Expanding definitions of obesity may harm children

To the Editor of the British Medical Journal:

I was disappointed at some of Mr. Moynihan’s assertions (1). He wrote
that I am “one of the driving forces” behind the deliberations of an
expert committee in the United States over whether to call children whose
body mass index is > 95th percentile for age and sex “obese” rather
than “overweight” and whether to identify children whose BMI is between
the 85th and 95th percentiles for age and sex as “overweight” rather than
“at risk of overweight,” as they are currently classified. Moynihan’s
article stated that I am “a senior member of the drug company funded
International Obesity Task Force.” This article is followed by a second
article by Moynihan, that suggested that the International Obesity Task
Force (IOTF) is a shill for drug companies (2). The juxtaposition of these
two articles implies that I am responsible for the committee’s decisions
and that furthermore my role is to promote the reclassification so as to
promote the use of drug therapy for obese children and adolescents.

Moynihan cites concerns raised by two senior scientists regarding the
change in terms and suggests that somehow my influence over the expert
committee is sufficient to prompt the committee to ignore the consequences
that a change in terminology may have. Such a suggestion demeans the
integrity, authority, expertise, and sensitivities of the 15 clinical
groups and organizations represented on the expert committee, including
the American Academy of Pediatrics, the American Academy of Family
Practice, the American Academy of Child and Adolescent Psychiatry, the
American Dietetic Association, and the National Association of Pediatric
Nurse Practitioners. That I declined to comment on concerns raised about
the expert panel’s deliberations does not imply some conspiratorial
intent. I declined to comment because it was inappropriate for me to do
so. Although my employer, the Centers for Disease Control and Prevention
(CDC), has provided financial support for the expert committee and its
writing groups, as have the American Medical Association and the Health
Resources and Services Administration, I am not a member of the committee.
Moreover, the committee’s recommendations have not been finalised, and
when they are, they will be those of the expert committee, not my
recommendations or the CDC’s.

A major inaccuracy in Moynihan’s first article is that I am a member
of the IOTF; I have not been a member of the IOTF since 2000. During the
time that I was a member, I chaired a working group on childhood obesity
that developed an international reference population for the
classification of childhood overweight and obesity (3). Drug therapy for
the pediatric population was not an approach that our working group
considered, nor is it one I have ever endorsed as routine therapy for
children or adolescents who are overweight or at risk of overweight. For
example, an editorial I wrote in 1994 raised concerns about the use of
drug therapy in the pediatric age group (4). More recently, we specified
that drug therapy be reserved for severely overweight children or
adolescents, and then only after the failure of more conservative therapy
(5). As we stated in that article, “Until more extensive safety and
efficacy data are available, medications for weight loss should be used
only on an experimental basis in adolescents and children.”(5,6) The
therapies used to treat overweight children have been based, and will
continue to be based, on the risks associated with their excess weight,
not on the terms used to describe them.

1. Moynihan R. Expanding definitions of obesity may harm children.
BMJ 2006;332:1412. (17 June.)
2. Moynihan R. Obesity Task Force linked to WHO takes “millions” from drug
firms. BMJ 2006;332:1412. (17 June.)
3. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard
definition for child overweight and obesity worldwide: international
survey. BMJ 2000; 320:1240-3. (6 May)
4. Dietz WH. Pharmacotherapy for childhood obesity? Maybe for some.
Obesity Res 1994;2:54-5.
5. Dietz WH, Robinson TN. Overweight children and adolescents. New Engl J
Med 2005;352:2100-9.
6. Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL. Behavior therapy
and sibutramine for the treatment of adolescent obesity: a randomized
controlled clinical trial.

Competing interests:
None declared