The Scottish Health Survey 2024 - volume 1: main report

6. Diet & Food Insecurity

Rory McClelland

6.1     Introduction

Poor diet is one of the leading risk factors for ill health globally[i] and dietary habits learned in childhood can influence behaviour later in life.

Non-communicable diseases (NCDs), such as cardiovascular disease, diabetes and cancer, are also referred to as chronic diseases as they often affect individuals over a long period of time. NCDs result from a number of risk factors, often in combination, including diet and obesity. The risk of such conditions can be reduced by improvements in the nutritional content of diets[ii],[iii].

The Scottish Government defines food insecurity as a full range of experiences from worry regarding ability to afford food, through to compromising on quality and quantity of food and experiencing hunger[iv]. As well as mental health, food insecurity has been associated with a number of other chronic health conditions such as type 2 diabetes, obesity and heart disease[v]. Increases in the cost of living, including food prices, have placed additional economic pressure on households, widening inequalities and increasing the likelihood of turning to less healthy but cheaper foods[vi],[vii].

6.1.1     Policy background

Diet

The Population Health Framework sets out a clear ambition to enable everyone to lead longer, healthier and fulfilling lives[viii]. This includes supporting people to eat a healthy, balanced diet.

Eating well is a key public health priority for Scotland. A Healthier Future: Scotland’s Diet and Healthy Weight Delivery Plan[ix], published in July 2018, sets out a vision where everyone eats well, diet-related health inequalities are reduced and food insecurity is tackled.

A new Diet and Healthy Weight Implementation Plan is being developed to support the Population Health Framework. This will contain a refreshed set of actions that will be published in due course. The Delivery Plan is underpinned by the Scottish Dietary Goals[x] and initiatives such as Eat Well Your Way and Parent Club[xi]. The Scottish Government commitment to legislation restricting the promotion of less healthy food and drink sold to the public will be informed by the outcome of a consultation on the detail of proposed regulations which closed in May 2024[xii].

The Scottish Dietary Goals (SDGs), revised in 2016, provide the basis for a healthy balanced diet. The Goals (details of which can be found in the 2024 technical report) describe, in nutritional terms, a diet that will improve and support the health of the Scottish population. These Goals are currently being reviewed by Food Standards Scotland.

Aligned with this, in 2023, Food Standards Scotland introduced a revised Public Health Nutrition Strategy[xiii], which focuses on measures that aim to make nutritious options more accessible and affordable and reduce health inequalities.

Food Insecurity

In 2022, the Good Food Nation (Scotland) Act[xiv] was introduced which requires the Scottish Government, local authorities, and health boards to produce long-term food plans aimed at improving access to healthy, sustainable, and affordable food. The Act promotes a joined-up, rights-based approach to food policy, focusing on reducing food insecurity, improving health and wellbeing, and supporting a fairer, more sustainable food system.

In June 2023, the Scottish Government published the Cash-First: Towards Ending the Need for Food Banks in Scotland plan[xv] which sets out a human rights approach to tackling food insecurity and ending the need for food banks in Scotland. Over three years, nine collaborative actions will be taken forward to improve the response to crisis, using a cash-first approach so that fewer people need to turn to food parcels.

6.1.2     Reporting on diet and food insecurity in the Scottish Health Survey

This chapter presents findings on the reported dietary intakes of adults in the Scottish population in 2024, in relation to some of the SDGs. Reporting includes average daily intakes of[xvi]:

• Fruit and vegetables (portions[xvii])
• Energy (kcal) and energy density (kcal/100g)
• Total fat and saturated fat (g and % total energy and % energy excluding ethanol)[xviii]
• Free sugars (g and % total energy and % energy excluding ethanol)
• Red and red processed meat (g)
• Fibre (g)

The proportion meeting each of these SDGs, with the exception of the SDG for reduction in energy intake, is also reported.

In this chapter, food insecurity data is also presented for adults. Figures are reported by age, sex and for food insecurity, by household type.

An interactive data dashboard is also available presenting key indicators for Scotland, NHS Boards and local authority areas.

In 2024, dietary data for adults was collected using online dietary recalls (Intake24), following the conclusion of the main SHeS interview. The use of Intake24 allowed for monitoring of a number of the SDGs.

