Time to get tough on obesity, but will industry play ball?

Finally, after over a year of anticipation, the Scottish Government unveiled its proposals to tackle Scotland’s rising problem with obesity.

Shortly after this year’s Scottish Health Survey revealed yet another rise in the average BMI of a Scottish adult and the fact children are consuming more food high in sugar and saturated fats than their parents, Public Health Minister Aileen Campbell announced the Scottish Government’s intentions with a new consultation.

The stakes are high. Most people in Scotland are now overweight. Two-thirds of adults and a quarter of children are overweight or obese, leaving the number of people with a healthy weight in the minority. 

Furthermore, obesity rates vary by age, gender and socio-economic status.

Children in more deprived areas are far more likely to be obese, while a staggering 85 per cent of men aged 65-74 in Scotland are overweight or obese. 

The cost to the nation’s health is astronomical, with clear links to rates of heart disease, cancer, type 2 diabetes, stroke and many other conditions. 

The cost to the NHS is around £600m per year, with further impacts on productivity and the size of the Scottish economy.

And this growing burden of obesity is driven primarily by our diet, which has a far bigger impact on weight than exercise. 

The Scottish Government sets national dietary goals to improve the nation’s diet, which were revised in 2016.

These include eating five fruit and vegetables a day, increasing consumption of fibre and oily fish while reducing red and processed meat, saturated fats and sugar.

But the Scottish Health Survey shows Scotland’s calorie intake is as high as ever, while average daily consumption of oily fish and fibre remains below healthy levels. 

The consumption of fruit and vegetables in Scotland is actually in decline. In short, the dietary goals have made not a jot of difference. 

Meanwhile, products that contain no nutritional value whatsoever, which experts generously call “discretionary” food and drink but is more commonly known as junk food, such as pastries, biscuits, cakes, confectionery and sugary drinks, remain very popular indeed.

So popular, in fact, that population-level consumption of these products needs to be halved, according to food safety agency, Food Standards Scotland (FSS).

It should not be too much of a surprise, then, that the Scottish Government’s obesity and diet strategy proposes a tougher approach than the dietary goals.

There are three main themes which have been opened to consultation: restrict promotions  such as multibuy or buy one get one free; restrict non-broadcast advertising; and invest £42m to “establish supported weight management as a core part of treatment for people with, or who are at risk of, type 2 diabetes”.

There is also a recognition that issues of reformulation of recipes, labelling and broadcast advertising will need a UK-wide approach, and industry will be expected to examine portion size and calorie content.
These are based on the recognition that it has become challenging for people to make healthy choices.

Introducing the consultation to parliament, Campbell said: “I am clear that improving the food environment is the single biggest change that we need to see in Scotland. The reality is that many of us find it challenging to make healthy choices in an environment where food and drinks that are high in fat, salt and sugar are cheap, widely available and heavily promoted.

“I do not doubt for a minute the value of food labelling and other ways to help people make informed decisions. However, the odds are stacked against most shoppers. 

“We have data that shows that 35 per cent of all food and drink purchased in Scotland is on price promotion – around double the figures for Germany, France and Spain. We know that food that is high in fat, salt and sugar is more likely to be bought on promotion, compared to healthier alternatives.”

But will discussion during the consultation be about what products will be restricted and how the restrictions will work, rather than a conflict with industry about the need for restrictions in the first place?
While the strategy recognises “some progress” has been made through voluntary action by industry, it has not met the “scale and pace of change required”.

And discussions around the Scottish Government’s Supporting Healthy Choices Voluntary Framework “has not delivered sufficient commitment to action, particularly in relation to promotions”, it said.

Campbell was clear she does not intend the proposals to be watered down, as appeared to happen to the UK strategy, which was downgraded to a ‘plan’ and placed no statutory duty on industry or retailers.

“I cannot be more straightforward – we want to restrict the marketing and promotion of high fat, sugar and salt foods,” she said.

There have been some early signs of resistance from industry. 

