Obesity task force linked to WHO takes “millions” from drug firmsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7555.1412-a (Published 15 June 2006) Cite this as: BMJ 2006;332:1412
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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
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.
Director of Policy and Public Affairs
International Association for the Study of Obesity,
231 North Gower Street,
London NW1 2NS
(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.
I am an employee of the International Association for the Study of Obesity. I have no conflicting interests.
Competing interests: No competing interests