Andy Maciver: Obesity is being enabled by our own national health service

Just under two weeks ago, I spent the best part of a day at the new Royal Hospital for Children and Young People (RHCYP) in Edinburgh – the Sick Kids, as we will probably forever know it.

It has all the freshness one would expect of a new building, child-centred design in the waiting areas and an airiness which its beautiful but dank predecessor by The Meadows lacked.

We spent some time in the outpatient waiting area, a veritable cornucopia of stimulation to keep children’s minds off the reasons for their visit; from there up to the orthopaedic waiting room, a quieter place with brain games, arts and crafts, and plenty more to keep kids (and parents) occupied ahead of a procedure.

Then, though, the canteen. The RHCYP canteen could have been carved out of the old hospital at Sciennes and lifted straight into Little France. I’m referring not to the layout, although it is decidedly small for an area catering for such a volume of patients and staff, but to the culinary contents.

Before I offer you the specifics of the canteen menu, we should perhaps think of the context. Two-in-three adults in Scotland, and one-in-three children, are overweight, according to Obesity Action Scotland. A quarter of adults and one fifth of children are obese, with a Body Mass Index of over 30. Now, BMI may be an imperfect way to measure health, but whatever way we slice it, Scotland is one of the fattest nations on earth.

The consequences of this are widespread, permeating so many areas of our lives. Being too fat significantly increases our chances of developing Type 2 Diabetes, cardiovascular disease and a variety of cancers. It increases infertility and creates complications during pregnancies. It contributes to dementia, and not surprisingly puts severe physical strain on other parts of the body. And poor physical health is strongly linked to poor mental health.

As well as being a primary cause of ill health and early death, being overweight or obese is a primary cause of the NHS’s financial ill health. Scotland’s average salary is roughly £25,000, with the income tax payable being around £5,000 per year. The NHS receives, very conservatively, around one-third of Scottish Government spending, so an average earner spends over £1,500 of their personal earnings on the NHS every year. And, of course, that does not include any of the other taxes they contribute to the government’s pot.

Obesity costs the NHS vast sums of money; your money, readers.

And yet, here in the RHCYP canteen, obesity is being positively enabled by our own national health service. We can debate whether being too fat is a result of poor personal choices, or a result of being exposed to an obesogenic environment, or both. That is a moot point when there is no healthy personal choice available, as is the case in an NHS canteen.

I was in the RHCYP canteen at breakfast time. I hadn’t expected smoothies and freshly cut pineapple, but naively I had presumed there might be porridge, perhaps some toast, a selection of cereals from which I might be able to choose a relatively healthy, low-sugar option. Failing that, I thought, they might at least have pastries; hardly healthy, but at least baked rather than fried.

What I was met with was tray upon tray upon tray of fried, processed meat, fried eggs, and all the other delights which make up that supposedly occasional treat, the full Scottish breakfast.

Fortunately, the lady in front of me bought me some time to fully peruse. She had a dairy intolerant child with her (hardly a rarity in a children’s hospital) and was asking what dairy free milk alternatives were available. The answer was “none”.

As I waited, I was saved by the small basket beyond the fry-up, which had a couple of packets of Weetabix and some Alpen, which kept me going until lunchtime.

Having seen the canteen’s lunch menu – macaroni cheese, fried fish and chips, or a pie – I went next door to the Royal Infirmary and bought a mango and crayfish salad from Marks and Spencer.

My lunch choice is unimportant. But the availability of healthy choices in an NHS canteen is. On the most basic level, the staff who work in the NHS need to be enabled to lead from the front when it comes to action against obesity; how can an overweight patient be expected to take a telling from a medical professional who is himself or herself overweight? However, being a healthy NHS worker and using an NHS canteen every day do not go hand-in-hand.

More broadly though, the creation of a brand new canteen in a brand new hospital, and the stocking of it with food that makes healthy choices effectively impossible, says something about the NHS as a strategic entity.

It tells me that the NHS is lackadaisical and slapdash. It tells me that the NHS is not serious about getting the basics right.

Following the pandemic, the NHS has never been held in higher regard by the people. There is no other national institution for which we would spend our Thursday evenings publicly clapping. It is our religion, whether we like it or not.

And, indeed, there is much in its performance to be pleased with. The Accident and Emergency service is generally very good. Paediatrics, the reason for my visit, provides excellent service and excellent outcomes.

But that is not true across the board. We have 20 per cent fewer doctors than the OECD average. We have half the number of beds. Less than half the number of MRI scanners and CT scanners. We scrape into the OECD top-20 survival rates for the major cancers – colorectal, breast and cervical – but we don’t make the top-20 for mortality rates after heart attack, haemorrhagic stroke or ischemic stroke.

In our praise for the service, we should not close our eyes to its problems. There is much work to be done, which extends beyond simply increasing its funding.

I won’t pretend that a healthy canteen is the silver bullet. But it’s a start.

Andy Maciver is Director of Message Matters

Our columns are a platform for writers to express their opinions. They do not necessarily represent the views of The Herald.

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The Herald Scotland

The Herald is a Scottish broadsheet newspaper founded in 1783. The Herald is the longest running national newspaper in the world and is the eighth oldest daily paper in the world. The title was simplified from The Glasgow Herald in 1992