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Venous thromboembolism (VTE) is not recorded as a single separate diagnosis and represents a range of conditions. VTE is likely to be the underlying condition in almost all cases with a recorded diagnosis of pulmonary embolism. Some, though not all, cases with the diagnosis ‘phlebitis and thrombophlebitis of the lower extremities’ are associated with VTE, particularly where the site is the deep veins of the leg.

The number of hospital stays in NHS Scotland with a recorded diagnosis of pulmonary embolism or with ‘phlebitis and thrombophlebitis of the lower extremities’ for the time period 1 April 2020 to 30 September 2020 are shown in the following table. (Data for the period up to December 2020 will be available from 25 May 2021.) It is not possible to say how many of these episodes were specifically related to the COVID-19 pandemic.

Venous thromboembolism may occur at many sites other than the lower extremities, including the portal, renal and cerebral circulations, but these cases are not included here.

Table: Number of hospital stays for pulmonary embolism and for ‘phlebitis and thrombophlebitis of the lower extremities’* (without mention of pulmonary embolism) in NHS Scotland, 1 April 2020 to 30 September 2020.
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We support the mission of World Obesity Day, which aligns with the five key outcomes set out in our 2018 Diet and Healthy Weight Delivery Plan: giving children the best start in life; creating a healthier food environment; better access to weight management services; leadership; and reducing health inequalities. The Delivery Plan is at https://www.gov.scot/publications/healthier-future-scotlands-diet-healthy-weight-delivery-plan/ .

Evidence shows that people living with obesity often experience stigma from employers, health professionals, the media as well as from family and friends. This stigma and weight bias has been associated with poorer mental health, negative experiences of healthcare provision, which can then be a barrier to accessing support that could help people live healthier lives. This is why we have included actions in our Delivery Plan action to address weight-based stigma and discrimination. Included in our Delivery Plan is the commitment to better understand the extent to which weight-based stigma prevents young people from seeking health care advice, treatment and support through research. The Delivery Plan also contains a commitment to act upon the findings.

In March 2020, the Mental Health Foundation co-chaired the Scottish Government’s Advisory Group on Good Body Image for children and young people, and published a report with a number of recommendations relating to the eradication of weight stigma and bias. The report can be accessed here: https://www.mentalhealth.org.uk/sites/default/files/MHF_Body-Image2020_Report_ONLINE-VERSION%20%281%29.pdf .

In response to this publication, Public Health Scotland are developing weight stigma discrimination training and communication guidelines that will initially be aimed at health care professionals in the NHS but will also be freely available for anyone to access.

In 2020-21 we provided Obesity Action Scotland with over £200,000 of grant funding. Obesity Action Scotland provide leadership and advocacy to health professionals, policy makers and the public on preventing, and reducing obesity and overweight in Scotland by:

• Raising awareness and understanding of health harms and drivers
• Identifying and pursuing effective prevention strategies
• Undertaking appropriate research and evidence gathering
• Promoting healthy weight

We are aware of evidence highlighting the impact obesity can have on the severity of COVID-19. We are learning more about the virus and its relationship to obesity and health inequalities all the time. This is why addressing overweight and obesity remains a public health priority. Our Diet and Healthy Weight Delivery Plan outlines our vision of a Scotland where everyone eats well and has a healthy weight.

The Delivery Plan acknowledges that deprivation is a contributory factor to levels of obesity and overweight in the Scottish population, and sets out actions to be taken forward to address this. The pandemic has underlined the importance of this approach.

We consider that the actions contained in the Delivery Plan to improve the food environment are still the right approach but their timing will require careful consideration in light of the pandemic’s impact on society. The administration in place after the Scottish Parliamentary election may therefore wish to give this matter careful consideration.

The annual Diet and Healthy Weight Monitoring Report publishes official statistics on obesity, measured against the obesity indicator framework, with reference to wider health inequalities. The most recent publication can be found here: Diet and healthy weight: monitoring report 2020 - gov.scot (www.gov.scot) .

