Food for Thought - Beating Scotland's Bottle Culture

But with obesity levels rising and weight-related diseases on the increase and a diet still high in fat, salt and sugar, Scotland's reputation as the 'sick man of Europe' seems worryingly entrenched.

Professor Anderson, who also chairs the University's multidisciplinary Obesity Research Group, is well aware of the scale and range of the problem.

'I've always said what I do is not rocket science, it is much harder than that,' she says. 'My research is aimed at changing behaviour and that is a very, very difficult thing to achieve.'

Part of the problem, she believes, is that many of the attitudes resulting in unhealthy lifestyle choices are culturally embedded and weave their way through many different aspects of people's lives.

'We have, in Scotland, what I have described as a bottle culture,' she explains.

'It starts in infancy with how we feed our babies and continues through childhood and into adulthood with the consumption of sugary drinks.

'There is plenty of information about the benefits of breastfeeding and it is still the most important early intervention but not enough women do it for long enough. Things are improving. Data shows that more babies are being put to the breast on day one but the numbers do still tend to plummet after that.

'That's the start of the bottle culture and it continues with the age at which solid food is introduced. It is stretching out now but there has been a tradition of introducing solids far too soon, putting it in baby's bottles etc.

'It is also evident in the amount of sugary drinks we as a nation consume. There is one thing that is definitely linked to obesity and it is sugary drink consumption. Our bodies are not good at picking up liquid calories.

Bottle culture starts in infancy with how we feed our babies and continues through childhood and into adulthood with the consumption of sugary drinks.

'Even drinks that are marketed as being healthy can be very calorie and sugar rich. We tested some milkshakes and smoothies and found a peanut butter milkshake which had more than 1000 calories per serving!'

Professor Anderson acknowledges that another part of the problem is consumer confusion over what is healthy and what is not. Responsibility for this, she believes, lies with the food industry.

'Communicating nutritional information has become very complex. There are different types of food labelling with different kinds of information. The food industry has made it so complicated that many people feel overwhelmed and can't really be bothered with it.

'The food industry is very clever at influencing individual choice. Part of our work has been looking at portion sizes. Manufacturers now produce food in multi-packs. Although individual portions may be quite small, they are sold in multiple units and therefore encourage over consumption.

'We have also studied ready meals which is a major growth area. We analyzed about 300 meals and only 16% met nutrient standards. Even the ones labelled healthy didn't meet the standards. Some were too low in calories so again what happens is that people eat more than one or supplement it with other energy dense (fatty and sugary) foods.'

Professor Anderson, a nutritionist who still carries out clinical work, is a firm advocate of individual responsibility but believes tackling the obesity epidemic and its attendant health problems needs a much wider approach.

'There are two ways to change behaviour,' she argues. 'One is at an individual level where efforts to change diet and physical activity levels are based on education and support, and the other is at a societal level.

'It is up to each individual what they eat. What you put in your mouth is a personal choice but that choice can be made much easier by what is going on around you.

'Individuals have to believe they can do something about their own health but there needs to be support too. Part of the work I do is in identifying opportunities where people are more likely to be open to advice and support. For example our Livewell programme, funded by the World Cancer Research Fund, focuses on people aged over 50 who have been successfully treated for bowel cancer.

'These people are interested in maintaining the health they now have through trying to attain a healthy diet and become active but need guidance and support for what they can manage and, indeed, should be capable of, especially if they have other disabilities.'

Other intervention programmes include WeighWell, funded by the Medical Research Council, aimed at helping women lose weight after the birth of a baby, and HealthForce, funded by the National Prevention Research Initiative, which looks at helping adults from deprived backgrounds who are taking part in a cardiovascular screening programme, make healthier lifestyle choices.

But while these offer individual advice and support Professor Anderson believes it is at a societal level that much more could be done and where stronger political leadership is needed.

'We need to move beyond health education,' she argues. 'The biggest challenge is bringing the politicians on board. The kind of changes we need to see are unlikely to come about just by health education and a focus on the individual. We need much stronger leadership.

'Politicians are elected for short terms of office whereas changing attitudes and behaviour is a long-term project. Politicians need to win votes so they are not going to do something that is unpopular. It is always going to be a matter of compromise, but we need significant moves in the right direction.'

Professor Anderson believes tighter controls over advertising would be one such move and she is heartened by the Scottish Government policy document Healthy Eating, Active Living which supports the stance that there should be a pre-9pm ban on TV advertising for foods that are high in fat, sugar and salt.

'There are windows opening up that little bit wider which are quite hopeful,' she says. 'I would also like to see better use of advertising. We have some fantastic agencies who do really great work so why can't we use them for healthy food choices rather than unhealthy ones.

'Of course we would need the budget for that and at the moment the amount of money available for health promotion is very small compared to that spent by the food industry.'

Despite the scale of the challenge, Professor Anderson and her team remain hopeful about the prospect for change and the likelihood of a long-term dilution of Scotland's unhealthy dietary traditions.

'Small changes can have a significant impact and we need to celebrate and encourage these changes. If you take the fivea- day campaign, for example, there are people who never ate any fruit and vegetables before who are now eating one or two pieces. That is not ideal but it is still an improvement and it is something to build on.

'Breastfeeding is the same. Rates are not as high as we would like but if we can persuade and support someone to breastfeed for even a few days or a few weeks then it is better than not at all and we should see that as a success.

'Avoiding weight gain is another achievable goal. Certain cancers are linked with weight gain (not just obesity per se) in adult life so avoiding putting on weight is something we should all strive for.

'Obesity is staring us in the face. It poses a major risk for chronic diseases including type 2 diabetes, cardiovascular disease, hypertension, stroke and some forms of cancer. But there are encouraging trends. The plan to take junk food and vending machines out of school and control what is available is good and there needs to be more of that.

'Attitudes can change. Cultures can change. What happened with the smoking ban and people's attitude to smoking shows what can be achieved but it needs strong leadership and it takes time.'