But as the challenge of healthy living moves into mainstream debate, fresh thinking is bringing new ideas. Health economists at UK social innovation agency, Nesta, have calculated a combination of measures that could bring measurable improvement well within a decade. Scotland’s economy would benefit from a healthier workforce, benefiting businesses, but the food sector would need to change to make this happen.
The answers are radically different from earlier thinking. The problem of unhealthy weights and obesity is a global one and the labels themselves do not help. Too much emphasis has been placed on the need for citizens to make good choices about diet and exercise – seeing the solution as a matter of self help. But there is little evidence that education and food information changes behaviour quickly enough.
More recently, the arrival of new weight loss drugs has turned attention to medical approaches. Apart from the enormous expense involved and possible adverse long term consequences, this looks like a sticking plaster for a big deep-rooted problem. Drugs may be a bridge for some, but likely can only be a small part of the overall solution. What policymakers need is an evidence-based toolkit of effective low cost measures.
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Policy needs to recognise the difficulty that people have with food choices. Our brains are given unhelpful signals by many ultra processed foods and this is compounded by incentives from promotions and availability. Apart from the length of time that behavioural change usually takes, it will always be an uphill struggle against conflicting incentives from the food and drink industry. The key is to set a programme of change in the food industry that drives lower calorie intake and improved nutrition. Medium and large suppliers would be the main focus of the policies, which might actually be welcomed by many of Scotland’s own food producers. Given the dominant market share of big supermarkets and producers, most of the needed impact would come from changes they make rather than hitting Scotland’s smaller firms.
The policy menu could include making healthier food more appealing by shifting promotional activity towards healthier choices. Similarly, by encouraging reformulation and smaller portion sizes, healthy food would become more accessible and affordable. In total, more than 30 policy choices are available, with many focused on the role played in diet by food and drink that is high in fat, salt or sugar (HFSS). England brought in legislation in 2022 in positioning of less healthy food and drink, with action on promotions and pricing due in 2025. Critics point to the risk that pricing may exacerbate poverty inequalities but this approach has already been successfully taken in Scotland with alcohol. Scotland has consulted on HFSS and plans a stronger set of restrictions than England.
While legislation seems to target specific foods as “bad”, diets have to change and the current retai