Diet and levels of obesity and overweight in adults and children are also measured annually as part of the Scottish Health Survey. This information is available at SIMD quintile.

Plans to meet to discuss the annual Long-term Monitoring of Health Inequalities report, including a review of indicators, has been postponed due to the COVID-19 pandemic. This is hoped to restart again later in the year.

We are aware that the pandemic has impacted the delivery of weight management services across Scotland. Staff have been redeployed to acute COVID-19 response, which has resulted in the pausing of some in-person weight management services across Boards over the past year.

Boards are required to report quarterly to the Scottish Government on their progress in relation to the Framework for the Prevention, Early Detection and Early Intervention of Type 2 Diabetes. This reporting mechanism allows us to assess any impact of COVID-19 on weight management services that are integral to Type 2 Diabetes care.

The provision of weight management services has continued throughout the pandemic on digital platforms such as NHS Near Me. Boards are refocusing pre-COVID services to include digital and technological solutions to improve flexibility of care. Further information on Near Me can be found here https://www.nearme.scot/ .

Public Health Scotland will publish a national report this year on the core national weight management dataset, incorporating data analyses and reflections on COVID-19 impact on data collection. This report is expected in May 2021. We will use this dataset to assess the weight management services currently offered and the outcomes achieved by users.

We recognise that supporting people to remain physically active and keep mobile can reduce the incidence of both venous thromboembolism and pulmonary embolism. Being physically active is particularly important during the COVID-19 pandemic as this not only has significant benefits for our physical health but also our mental health.

Evidence based local pathways have been developed to support standard assessment and timely referral for appropriate investigations of venuous thromboembolism, with quick scan response times.

The pathways also support the need for ongoing follow up, or further investigation where clinically appropriate. This is supported by pharmacy teams to allow rapid access to anticoagulants and new oral anticoagulants in the community to reduce the need of regular INR blood monitoring.

Our 2018 Diet and Healthy Weight Delivery Plan sets out that we will give children the best start in life through a broad range of action to support children and their families to eat well and be a healthy weight. The Delivery Plan is at https://www.gov.scot/publications/healthier-future-scotlands-diet-healthy-weight-delivery-plan/

We want to ensure parents and carers are supported to make informed decisions, whether it’s about breastfeeding and weaning, nutrition, portion size or mealtime behaviours. Furthermore, should their child’s weight become a concern, we want parents to understand why it matters, and to feel supported – not judged – with good advice and services.

There is strong evidence that breastfeeding is one of the most important things that a mother can do to give her baby the best nutritional start in life, which can also be a means of preventing obesity among infants and young children. We have provided over £5 million in additional investment over the past three years to NHS Boards and launched a Breastfeeding Friendly Scotland scheme to promote, support and protect breastfeeding. The Becoming Breastfeeding Friendly Scotland report is at: https://www.gov.scot/publications/becoming-breastfeeding-friendly-scotland-report/

Public Health Scotland published Core Standards for Healthy Weight Management in 2019. It strongly encourages NHS Boards to continue to innovate by developing and testing more efficient, responsive, and family-centred approaches to continually improve the quality of the services provided. The standards recommend that NHS Boards, in line with the best available evidence, provide treatment programmes for children and young people, which are ‘multicomponent’ and incorporate the following elements: behaviour change, are family based, involve at least one parent/carer and aim to change the whole family’s lifestyle. The standards are at: http://www.healthscotland.scot/media/2658/standards-for-the-delivery-of-tier-2-and-tier-3
-weight-management-services-for-children-and-young-people-in-scotland-english-oct2019.pdf

We are providing over £600,000 this financial year to ten NHS board-led projects, working with families to help prevent and reduce levels of childhood obesity. Many of these are trialling a family-centred approach, with particular focus on parents and families from disadvantaged backgrounds.

Our Parent Club site ( https://www.parentclub.scot/ ) provides a range of hints and tips to help families enjoy healthier meals and snacks, especially for those on a budget. The site recognises the additional challenges parents are facing during the pandemic so the advice does not just look at what to eat but how preparing food can be educational and fun.