For detailed definitions of terminology used in this chapter and for further details on the data collection methods for diet and food insecurity, please refer to the Scottish Health Survey 2024 - volume 2: technical report.

6.1.3    Comparability with other UK statistics

Dietary intake data is collected in the National Diet and Nutrition Survey (NDNS)[xix] for Scotland, Wales, England and Northern Ireland and is designed to be representative of the UK as a whole. For NDNS 2019 to 2023 the method of recall collection and analysis is comparable with SHeS. SHeS however is based on up to 2 recalls, whilst the NDNS uses up to 4, and is representative of the Scottish adult population.

Food insecurity prevalence estimates are available from the UK-wide Family Resources Survey (FRS)[xx] for Scotland, Wales, England and Northern Ireland and are fully comparable.

6.2     Results

Summary points

In 2024:

• Just over one in ten adults (11%) ate the SDG of five or more portions of fruit and vegetables per day, with a mean intake of 2.9 portions per day. The proportion eating five portions or more per day was the lowest in the timeseries, with prevalence in the range 20%-24% between 2003 and 2021.
• Less than one in five adults (19%) met the energy density SDG of no more than 125 kcal/100g/day. The average energy intake per day was 1,538 kcal.
• Thirteen per cent of adults met the SDG for saturated fat of no more than 10% of energy excluding ethanol. Only 3% of those aged 75 and over met the goal.
• Less than a quarter (22%) of adults met the SDG of free sugars accounting for no more than 5% of energy excluding ethanol. On average, free sugars were double the recommendation, making up 10% of energy intake.
• Almost three quarters (74%) of adults met the 70g or lower SDG for red and red processed meat, a proportion that was higher among females (84%) compared with males (63%).
• Less than 1 in 20 (3%) adults met the SDG fibre target of 30g or more per day, with an average intake of 15g per day.
• Eight per cent of adults worried about running out of food due to a lack of money or other resources in the last 12 months, a decrease from 14% in 2023 which was the highest level in the timeseries.
• Just over a third (36%) of adults in single parent households had worried that they would run out of food in the last 12 months for 2023/2024 combined.

6.2.1     Around one in ten adults met the SDG for fruit and vegetables, the lowest proportion recorded across the timeseries

Just over one in ten adults (11%) ate the SDG of five or more portions of fruit and vegetables per day in 2024, a significantly lower proportion than the range recorded between 2003 and 2021 (20%-24%)[xxi]  [xxii]  Between 2021 and 2024, the proportion of adults who ate no fruit or vegetables/less than half a portion remained at 3%.

A mean of 2.9 portions of fruit and vegetables were consumed per day in 2024, the lowest mean recorded.

6.2.2     Fruit and vegetable consumption was lowest among adults aged 25-34

In 2024, the proportion of adults who consumed the SDG of five or more portions of fruit and vegetables per day was highest among those aged 35-44 (16%) and lowest among those aged 25-34 (7%).

The proportion of males and females who consumed five or more proportions of fruit and vegetables per day was similar across age groups, with the exception of 16–24-year-olds where four times as many males (20%) met the SDG compared with females in the same age group (5%).

Table 6.2

6.2.3     Less than one in five adults met the energy density SDG

In 2024, the average energy intake was 1,538 kcal/day for adults, with averages of 1,699 kcal/day for males and 1,391 kcal/day for females.

Energy intake varied by age, ranging from 1,663 kcal/day among those aged 16-24 to 1,359 kcal/day among those aged 75 and over.

The average energy density of foods consumed by adults in 2024 was 164 kcal/100g/day. Less than one in five adults (19%) met the energy density SDG of no more than 125 kcal/100g/day, a proportion that increased from 7% among those aged 16-24 to 36% of those aged 75 and over

Table 6.3

6.2.4    Total fat intake exceeded the SDG for more than half of adults

Among all adults, just under half (47%) met the SDG of no more than 35% of energy excluding ethanol to come from total fat in 2024. Similar patterns were evident for both males and females across age groups with the exception of those aged 16–24 where almost twice as many males met the total fat SDG (61%) compared with females in the same age group (32%).

