It might be hard to swallow but here's how we fix our dire Scottish diet

The problem: Sugary drinks and sugar

The evidence on sugar is too much too ignore and the UK government has accepted the recommendation that sugar intake should decrease. When it comes to sugary drinks, there is an association between sugary drink intake and type 2 diabetes in adults. In children, sugary drinks are associated with poor oral health and obesity. Dental disease is the single most common reason for admission of children to hospital in Scotland.

The problem we have to tackle is both is both sugary drinks and sugar. If we were to only tackle sugary drinks we still wouldn’t deal with other major sources of sugar in our diet which are confectionery, biscuits, and cakes. Sugar containing soft drinks provide 22% of the sugar in our diet and the total confectionery and sweet biscuits provides is 23.8%. We must also look at confectionery and sweet biscuits.

The solution: look at tobacco control

The tobacco control model has focussed on a trio of approaches namely pricing, availability and marketing and its been effective. I don’t think that a single action only geared at pricing or marketing will be as effective as the three of those together. We need a sugary drinks tax, but we need other measures. We also need to think very strongly about availability.

Some things are already happening in the public sector, for instance the drinks standards for schools prohibit high sugar drinks and give very detailed information on the sugar content that can be permitted. It is likely that the current standard will become stricter to match the new dietary recommendation. But how do we tackle the private sector? I’m not saying that sugary drinks or sweets or cakes should be banned. Because tobacco isn’t banned. You can buy tobacco, it’s just a bit harder than it was. When I was a kid and we were planning Christmas presents for the uncles we used to buy them cigarettes. You would never do that now. We give them boxes of chocolates, cakes, and alcohol. There are a lots of parallels with tobacco. It’s not about banning these foods but making us think twice about how much we need to purchase that sugary foods and drinks that impact on human health – especially that of our children. I honestly don’t think that limiting marketing is going to impinge on the human rights of anyone.

Joanna Blythman, Sunday Herald restaurant critic anad author of Swallow This: Serving Up The Food Industry’s Darkest Secrets

The problem: government guidelines

The government NHS guidelines for healthy eating are hopelessly out of date: they need to be overhauled. And they will be. The official guidance is fundamentally so wrong as to be dangerous. It’s making people ill trying to follow it. We have been told for ever and a day that saturated fat was the devil incarnate. That’s a load of nonsense. They need to revise the Eatwell plate - the health advice picture which shows you the proportions of different foods you should have. It’s become such an embarrassment that plate. It’s got things like Battenburg cake and a can of coke. It’s like a 1950s binger’s idea of healthy.

Another bit of government healthy eating advice was to base your meals on starchy foods. That phrase is omnipresent. So you look at the plate and there are piles of corn flakes and rice and pasta and bread. But what people are beginning to realise is that essentially when you eat carbohydrate you’re really just eating sugar by another name, because carbohydrates are quite quickly metabolised as sugar. And the problem is not just obesity. It’s diabesity now. Type II diabetes is huge.

The solution: rewrite the guidelines

The key measure would be to rewrite government healthy eating advice. It needs to come down to a couple of lines: avoid processed food. cook your meals as much as possible from raw, whole ingredients.

Until we stop telling people the wrong things about nutrition we’re not going to make any progress. It’s no good saying to people you’re allowed a little treat and a bit of sugar is okay. You have to say to people just don’t eat processed food. If I have to say just in a sentence to people how to be healthier and have more fun in life, it’s avoid processed food. And I have to get it down to one word, it’s cook.

I think a lot of people know at an intuitive level all this stuff in packets it can’t be good: it’s not how we used to eat. But then they see all these reassuring labels on it, logos saying it’s towards your five a day, or low-cal, and they feel reassured that that’s all right. But it’s not. It’s all wrong.

