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Child obesity: Scots experts look to Amsterdam for solution

The Dutch capital's child obesity rate has fallen by 12% since the project launched.

It is one of the most significant public health challenges facing Scotland today.

Being overweight or obese is linked to a host of health issues that affect both quality of life and, in some cases, length of life.

These issues include poor cardiovascular health as well as the increased likelihood of strokes, diabetes and asthma.

Being overweight is also now the second biggest preventable of cancer after smoking.

A ScotPulse survey for STV News revealed on Wednesday that 60% of Scots would support a ban on junk food advertising before the evening.

It comes as the World Health Organisation (WHO) revealed a tenfold increase in global childhood obesity in the past 40 years.

"The burden of poor diet on Scotland is immense," says Lorraine Tulloch, programme lead for Obesity Action Scotland.

She adds: "Poor diet across the UK is now the number one burden on the NHS."

In the Dutch capital of Amsterdam, a radical, all-encompassing approach to tackle what city politicians have dubbed the "wicked problem of obesity" has reaped dividends.

Amsterdam: City implemented a radical healthy weight programme in 2012.
Amsterdam: City implemented a radical healthy weight programme in 2012. STV

If there is one thing experts in the field can agree on, it is that the best way to tackle the issue head-on is to start trying to change people's habits at a young age.

In Amsterdam, this has meant a comprehensive healthy weight programme targeting education, local communities and the family home, supermarkets and shops and even the advertising industry.

Facing a childhood obesity rate of one in five (21%) in 2012, Amsterdam officials demanded change - and got it.

Three years later, the city's municipal government said the number of overweight children had fallen by 12%.

"What was interesting around the Amsterdam work was that they have seen a reduction in childhood obesity across all the socioeconomic groups," says Ms Tulloch.

"That is something we've not managed to achieve in Scotland. The benefits of the programme that they have put in place are that they have targeted and focused resources on the areas where the most help was needed.

"They have picked geographic areas within the city and they have worked hand-in-hand with the community and with schools in those areas to deliver change."

STV News went to Amsterdam to find out first-hand what progress has been made and what lessons might be applied in Scotland.

Karen den Hertog heads up the city's healthy weight programme, which she says was intended to bring about a "paradigm shift" in food culture.

She explains: "We don't want to change things momentarily or just provide families with once-in-a-while moments where we put a healthy lifestyle in the spotlight.

"We really want to make that lifestyle choice possible for all Amsterdam families and especially for all Amsterdam children.

"So we realised that for this to really work it would probably take a generation of children to really change the environment, get healthier and bring all the stakeholders on board."

'It's very easy to just take a takeaway or give your kids something with a lot of processed products in it.'
Karen den Hertog, head of Amsterdam healthy weight programme

There is a long list of such stakeholders the city relies on to buy into the programme, from parents and families through to schools and local businesses.

Ms Den Hertog says she was amazed at the level of interest, however, and cites examples of local business owners teaming up with schools to prohibit junk food products during lunch breaks.

For families from lower on the socioeconomic scale, much of the programme is about equipping people with the knowledge needed to make healthier choices.

"It's very easy to just take a takeaway or give your kids something with a lot of processed products in it," she says.

"We're trying to provide a healthy environment and to provide people with the skills to make the healthy choice in that environment."

Supermarkets: Coosje Dijkstra is researching how we pick our food choices.
Supermarkets: Coosje Dijkstra is researching how we pick our food choices. STV

Coosje Dijkstra, a researcher at the Free University of Amsterdam, is at the frontline when it comes to helping people make better choices in the supermarket.

Putting promotional displays of healthy items like fresh fruit next to checkout counters, she is investigating to see if this results in an increase in purchases of the healthy products and a decrease in sales of unhealthy ones.

Some supermarket employees have also been trained up to become "healthy supermarket coaches" in store to teach children about healthy eating.

