5 years on, are we on track to halve childhood obesity in Scotland by 2030?

Exactly 5 years ago (14th May 2018) former First Minister Nicola Sturgeon announced an ambition to halve childhood obesity by 2030. This landmark announcement set out a clear commitment to prioritise child health and recognised the importance of healthy weight. The commitment was formally published in the Diet and Healthy Weight Delivery Plan in July 2018.

So, 5 years on from the announcement, what does halving childhood obesity mean in practice and how likely is it that it will be achieved?

Halving childhood obesity in Scotland by 2030 would mean achieving a child obesity prevalence of 7%. Although the commitment was announced in 2018, the baseline data year for the ambition is 2016. In that year, 14% of children were at risk of obesity^[1].

The latest available data paints a stark picture of a significant and growing issue of childhood obesity in Scotland, and demonstrates that we’re heading in completely the wrong direction. Data from the 2021 Scottish Health Survey (SHeS) reports that 18% of children are at risk of obesity^[2], which represents a 4% increase from the baseline, and moves us even further away from achieving the ambition by 2030.

The lack of progress on this issue is unsurprising. We have seen policy commitments that would improve the food environment for children, such as restricting unhealthy food promotions, delayed.    The lack of action means that more and more children are facing the physical and mental health consequences of living with a higher weight both now and in their future adulthood.

This has to change.

Figure 1 below shows the percentage of children at risk of obesity in Scotland each year since 2010. The purple line on the graph indicates the 7% child obesity prevalence we need to achieve if we are to halve childhood obesity by 2030. The orange line on the graph shows the actual rate of children at risk of obesity each year since 2010.

Figure 1: Proportion of children at risk of obesity in Scotland 2010 - 2021 (based on Scottish Health Survey data)

Why does it matter?

Protecting and enhancing children’s health is crucially important. Childhood is a critical stage and has a significant impact on health outcomes in adulthood. Evidence shows that children at risk of obesity are much more likely to have obesity as adults[3], and once they have obesity, it is very challenging to return to a healthy weight. Obesity in childhood also has a profound impact on children’s physical and mental health and wellbeing, including a greater risk of high blood pressure and cardiovascular disease, type 2 diabetes, joint problems, low self-esteem, and impaired social, physical and emotional functioning[4], all of which impact of the ability of a child to live a happy and healthy life.

Addressing childhood obesity is now even more important in the face of an ongoing cost of living crisis that continues to impact on food prices. Food prices are continuing to rise well above the rate of inflation, which overall is actually starting to fall, and is one of only a few areas where prices are still going up – the latest data from April 2023 shows that food prices rose by 19.1%, compared to an overall inflation rate of 10.1%[5]. Not only that, within the overall rise, it is healthier and staple food products, like eggs, some fruit and vegetables, and milk that have seen the biggest rises, with prices of unhealthy discretionary products rising much less sharply. This is having a profound impact on children’s diets now, as many families struggle to afford a healthy diet, and will of course have longer-term health impacts too.

What can we do?

There are things we can do. There are a range of evidence-based policy actions and interventions that can be taken which fall within the devolved competencies of the Scottish Government that will have a significant impact on preventing and reducing childhood obesity by tackling the food environment that currently puts a spotlight on unhealthy foods. We now need Scottish Ministers to be bold and urgently take these actions forward.

The Diet and Healthy Weight Delivery Plan included commitments that would make a good start in addressing the availability, affordability, and acceptability of unhealthy discretionary food and drink products high in fat, salt and sugar (HFSS). But these commitments have yet to be implemented and we are 5 years further on.

The Scottish Government pledged action in the following areas:

• Restricting promotions - of HFSS products within premises and further consideration on the scope for relevant restrictions online
• Advertising – work with local authorities to restrict outdoor advertising of HFSS products on billboards, on public transport, at bus stops and public transport interchanges; and work with the UK Government on areas of advertising that are reserved to Westminster including online and television advertising, and action on front of pack and nutrition labelling
• Out of home – develop and implement an Out of Home Strategy to support healthier choices, with a focus on how to encourage calorie reduction and measures to encourage food outlets to provide better information to customers, including calorie information on menus, and how the public sector can be an exemplar in food provision.         

These policies would make a difference. A recent modelling study, commissioned by the Scottish Government on the potential impact of restricting unhealthy food promotions, found an average reduction of 442.6 calories per capita per week across the categories of families with children[6]. In their 2022/23 Programme for Government[7], the Scottish Government committed to introducing a Bill to take forward their pledge to act on restricting price and location promotions of HFSS products, via the Public Health (Restriction of Promotions) Bill, before the end of this Parliamentary year (end of June), but to date this has yet to materialise. A Bill on promotions has been promised since 2018.

What should we do?

So, can Scotland halve childhood obesity by 2030? Based on the current direction of travel, the answer is almost certainly no. However, we must strive to make the changes necessary to decrease prevalence. The Scottish Government and its partners have powers and levers that can make a difference. We need the Scottish Government to act on these powers, taking urgent and bold policy decisions to address the availability, affordability, and acceptability of unhealthy HFSS products, and recognise the need for statutory interventions to improve the food environment now and for future generations.

Failure to act will result in even more children growing up at risk of obesity and subsequently living with obesity as adults, with profound implications for the health and economic prosperity of the country.

References

[1] Scottish Government (2019) Scottish Health Survey 2018 Supplementary tables – Body mass index - https://www.gov.scot/publications/scottish-health-survey-2018-supplementary-tables/

[2] Scottish Government (2022) Scottish Health Survey 2021 Volume 1 – main report  https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2022/11/scottish-health-survey-2021-volume-1-main-report/documents/scottish-health-survey-2021-volume-1-main-report/scottish-health-survey-2021-volume-1-main-report/govscot%3Adocument/scottish-health-survey-2021-volume-1-main-report.pdf

[3] https://www.obesityactionscotland.org/healthy-weight-data-info/healthy-weight-in-scotland/children-and-young-people/

[4] https://www.ncbi.nlm.nih.gov/books/NBK570613/

[5] Food Foundation Food Prices Tracker April 2023 - https://foodfoundation.org.uk/news/food-prices-tracker-april-2023

[6] Scottish Government (2022) Economic modelling: reducing health harms of foods high in fat, sugar or salt https://www.gov.scot/binaries/content/documents/govscot/publications/research-and-analysis/2022/05/economic-modelling-reducing-health-harms-foods-high-fat-sugar-salt-final-report/documents/economic-modelling-reducing-health-harms-foods-high-fat-sugar-salt-final-report/economic-modelling-reducing-health-harms-foods-high-fat-sugar-salt-final-report/govscot%3Adocument/economic-modelling-reducing-health-harms-foods-high-fat-sugar-salt-final-report.pdf

[7] Scottish Government (2022) A Stronger & More Resilient Scotland: The Programme for Government 2022-23 https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2022/09/stronger-more-resilient-scotland-programme-government-2022-23/documents/stronger-more-resilient-scotland-programme-government-202223/stronger-more-resilient-scotland-programme-government-202223/govscot%3Adocument/stronger-more-resilient-scotland-programme-government-202223.pdf