The Federation of Small Businesses warned about the impact the proposals “could have on every local fishmonger, takeaway, deli, corner-shop and baker”, faced with competition from big business.

David Thomson, chief executive of manufacturers’ body the Food and Drink Federation (FDF) Scotland, told Holyrood restrictions on advertising would be a “huge misfire” when the marketplace is already “strictly regulated”, pointing to new guidelines about advertising junk food to children.

He also questioned other proposals.

“Restricting promotions will hit the poorest shoppers hardest – at a time when all customers are seeing increases to the cost of their weekly shopping basket,” he said.

“The regulation of promotions within retail premises is a hugely complicated area and could create unfair disadvantage to different types of products. 

“We would urge [the] Scottish Government to consult widely and to gather evidence on the financial, practical and legal implications for businesses and consumers before seeking to change the law.”

But consulting widely is exactly the intention. “We want to hear the views of a wide range of stakeholders on our proposals, the priorities, implementation, and – looking ahead – what more should be done,” the document says. 

There is a sense, too, that industry will ultimately recognise the realpolitik and follow public opinion, which certainly appears to back stronger action on obesity.

Figures from FSS reveal nearly 40 per cent of all calories consumed are purchased as a result of supermarket price promotions, and a survey commissioned by Cancer Research UK suggests seven out of 10 Scots support a ban on them.

And unlike tobacco and alcohol, where restrictions have been challenged by industry in the courts –with last week’s Supreme Court decision on minimum unit pricing on alcohol ending five long years of legal wrangling – the food and retail industries are still very much round the table and part of the discussion. 

In fact, retailers did not challenge the ban on multibuy promotions of alcohol in October 2011.

Whether that measure was a success, however, is another story, with alcohol sales increasing and alcohol-related deaths in Scotland 54 per cent higher than in England and Wales.

The response from industry to the multibuy alcohol ban was to reduce single prices, so instead of three bottles of wine for £10, it would be easier to find a single bottle 
under £4. 

Is it possible there could be a similar response to a ban on junk food multibuys? There is some evidence retailers are already moving to individual price reductions, with Sainsbury’s, for example, moving away from multibuy promotions over the last year. Tesco has also indicated it has moved away from short-term promotions.

This is more likely to be a response to competition from the fast-growing Aldi and Lidl than it is to be anticipation of a ban, but there is, nonetheless, a sense the industry recognises things must change. 
The question is whether it will have an impact on consumption.

In preparation for its work on obesity, Scottish Parliament researchers went as far as naming five brands which contributed to Scotland’s love affair with junk food: McDonald’s, Greggs, Tesco, Asda and Morrisons. 
Of these, only Greggs didn’t respond to contact from Holyrood.

McDonald’s said the company would engage with the consultation.

“At this stage, we await further details of the diet and obesity strategy outlined by the Scottish Government,” a spokesperson said.

“We welcome the opportunity to play our part in working with the Scottish Government and other stakeholders in their efforts to improve public health.”

Supermarkets referred us to the industry body, the Scottish Retail Consortium (SRC), to speak on their behalf.

Ewan MacDonald-Russell, SRC Head of Policy, welcomed the fact efforts to reformulate products and inform customers had been recognised in the strategy document.

“Responsible retailers are committed to supporting the Scottish Government’s ambition to encourage consumers to make healthier choices,” he said.

While he cautioned a uniquely Scottish approach to labelling could be difficult for products also sold south of the border, potentially adding to costs, he was more pragmatic about price promotions. 

“We have been clear any measures brought forward must be on a mandatory basis, and it’s positive to see the Scottish Government have accepted that argument,” he said.

Public health campaigners are used to hearing industry favour self-regulation, and certainly one of the biggest criticisms of the 2016 English obesity action plan was that it was based on voluntary action by the food and drinks industry. 

Is it surprising, then, to hear a call for mandatory restrictions from Scottish retailers? Not when you consider the supermarket industry is still recovering from a scandal around the price fixing of dairy products a decade ago.