A successful trial across two supermarkets now means the initiative is likely to be rolled out in a further four or five stores in the area.

"The neighbourhoods here are of a lower socioeconomic position, so people have a lower education, have a lower income and life is tough," Ms Dijkstra explains.

"Having a healthy diet is not their first concern, or there are lots of other concerns.

"So we try to create interventions that make the healthiest choice the easiest choice."

Dream Support: Community network promoting healthy eating.
Dream Support: Community network promoting healthy eating. STV

Members of the local community seem to have responded positively to these interventions.

Dream Support is a network of community members who have taken it upon themselves to promote healthy choices in their neighbourhoods, including holding events such as cookery classes and community cook-offs.

We spoke to three organisers in the group: Mariam Tahiri, Hanne van der Kolk and Maryam Denguir.

"It impacted my family," says Ms Tahiri. "My father started running again, my mother cooks in a cooking club and does things differently now.

"My mother also followed the programme and actually pointed it out to me. One person tells another person, and that's how we do it."

Before getting involved in Dream Support, she "wasn't healthy at all", she adds.

"I loved energy drinks, which is like six sugar cubes in one little can, and now I don't drink that anymore - I choose water instead," she says.

"The magic of this programme" is that initiatives come from people in the community themselves, says Ms Denguir.

Their aim, she adds, is to help people in poverty "maintain a positive mindset" when it comes to healthy living.

There is a lot of poverty in Amsterdam, says Ms van der Kolk. "It's hard for people to make healthy choices," she explains.

"But if you connect with them and show you can do it in your daily life, and it's not really necessary to be expensive, then they like to do it."

Karen den Hertog: Healthy weight programme 'could inspire' Scotland.
Karen den Hertog: Healthy weight programme 'could inspire' Scotland. STV

Can the success of Amsterdam's programme be replicated in Scotland? What would need to happen?

"It could inspire Scottish politicians," says Ms den Hertog.

"I think the starting point would be politicians with a strong politicial passion and strong political leadership to really put their foot down and say 'This is it. No more increases of overweight and obese children in Scotland - we are really going to stop this here'."

Amsterdam's deputy mayor Eric van der Burg was the person in the city who decided enough was enough back in 2013.

"As might surprise many people, immediately the whole city council gathered around him and approved of his new policy," Ms den Hertog explains.

"Already within the first one or two years there were so many stakeholders in town that came to us, said: 'OK can we join, can we take part in this?'

"So I think it takes political courage and political leadership to start, and then an openness at every single level of government to work together with your partners."

'At the moment in our day-to-day life we are bombarded by price promotions that we know are skewed towards unhealthy foods.'
Lorraine Tulluch, Obesity Action Scotland

Ms Tulloch agrees that for such a programme to be successful here would require political leadership - as well as significant investment of financial and human resources.

"What is also very interesting is that {in Amsterdam] they have taken a very broad programme of actions forward," she adds.

"It has involved everything from improving the built environment of the city, installing water taps around the city, all the way through to training health professionals in consistent messaging."

She says looking to change food culture in Scotland in similar ways to what the Dutch capital has attempted is "something we absolutely need to do".

Ms Tulloch recommends the banning of junk food adverts on television pre-watershed as one policy solution.

"At the moment in our day-to-day life we are bombarded by price promotions that we know are skewed towards unhealthy foods," Ms Tulloch says.

"We are faced with adverts and marketing initiatives that are skewed towards unhealthy foods.

"We need to level that playing field and redirect it towards healthy foods so that we can improve our diet."

A ScotPulse survey carried out by STV News found around six in ten Scots agree TV adverts for junk food and drinks should be restricted.

On Thursday, STV News will take a closer look at Amsterdam's healthy weight programme in schools, comparing it to what's happening in Scotland.

Download: The STV News app is Scotland's favourite and is available for iPhone from the App store and for Android from Google Play. Download it today and continue to enjoy STV News wherever you are.

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