Pete Ritchie, executive director of Nourish Scotland

The problem: the promotion of sugar and fat

There’s limited value in telling people stuff about what’s healthy and what’s not. Around 85% of people have heard about five a day, but they don’t do it. What we’re saying is you’ve got to change the food environment that most people experience every day. The recent Food Foundation report, Force Fed, showed the food environment the average family is in. Now if you’re swimming in that water, you can’t change it on your own. And for most people the environment is one where sugar and fat are promoted very aggressively: 60% of the food adverts are about promoting confectionery and convenience foods; 4% or less goes on promoting vegetables. The food the system is trying to sell us is sugar and fat, because that’s where the margins are. Unhealthy calories are three times cheaper than healthy calories.

The solution: a levy on food retailers

We need supermarkets collectively to sell less sugar, less sugary drinks, less processed foods. We would argue for a levy on retailers and caterers who have multiple outlets, on the proportion of food they’re selling. If you take the 5% sugar target that Food Standards Scotland has recommended, you can quite easily add up all the bar codes of all the items sold in your supermarket, and for every percentage over 5 percent you pay a levy. The same principle for fat, or a shortfall in fibre. Some 90% of the food we eat every day comes from the the chains, and because the chains collectively control the food environment we experience most of the time, what they are putting on our plate should meet dietary guidelines collectively.

Professor Mike Lean, nutritionist, University of Glasgow

The problem: Too few fruit and veg

In 1993 I worked on the Scottish Diet report, looking into the public health issues in Scotland which were related to diet. We worked out that, yes, there’s a lot of heart disease, diabetes and cancer which are related to the diet and lo and behold the Scottish diet is a bit high in saturated fat, doesn’t have enough fruit and vegetables. One of the problems was we were forbidden to talk about obesity. The Conservative government didn’t believe in it. So anyway we worked out what we would have to do to improve the Scottish diet: reduce the saturated fats. We thought in order to do that the food supply needs to change. We devised a strategy. But the government then said, you must not write anything about the strategy. They said that we don’t need to change the food supply, we just need to educate people. So the strategy didn’t happen and no money was put behind achieving the targets. We published the Scottish diet targets. And they are still there, online. We didn’t achieve them. When they were reviewed in 2008 nothing had changed.

The solution: change the food supply

Most importantly we need to change the food supply. We’re going to need more of some things and less of some things. Scotland produces a lot of fruit and vegetables but we export most of them. We produce a lot of fish but we export most of that. Then we have lots of meat. More than we need. So we have to say we don’t need all of this meat, it’s not poisonous but we don’t need so much of it. And if we were to improve health we should move people towards a pattern of eating which is more like the Mediterranean style of eating where we eat meat as a special occasion thing. Once a week is plenty. We should have much more reliance on beans and lentils.

I wouldn’t alter much from the original strategy. But I would be much firmer on attacking the way in which extra calories are shunted at us. We still have chip vans hovering around schools at lunch times. I think we have to have some licensing arrangements for providing meals and snacks, and that in order to have a license people ought to know what food is and what it’s for. It’s not just a commodity in a packet. If you’re going to sell a meal we should say you should have some understanding of nutrition.

Georgina Cairns, food marketing researcher, University of Stirling

The problem: Junk food marketing

I did research for the Scottish Government into the impact of promotions, collecting responses from children and young people across all of Scotland. They were asked about the marketing promotions they had seen during the previous seven days and about any purchases they had made in response to a promotion. Nearly 2/3 of respondents reported seeing one or more marketing promotion, and nearly half reported making one or more purchase because of a marketing promotion. Price promotions were the marketing method most likely to trigger a purchase. Foods and drink high in fat, salt and sugar are promoted most heavily. Three quarters of observations were for that class of foods and 68% of purchases because of some form of promotion were for them. Contrast this with our findings on fruits and vegetables, unsweetened whole grain products, and we find that less than 10% of observation were for these foods, and only 9% of purchases in response to a promotion were for these healthful products. So one key take home message is that the marketing landscape is dominated by promotions for high fat and sugar foods and drinks.

Solution: No more promotions

Ending price promotions on foods and drinks high in fat, salt and sugar would be my first recommendation. I would also like to express my very strong support for ending 'till prompts' for the same types of products. The overall mix of foods and drinks being promoted needs to be re-balanced. More visibility for healthful products and less high fat and sugar products can only make our lives as consumer trying to eat sensibly, easier.