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LETTERS: Carrie H Ruxton WHO obesity charter seems more like a mantra BMJ 2006; 333: 1221-b [Full text]

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Salt and obesity

Michael E J Lean   (15 December 2006)

Response to Prof Lean

Carrie Ruxton   (6 April 2007)

Salt and obesity 15 December 2006
Michael E J Lean, Professor of Human Nutrition Human Nutrition, University of Glasgow, Glasgow Royal Infirmary, G31 2ER Send response to journal: Re: Salt and obesity	Dear Editor I write to inform Carrie Ruxton, and any who read her letter (BMJ letter - 9 December 2006) which stated “As far as I am aware, there is no relation between salt and the aetiology, prevention and treatment of obesity”. People who are obese must of necessity consume more food energy than others who are not – particularly those who manage to remain physically active. Otherwise, they lose weight. Our food supply is very heavily contaminated by salt, used as an additive by food manufacturers and caterers. About 80% of all salt eaten has been added before it reaches our tables. People who eat more food energy, to become and stay obese, inevitably eat more salt. The accumulated effect, of extra salt consumption, over many years of weight gain and obesity is to contribute to hypertension and left ventricular failure in obese people, ultimately to accelerate CHD, stroke and death. Losing 5-10 kg weight reduces blood pressure substantially, and this relates in part to a lower dietary salt load. So, no, Dr Ruxton – the European Obesity charter is not “a mantra”. For obese people especially who cannot lose weight, avoiding salt as a food additive is one valuable part of treatment to help reduce their medical complications, independently of what weight loss they can manage. Competing interests: None declared
Response to Prof Lean 6 April 2007
Carrie Ruxton, Freelance Dietitian Cupar, KY15 4EA, UK Send response to journal: Re: Response to Prof Lean	Professer Lean states that salt reduction is important in the treatment of co-morbidities related to obesity. However, he did not actually address the point of my letter, which was to question why WHO seems to believe that salt reduction would impact on obesity prevalence. As the following quote demonstrates, the 2006 WHO Charter clearly links obesity prevalence with high intakes of salt: "An energy imbalance in the population has been triggered by a dramatic reduction of physical activity and changing dietary patterns ... containing high proportions of saturated as well as total fat, salt, and sugars ..". The Charter then identifies action that would reduce the prevalence of obesity, including: "reduction of fat, free (particularly added) sugars and salt in manufactured products". I return to my original point that the WHO guidelines simply repeat a salt-sugar-fat mantra without sufficient evidence to show how these dietary changes would help Europeans avoid obesity. I am no apologist for the salt industry and do not contradict Prof Lean's view on the importance of salt in cardiovascular health. However, it is not clear to me what evidence links salt with obesity prevalence, and this makes me wonder about the validity of the other pronouncements in the WHO Charter. Competing interests: None declared