“Action on pricing and promotions can only be done on a mandatory basis,” MacDonald-Russell told Holyrood.

“Asking retailers to agree to codes on pricing and promotion runs the risk of breaching competition law. 

“Decisions on these areas by retailers are fundamental to how they operate and compete, and therefore, we think should not be subject to government regulation without very compelling reasons and specific evidence.

“That evidence should refer both to the specific health improvements a proposal could lead to, but also consider the effect of increasing the cost of shopping for consumers, at a time where household budgets are already stretched.”

Proposals for restrictions on promotions, then, will require clarity around exactly what products are identified as high in sugar or fat. 

Cheese, for example, is very high in saturated fat but is also being pushed as a high-quality Scottish export. 

Haggis is also high in salt and saturated fat, but will supermarkets be expected to stop promoting it around Burns Night?

The consultation may focus on identifying what products are causing the most harm and reaching an agreement on what should be restricted.

This could lead to a situation like former chancellor George Osborne’s levy on sugary drinks, which saw an exemption on some fruit juices and milk drinks, apparently in recognition of their nutritional value. Both can be as equally high in sugar as some soft drinks.

This is identified in the Scottish Government’s consultation document, which suggests the exemption should only apply to milk products which are at least 95 per cent milk.

Even though Osborne’s ‘sugar tax’ will not come into effect until April, it has already seen the soft drinks industry reformulate their products and introduce new sugar-free alternatives.

The Scottish Government has acknowledged UK-wide work to make products healthier in its consultation, and pledged to lobby on a UK level on reformulation, labelling and portion sizes, and support small Scottish firms to improve on these areas.

MacDonald-Russell says members have already shown commitment to improve products.

“Retailers, many of whom operate across the UK, are committed to developing healthier products which retain the taste and flavour of the original, but which have substantially reduced levels of unhealthy components,” he says.

“The retail industry has already reformulated products to reduce levels of salt and sugar, and will continue to develop and improve these products.”

Television advertising of junk food before 9pm is one example of where the Scottish Government will ask for more powers if the UK Government does not take action. 

What impact the new strategy can have on the out-of-home fast-food industry remains to be seen, with fierce competition between local businesses and huge franchise outlets pushing prices down and portion sizes up.

Ultimately, however, the fact the diet and obesity strategy is being consulted on as the Scottish Government prepares a landmark ‘Good Food Nation’ Bill allows for a wider perspective and holistic approach.

MacDonald-Russell sees it as a positive. “Looking forwards, it’s encouraging the Scottish Government seem committed to a cohesive policy approach across multiple portfolios towards developing the Good Food Nation Bill,” he says.

“As ministers have said, this should be an enabling bill which looks not [only to] enable cultural change encouraging Scots to appreciate their food and make good decisions as to what to eat. Of course, that doesn’t mean an austere approach to food, but one which focuses on the fantastic natural harvest Scotland produces. 

“The retail industry, which is an enormous supporter of Scottish food and drink, will continue to play our part in that process.”

There is similar optimism from food sustainability and justice campaigners, Nourish Scotland. Executive director Pete Ritchie tells Holyrood the bill is an opportunity to take an “integrated approach” to tackling Scotland’s poor diet alongside other pressing issues such as climate change.

“The thing about food is that it’s all connected – we won’t be able to solve obesity without ensuring people have the money they need to eat well, and shops near them that sell healthy food at a fair price,” he said.
“That means needing to think about everything from the planning system to how we value and support Scotland’s producers.”

With a stated ambition to develop “a positive relationship with food from birth to adulthood” in the obesity strategy, will the Good Food Nation Bill rebalance the food environment enough to make such a cultural change possible?

“Only a whole food system approach will be effective in resolving the major challenges we have ahead and fulfil Scotland’s ambition to become a good food nation,” says Ritchie.

In the meantime, the diet and obesity consultation is open until 31 January.