When a person comes into my surgery and they are obese, I do not bring up the subject unless they do," says Dr Colin Guthrie, who works as a GP in Scotstoun, Glasgow. "I can't do it because I would be having a long conversation with every second or third person about obesity."

That is the size of Scotland's weight problem. The quantity of excess fat rolling around Dr Guthrie's waiting room is also lolling on bus seats, wobbling about playgrounds and sagging on sofas across the country.

Two-thirds of men and almost three-fifths of women are overweight or obese, according to the latest Scottish Health Survey. The proportion of morbidly obese adults - those most at risk from their size - has doubled since 1995 and, worse, around a quarter of children aged between two and four years are considered overweight.

It is as if no attention has been paid to what people are putting in their mouths for the past 20 years. But that is not the case.

Dr Guthrie has spent five to six years of his life focusing on patients who were risking their health through poor diet and lack of exercise. Special weight loss clinics were organised at his surgery, he says, patients were given extra advice and support to diet and exercise and a group of diabetics began to show real improvement.

"I was short-listed for a prize in London," he adds. "Two years later, guess what happened? They were all back to square one."

The disappointment of this discovery has stayed with Dr Guthrie and shaped his perspective on the problem ever since.

"I was so convinced as a doctor that I knew what was right and I could teach my patients to do as I did," he says. "But at the end of it all, it was me that did not understand.

"You cannot look at an individual in isolation. You have to change the environment so it is easy for the average person to decide to cycle to work or to go to the corner shop and get some nice oranges.

"Some poor mum with two children and no husband, she doesn't have money to spend on oranges."

Being overweight is a natural outcome of the convenience, consumer society in which we live, he argues, and therefore radical changes are required to reverse the trend.

Dr Guthrie believes that all cities should have speed limits of 20mph so it is safer for children to walk and play in the streets and for their parents to cycle to work. He is also backing road pricing as a way of encouraging people to leave their cars at home. "Politicians have to take decisions that are unpopular," he says, giving the abolition of slavery and votes for women as examples of policies that were brave at their time but honoured by history.

In fact, more recent legislation, such as the ban on smoking in enclosed public places in Scotland, has become the yardstick of what can be achieved among health campaigners. This landmark followed years of health warnings, tighter and tighter crackdowns on tobacco advertising and investment to help people quit the habit.

Even so, researchers have found that only one in 10 people living in Glasgow's poorest neighbourhoods has any intention of giving up smoking in the next six months.

Arguably, compared to the anti-smoking drive, the bid to change Scotland's diet and exercise regime is only taking its first shaky steps.

And yet a ground-breaking plan to change eating habits in Scotland was actually published in the mid- 1990s. It set targets for increasing the intake of fruit and vegetables and cutting consumption of sugar and saturated fat. It was applauded by the World Health Organisation and distributed across Europe.

Then what happened? Millions of pounds was spent on healthy eating campaigns in Scotland and last year a review revealed progress had been made to achieving just one of the nine goals. Evidence, like Dr Guthrie's experience, of the need to do something new, something bigger, to make a difference.

Professor Mike Lean, expert in human nutrition at Glasgow University and one of the authors of the Scottish Diet Action Plan, can list a number of moves the country can realistically make to start turning the corner. First he points to the level of investment in preventative health care.

A balance needs to be struck between paying for the heart operation that extends a pensioner's life for a few months, he says, and paying for the support that would stop his grandson also dying from heart disease. At the moment, Professor Lean believes "rescue" work is getting the lion's share of investment.

Standing up to the food industry is also on his list, with Scotland being given extra powers to handle the trade. He says: "Are we strong enough in Scotland to say, no we do not want lard on our supermarket shelves?'" He also believes that home-grown produce could be much more heavily promoted to Scottish buyers, challenging the attitude that our cuisine comes from the deep fat frier, improving diet and cutting food miles all at the same time.

"Scotland has the very best food available in Europe," he says. "We produce the quality fish, the quality meat, the quality vegetables. People do not realise this."

Furthermore he wants all chefs and caterers trained in nutrition. Enter a restaurant or canteen just now and neither the customer nor the chef has much idea how many calories the menu contains. Professor Lean suggests that a system be set up where meals are designed to provide consumers with the appropriate number of calories (around 800) and dinners that include more are clearly labelled.

"If we are going to reduce disease by changing the way people eat, we have to do something pretty radical," he says.

Drastic action is also needed to tackle the drinking culture north of the border. Official records show that Scots are drinking themselves to death at twice the rate of the rest of the UK.

Dr Ewan Forrest, a liver disease specialist at Glasgow Royal Infirmary, said it is not so much the numbers that are shocking, but the way alcohol is robbing young people of their lives.

"There are men and women in their 20s and 30s who are dying of liver failure, who themselves have young children," he says. "That is devastating."

Experts blame the low price of booze for the appaling trend, raising questions about how Holyrood could make a difference without the power to increase the price through taxation. But when 284 people die because of alcohol in Glasgow every year, can there be any excuse for inaction?

People are paying for their eating, drinking and smoking habits with their lives. Scotland has the second-highest mortality rate in Europe, according to Glasgow University research. Only Portugal has a higher toll.

The responsibility for changing these horrifying statistics rests with everyone in Scotland.

What the parties say

Labour

SNP

Conservative

LibDem

Green

SSP

Solidarity

12:01am Monday 9th April 2007

Print

Email this