The latest National Diet and Nutrition Survey (2016-2019) was published at the end of last year and there have been some noteworthy developments since the last survey (2014-2016). We discuss how these changes relate to our Scottish Dietary Goals and what we can do next to improve our chances of meeting these goals and the health of the nation.
What is this survey and why is it important?
The National Diet and Nutrition Survey Rolling Programme has been in place since 2008. The survey assesses the dietary intake and nutritional status of the UK population aged 18 months and over. Whilst this survey doesn’t focus on Scotland alone, it has been designed to be appropriately representative of Scotland, therefore we can use the results to consider our progress towards the Scottish Dietary Goals.
What are the Scottish Dietary Goals?
These goals describe the nutrition targets we should aim for in order to improve and support the health of the Scottish population1. As a nation, we have consistently missed meeting these goals for close to two decades2. However, it’s not all bad, there have been improvements made in several categories, and this survey highlights where we need to make more effort.
Some key Scottish Dietary Goals3
What’s getting better?
Overall, we have lowered our consumption of red and processed meat across all age groups achieving the dietary recommendation of 70g or less per day4. This is noteworthy as lower consumption of these foods has been associated with lowered risk of bowel cancer5. Recent Obesity Action Scotland research concluded similar findings, noting an improvement in primary school meals in Scotland, as less red and processed meat was found on menus compared to previous years6. This followed a pledge by the Scottish Government to improve school nutrient standards and set a maximum limit for processed red meat consumption in schools7.
Overall, across all age groups, we are consuming less sugar-sweetened soft drinks than we did in 2014-2016, ranging from a reduction of 12% to 44% since 2008, with the biggest reduction observed amongst 4-10 year olds4. Sugar sweetened soft drinks have been associated with higher calorie intakes and increased risk of overweight and obesity.8 Improving our food environment is key to help reduce our sugar intake, and this was one of the thoughts behind the 2018 Soft Drinks Industry Levy (SDIL), designed to encourage producers to reduce the sugar content in their products as part of UK Government’s Childhood Obesity Plan.
What do we need to work on?
The survey notes a reduction in intake of free sugars since 2014-16 which has been partly attributed to lowered intake of sugar-sweetened soft drinks; however, our intakes still remain high at almost double the recommended amount3,4. For adults aged 19-64, non-alcoholic beverages, preserves, and confectionery, as well as alcoholic beverages, contribute largely to free sugar intake9. Amongst children aged 1.5-3yrs, over 20% of free sugar intake comes from fruit juices, yoghurt, fromage frais and other dairy desserts9. Since 2008, there has been a 10% increase of confectionery consumption amongst 65-74-year olds4. Whilst the SDIL mandatory action has led to an almost 30% reduction of sugar in drinks subjected to the levy, the same could not be said for voluntary action designed to reduce sugar content of popular foods such as yoghurts, ice creams, breakfast cereals and biscuits10. With a less than 3% decrease noted in sugar, and no change in calorie content reported in 2019, we are far from our goal of reducing sugar content by 20%10.
Overall, fruit and vegetable consumption still falls short of the 5-a-day recommendation amongst most age groups. Whilst 11-18 year olds were least likely to achieve their 5-a-day goal, they did note a 4% increase in consumption from 2014-164. Despite this, only 12% of people in this age group met their 5-a-day reccomendations4. Our oily fish consumption also remains well below the recommended amount4.
Our intakes of total fat meet the Scottish Dietary Goal amongst all age groups; however, our saturated fat intake exceed the recommended amount3,4. The highest consumption is noted in people aged 19-64 with cheese, butter and meat products highly contributing to this intake4. In fact, men aged 19-64 years have increased their consumption since 2014-16.
Although children aged 4-10 are observed to have higher levels of vitamin D than previous years, 16% of adults (19-64years) are considered to have very low vitamin D levels associated with increased risk of poor musculoskeletal health4. This survey, however, did not report on number of people with adequate levels of vitamin D. One key dietary goal we are also not meeting is our fibre intake with less than 10% of people aged 19-64years meeting the 30g per day goal4.
Worryingly, 89% of women of childbearing age (16-49years) have lower than recommended levels of folate which is a crucial nutrient in reducing the risk of developing neural tube defects in the foetus4. With the increasing prevalence of women in Scotland starting their pregnancy with a BMI in the obesity category, which is associated with further potential harmful health effects in both mothers and children, there is an increasing need to focus on the health of this demographic.
We still have a way to go in meeting our dietary goals that have been recommended to best improve and support the health of the Scottish people. Two thirds of adults aged 16+ have overweight or obesity, and more than a quarter of adults have clinical obesity in Scotland11. Our poor diet across the nation is contributing to a number of health concerns including high levels of overweight and obesity2. We must urgently take preventative action to improve the food environment in Scotland, ensuring the healthy choice is the easy choice for everyone11.
In our 2021 manifesto for the next Scottish Parliament, we call for action to recognise the significant challenge obesity poses for public health and health inequalities in the nation11. We believe doing so will not only improve our national diet and health, but also reduce the burden of several non-communicable diseases such a type 2 diabetes, cardiovascular diseases and numerous types of cancers. To help achieve this, we ask that more work be done to restrict promotions and advertising of food and drink high in fat, sugar and/or salt in Scotland, whilst also ensuring that recovery of our out-of-home food and catering sector from the impact of COVID-19 supports enabling a healthier and sustainable food environment11.