scotland’s diet [reference 8].
Children
Because of the importance of nutrition to the development and future health of our children, improving the nutrition of food available to children should be a priority for all schools and parents. Both have an equally important role to play in a child’s healthy diet.
Research shows that in schools where there was no coherent food policy, children had poor knowledge of food and nutrition [reference 2]. Educating children in the benefits of healthy food is an essential element of encouraging healthy eating and approximately 97% doctors surveyed stated that the schools curriculum should reinforce messages of healthy eating.
To improve diet:
- Healthy food should be more accessible, affordable and appetising.
- Mandatory nutrient and compositional standards should be introduced for all food provided in the public sector with maximum/ minimum levels for fat, sugar, salt, vitamins and minerals.
- The sale of unhealthy food and drink products from vending machines in public sector buildings should be banned to reinforce the healthy eating message.
- The free fruit and vegetable scheme should be extended to all primary and nursery school children and the cost of fruit and vegetables should be subsidised to encourage health eating.
- The schools curriculum should reinforce messages of healthy eating.
1. Organisation for Economic Co-operation and Development. OECD Health Data 2001 A Comparative Analysis of 30 Countries. Paris. 2001.
2. British Medical Association. Preventing Childhood Obesity. London. June 2005
3. Public Health Nutrition. Early nutrition and risk of disease in the adult. Volume 4:6(A). pp.1335-1336. 2001.
4. National Audit Office. Tackling Childhood Obesity. London. February 2006.
5. Scottish Executive. The Scottish Health Survey 2003 Results. Edinburgh November 2005.
6. The Herald. New healthy school meals fail to entice the pupils. 7 June 2006
7. British Medical Association. Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books 1999.
8. International Obesity Taskforce. Obesity in children and young people, a crisis in public health. Geneva. 2004.
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk