Are we getting it right for every child? More than a quarter of Scotland’s children start school at risk of overweight or obesity

21 January 2021

With the coronavirus pandemic impacting many areas of our lives last year, it’s not surprising to hear that data collection for weight-related reporting has fallen victim to the unavoidable disruption of 2020. Despite the resulting fall in coverage, enough schools were able to participate in the Primary 1 BMI review to provide data representative of the whole of Scotland, and in December, Public Health Scotland published their 2019/20 report.

In this blog, we take a look at the recently published figures, consider how the coronavirus pandemic has impacted on the reporting of child healthy weight, and present a need for action to tackle this ongoing public health challenge.

Benefits of child healthy weight

Maintaining a healthy weight in childhood is beneficial to health throughout the life course.

Overweight and obesity in childhood is associated with a number of health problems, including early markers of cardiovascular disease, asthma and breathing difficulties, hypertension, and insulin resistance1. Damaging emotional and behavioural impacts have been noted, including, stigmatisation, bullying, low self-esteem and school absence2. It also has health implications as we move into adulthood: children with obesity have a higher likelihood of having obesity as adults3, increasing the risk of associated health problems such as type 2 diabetes, heart disease and various cancers4.

Prevalence of overweight and obesity among Primary 1 children in Scotland

This year’s review reports that 23% of Primary 1 children were at risk of overweight or obesity, with 10% specifically at risk of obesity. This remains consistent with the previous year’s findings, and although prevalence has fluctuated over the years, there has been no positive progress in reducing obesity rates within the last decade, with 22.4% of Primary 1 pupils in Scotland at risk of overweight or obesity in 2001/02.

Inequalities in child healthy weight

The inequalities gap in the BMI of Primary 1 children has been widening since records began in 2001/02. This is particularly the case for childhood obesity.

While children living in the most deprived areas of Scotland are more likely to be at risk of overweight than children in the least deprived areas (14% vs 11%, respectively), they are much more likely to be at risk of obesity (13.3% vs 6.4% respectively); in fact, their risk of obesity more than doubles.

Although there has been no real change in the obesity inequalities gap for Primary 1 children since the previous report, the gap in overweight has grown. The difference in prevalence of overweight between children in the most and least deprived areas was 1.8%; this has since widened to 3.2%.

Similarly, our recent analysis of data from the latest Scottish Health Survey report suggests that the gap in prevalence of overweight and obesity in Scotland’s children aged 2-15 widened by 5% between 2018 and 2019, with a 12 percentage point difference in risk between children living in the most and least deprived areas. Both the P1 BMI and Scottish Health Survey reports indicate that we are facing a significant and worsening challenge for inequalities and healthy weight.  We are not currently getting it right for all of Scotland’s children; much more work is required.


Primary 1 children in Scotland at risk of obesity, school years 2001/2 to 2019-20. Data from Primary 1 Body Mass Index (BMI) statistics Scotland 2019-20 report


Impact of the coronavirus pandemic on weight-related data collection

While the report states that the schools that took part are representative of the whole of Scotland, it is important to note that coverage dropped dramatically this year to only 41% of those eligible, as height and weight measurement were unable to take place in many schools due to the pandemic.

The exact impact COVID-19 will have on collection of data for school year 2020/21 is not yet known; however, in the past, data collection has taken place near the end of the school year, so whilst there is hope that the coverage may be somewhat higher than the 41% recorded this year, the impact of the current school closures remains to be seen.

Why is this data collection so important?

What we do know is that BMI-related data collection at different time points throughout the life course provides vital figures and statistics that help us visualise changes in population weight over time. This allows us to alert Governments and policymakers to any slowing or halting of progress towards reaching our population weight goals, and supports policy recommendations around the need to create healthier food environments.

It is imperative that we get data collection back on track as soon as possible, to support efforts to improve children’s health.

Achieving targets

While the Scottish Government has an ambition to halve childhood obesity by 2030, these reports have enabled us to highlight that we are still far off that target, and are in fact moving further from it. We are going in the wrong direction. 

The reports together also highlight the clear trend in the widening of inequalities in child healthy weight in Scotland, an issue that has been worsening over time.

A child’s weight can influence their physical and mental health both now and in their future.  Healthy weight is achievable for all children, but it will require bold and brave action to be implemented.  We must see our food environments changing both as we adapt to and recover from the pandemic.  We cannot wait any longer for action to be implemented.

We must create an environment in Scotland that provides healthy, affordable and accessible choices to everyone, especially our children.



  1. World Health Organization (2018) Obesity and overweight.
  2. Public Health England (2015) Making the case for tackling obesity. Why invest? 2016
  3. Singh A., Mulder C, Twisk JW., et al (2008) Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 9:474–488
  4. Jensen MD, Ryan DH, Apovian CM, et al (2014) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society. J Am Coll Cardiol 63:2985–3023.