The new Cancer Strategy for Scotland - why a focus on preventing obesity is critical

In June 2023, the Scottish Government published their new Cancer Strategy for Scotland, covering the next decade to 2033. This was accompanied by an Action Plan, which outlines short term priorities for the next 3 years. Both documents outline the Scottish Government’s vision for improving cancer survival and for providing excellent, equitably accessible care. Part of this vision includes a commitment that more cancers are prevented.

These documents were published after a consultation held last year. In our response to the consultation, we emphasised the need for a focus on prevention of cancer, given the significant and growing prevalence of both adult and child overweight and obesity in Scotland, and identified areas where this could be strengthened in the consultation proposals. It was great to see both the consultation summary report and 10-year Strategy document recognise the importance of prevention.

This is highlighted in Ambition 1: Preventing more cancers in the Strategy which recognises the importance of diet-related inequalities for prevention and outlines a commitment to reduce these inequalities, supported by actions in the Diet & Healthy Weight Delivery Plan, specifically including legislation to restrict promotions of less healthy food and drink at the point of sale.

Why is prevention so important?

Obesity, cancer risk and inequality

Obesity is the biggest preventable cause of cancer after smoking. 13 different types of cancer are linked to obesity, including two of the most common cancers – breast and bowel – and two of the hardest to treat - pancreatic and oesophageal [1].

This matters as obesity is a significant and growing public health issue in Scotland. Over two-thirds (67%) of adults and 28% of children have overweight and obesity. Specifically, for just obesity, 30% of adults are living with obesity, and 18% of children are at risk of obesity - both figures are the highest ever recorded in Scotland. And this is projected to further increase over coming years and decades. Research conducted by Cancer Research UK found that if current overweight and obesity prevalence trends continue, average adult overweight and obesity prevalence in Scotland is projected to increase to 68% by 2040*, which equates to around 3.2 million people [2]. Of course, this is not equally distributed across the population and masks significant inequalities, in both obesity and cancer incidence.

Cancer incidence and prevalence is clearly patterned by deprivation. The risk of developing cancer is 30% higher in the most deprived areas in Scotland compared to the least deprived [3], and long-term projections show a worsening of this trend. The previously mentioned research by Cancer Research UK highlights that, based on current trends, by 2040, the prevalence of obesity in the least deprived fifth of the population will decrease (from 22%) to 19% in 2040, but for the most deprived will increase to 41% (from 36% in 2019)[2]. 

This pattern is also replicated for obesity, with those in the most deprived quintile significantly more likely to have overweight and obesity than those in the least deprived quintile – 38% of adults in the most deprived quintile have obesity, compared to only 22% in the least deprived [4].

What this indicates is persistent and worsening inequality with deprivation a significant influencing factor for both cancer and obesity. Those living in our most deprived communities are more likely to have cancer and also be living with obesity.

To overcome and reverse this worrying trend, evidence clearly indicates a need for a focus on prevention. In 2018, the same year as the Diet & Healthy Weight Delivery Plan was published, the World Cancer Research Fund published a blueprint for cancer prevention, which set out a number of recommendations for cancer prevention. It recognises being a healthy weight and eating a healthy diet as being critical.

Significantly, the blueprint acknowledges and highlights that cancer prevention not only depends on choices of individuals but more crucially on governments creating environments in their towns, cities and countries that promote and facilitate lifelong healthy eating and a physically active lifestyle.

We need the Scottish Government to take urgent and bold action

If we are to achieve the ambition of the Cancer Strategy in preventing more cancers, it is essential that policies within the Diet & Healthy Weight Delivery Plan, particularly the implementation of legislation to restrict promotions, are taken forward as a matter of urgency. This implementation is key to cancer prevention.

It was confirmed in a statement by the Scottish Government Minister for Public Health and Women’s Health Jenni Minto MSP on 30^th May 2023 that restrictions on price and location promotions of less healthy food and drink products will now be introduced as regulations, via secondary legislation.

The Scottish Government now needs to progress forward with the implementation of these regulations as soon as possible, and ensure that they are broad in scope, covering as many types of promotions (both price and location) as possible.

Such policies are essential if we are to deliver a healthy weight for all and prevent more cases of cancer in the future. Such policies will help deliver a healthier Scottish population.

Read our Obesity and cancer – key facts and figures document for further information on obesity and cancer. 

* This calculation is based on 2019 observed overweight and obesity figures. The combined prevalence of adult overweight and obesity is reported as 66%.

References 

[1] Pati S et al (2023) Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management. Cancers (Basel). 2023 Jan 12;15(2):485. doi: 10.3390/cancers15020485. PMID: 36672434; PMCID: PMC9857053

[2] Cancer Research UK (2022) Overweight and obesity prevalence projections for the UK, England, Scotland, Wales and Northern Ireland (based on data from 2019/20) https://www.cancerresearchuk.org/sites/default/files/cancer-stats/adult_overweight_and_obesity_prevalence_projections_18-05/adult_overweight_and_obesity_prevalence_projections_18-05.pdf

[3] Public Health Scotland (2023) Cancer Incidence and Prevalence in Scotland to December 2021 https://publichealthscotland.scot/media/20142/2023-03-28-cancer-incidence-report_revised.pdf

[4] https://scotland.shinyapps.io/sg-scottish-health-survey/  - filtered for obesity, deprivation and year (2021)