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NEWS: Ray Moynihan Obesity task force linked to WHO takes "millions" from drug firms BMJ 2006; 332: 1412-a [Full text]

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IASO reponse

Neville J Rigby   (19 June 2006)

IASO reponse 19 June 2006
Neville J Rigby, Director of Policy and Public Affairs International Association for the Study of Obesity (IASO) 231 North Gower St, London NW1 2NR Send response to journal: Re: IASO reponse	To the Editor: Your correspondent overlooked and confused some very salient facts in the article "Expanding definitions of obesity may harm children". (News page 1412 BMJ June 17). The International Obesity TaskForce is not participating in the initiative of the American Medical Association, which has convened experts from 14 separate US organizations to consider how to address childhood obesity – something that few would disagree is one of the most pressing public health issues in the USA today. Moreover I pointed out to your correspondent that we were unaware that this particular initiative was currently under discussion. It is difficult to understand why the BMJ should prefer to indulge in vague conjecture about “expanding definitions of obesity” without providing its readers with some clear details of the scientific issues that are supposedly involved. The present definition of children's weight in the USA adopts the usage "at risk of overweight" for those above the 85th centile, and “overweight" for those above the 95th centile. Similar cut off points are applied in epidemiological analysis in Britain and elsewhere, but using the terms overweight and obesity. However these are population specific measures, that do not relate children’s body mass index (BMI) to the WHO international standard BMI cut-offs for adults as your report inferred. The value of these arbitrary centile cut-off points is the subject of much discussion, since, for example, the 95th centile in the USA reflects an even higher level of adiposity than does the 95th centile in Britain.(1) The AMA expert group has yet to decide its recommendations to the AMA Council on Scientific Affairs, which in turn has had no opportunity to decide on any proposals to the Federal agencies on the adoption of the clearer terms, overweight and obesity, or on what cut off points or methodology to apply. However it would seem highly improper to suggest, as the BMJ seems to do, that this group might in some way be seeking to artificially magnify the scale of the obesity problem among children in the USA or indeed is doing so at the behest or for the benefit of the pharmaceutical industry, an undeserved slur on the many dedicated experts concerned to address what is an undeniably mounting epidemic of obesity, not merely in the USA, but in many parts of the world. Dr William Dietz, head of the division of nutrition and physical activity at the Centers for Disease Control, Atlanta, was the original chair of the IOTF group on childhood obesity, although, as I made clear to your correspondent, he is no longer involved having served from 1998-2000. Dr Dietz’s original group developed the widely-used IOTF cut-off points for childhood overweight and obesity, which adopt a methodological approach relating growth curves and cut-off points to the WHO’s adult BMI criteria.(2) The purpose is to allow valid international comparisons of data, but it is not intended for clinical use. It has been generally highlighted by others as narrowing rather than expanding the definition of obesity in children, resulting in lower prevalence estimates than traditional alternatives.(3) The IOTF is part of the International Association for the Study of Obesity, which this year is celebrating its 20th anniversary as the scientific body uniting researchers, clinicians, health professionals and others concerned with obesity worldwide. Your reference to the IOTF having cash "amounting to more than £1m" is quite misleading; this does not refer to IOTF funds, but relates to the modest year-end reserves of an international medical organisation providing services to almost 50 associations with 10,000 members worldwide and seeking to meet the growing demands for engagement in many global initiatives. Like many charitable medical societies, IASO has benefited from donations from the pharmaceutical sector towards specific projects. It has also received foundation support for its work leading the Global Prevention Alliance with other international NGOs concerned about the rising obesity epidemic and related chronic diseases. IASO would be delighted to receive "millions" from donors wishing to support its work to promote strategies for the prevention of obesity, given the urgency and enormity of the public health challenge. It is more than disappointing that the British Medical Journal should not only miss an opportunity for a better informed discussion of the critical issue of childhood obesity, but should misinform its readers in this cavalier manner. Yours sincerely Neville Rigby Director of Policy and Public Affairs International Association for the Study of Obesity, 231 North Gower Street, London NW1 2NS Email: nrigby@iaso.org (1) Fig 3 in McCarthy HD, Cole TJ, Fry T, Jebb SA and Prentice AM Body fat reference curves for children International Journal of Obesity (2006) 30, 598–602; (2) Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ (2000) 320, 1240–1243; (3) Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL. Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index. Am J Clin Nutr. 2001 Jun;73(6):1086-93. Competing interests: I am an employee of the International Association for the Study of Obesity. I have no conflicting interests.