Average fat intake as a percentage of energy excluding ethanol was 35% with no significant differences by age or sex.

Just over one in 10 (13%) adults met the SDG for saturated fat intake (no more than 10% of energy excluding ethanol) with no significant difference by sex. Older adults were less likely to meet the goal than younger adults with 23% of 16–24-year-olds having met the goal compared with 3% of those aged 75 and over. Similar patterns were evident for both males and females.

Figure 6B, Table 6.4

6.2.5     Less than a quarter of adults met the SDG for free sugars

Free sugars made up an average of 10% of total energy intake excluding ethanol among adults in 2024, with no significant variation by age or sex.

Less than a quarter (22%) of adults met the SDG of free sugars accounting for no more than 5% of energy excluding ethanol.

Adherence to the SDG for free sugars excluding ethanol was lowest among adults aged 16-34 (17%-18%) and those aged 75 and over (19%) and highest among those between the ages of 35 and 64 (21%-29%).

Table 6.5

6.2.6    Almost three quarters of adults adhered to the daily intake guidelines for red meat

In 2024, almost three quarters (74%) of adults met the 70g or lower SDG for red and red processed meat, a proportion that was higher among females (84%) compared with males (63%). Variations by age were not significant.

Just over one in ten adults consumed 90g or more per day of red or red processed meat products (13%). The proportion of males who reported an average daily intake of 90g/day or more was over three times higher than the proportion of females (21% and 6% respectively). Variations by age were not significant.

Table 6.6

6.2.7    Less than one in twenty adults met the SDG daily fibre intake target

Less than 1 in 20 (3%) adults in 2024 met the SDG for fibre of 30g or more per day. The average adult fibre intake was 15g/day. Similar proportions met the goal and similar amounts per day were consumed for males and females and across the age groups.

Table 6.7

6.2.8     Adult food insecurity has decreased after reaching its highest point in the time series in 2023

In 2024, 8% of adults had worried about running out of food due to a lack of money or other resources in the last 12 months, a decrease from 14% in 2023 and a return to the range recorded between 2017 and 2021 (8%-9%). The largest decreases in the proportion worried about running out of food between 2023 and 2024 were adults aged 16-44 (from 20% to 10%).

In 2024, older adults continued to be less likely to have worried about running out of food in the past 12 months (3% among those aged 65 and over) compared with those aged 16-64 (8%-10%).

Six percent of adults reported eating less in the last 12 months due to a lack of money or other resources.  As recorded in previous years, those aged 65 and over were least likely to having done so in 2024 (2%).

The proportion of adults who had run out for food in the previous 12 months due to a lack of money or resources was 3%. This proportion decreased by age, from 5% of younger adults aged 16-44 to 1% among those aged 65 and over. Variations by sex were not significant.

Figures 6C & D, Table 6.8

6.2.9    Adults in single parent households were most likely to have experienced food insecurity in 2023/2024 combined

In 2023/2024 combined, just over a third (36%) of adults in single parent households had worried about running out of food in the last 12 months, followed by 21% of single adult and 19% of large family households.

Adults in single parent households were also the most likely to have reported eating less because of a lack of money or resources in the last 12 months (27%), again followed by single adult (18%) and large family (15%) households.

The same household types had the highest proportions of adults who reported having run out of food, with 15% of those in single parent households, 13% those in single adult households and 7% of those in large family households reporting having done so in the last 12 months.

Figure 6E, Table 6.9

Table List

Table 6.1  Adult fruit and vegetable consumption, 2024, by sex

Table 6.2  Adult fruit and vegetable consumption, 2024, by age and sex

Table 6.3  Adult average energy intake per day and average energy density per day, 2024, by age and sex

Table 6.4  Adult total fat/saturated fat intake, 2024, by age and sex

Table 6.5  Adult free sugars intake, 2024, by age and sex

Table 6.6  Adult red and red processed meat intake, 2024, by age and sex

Table 6.7  Adult fibre intake, 2024, by age and sex

Table 6.8  Adult food insecurity, 2017 to 2024, by age and sex

Table 6.9  Adult food insecurity, 2023/2024 combined, by household type and sex