Sponsoring the obesity crisis
Now we know that the tragic death of a three-year-old girl weighing 40 kilos was due to a rare genetic disorder and not, as the media had almost universally concluded, to gross parental neglect and cruelty. The Commons Select Health Committee chose to highlight this death as an example of children "choking on their own fat" in their 146 page report on obesity. But Brendan O'Neill of Spiked, who first revealed the truth behind the story, commented:
"If the Committee's aim in upfronting this tragic death was to get its report on the front pages of the papers, it succeeded. 'Three-year-old dies from obesity' said the simplistic headlines. One report described the death as a 'wake-up call' for parents; others accused the three-year-old's parents of 'stuffing her to death', as if this were some morbid modern-day version of a Grimm brothers' fairytale …"
Sheila McKenzie of the Royal London Hospital, who brought to the attention of the Health Committee the tragedy of the little girl, was apparently horrified by the report's treatment of the case and told colleagues that she had been misrepresented and was shocked by the way in which the issue had been reported in the media.
Three days later, Sarah Bosely reported in the Guardian that:
"MPs were criticised yesterday for failing to ask crucial questions about the death of an overweight three-year-old girl before they used her to illustrate the obesity pandemic sweeping Britain in the report that shocked the country two weeks ago. The girl's condition is now known to have been genetic. The Guardian has established that the doctor who told the Commons health select committee of the child's death was horrified by the prominent use of the case in the second paragraph of the report, which said that it 'offered a powerful insight into the crisis posed to the nation's health'."
What this sad piece of inappropriate opportunism reflects is the level of near panic that characterises the current discussion of obesity issues — a point stressed by Dr Jeffrey Friedman, an obesity researcher at Rockefeller University, in the New York Times:
"The obesity arena 'is so political, so rife with misinformation and disinformation,' he said . Obesity, Dr. Friedman says, is a problem; fat people are derided and they have health risks like diabetes and heart disease. But it does no one any good to exaggerate the extent of obesity or to blame the obese for being fat. 'Before calling it an epidemic, people really need to understand what the numbers do and don't say,' he said."
Friedman' claim is that the statistics demonstrate clearly that while the very fat are getting fatter, thinner people have remained pretty much the same.
Other specialists in food-related disorders have also drawn attention to the potentially damaging consequences of the increasingly irrational and politicised obesity debate. The psychoanalyst, Susie Orbach, author of Fat is a Feminist Issue, writing in the Observer argued:
"The hidden psychological effects of this attack on our body size are enormous. We are not going to protect the next generation by simply exhorting them to eat so-called good foods. Children who are growing up now have often imbibed anxiety around food and feeding. It has come along, quite unwittingly, with a mother's milk, as she seeks to manage the societal pressures to stay away from fat."
Orbach places the blame for much of the hysteria currently surrounding body size on those who stand to profit from it most directly — the diet and fitness clubs, slimming magazines and the pharmaceutical companies who manufacture weight-loss drugs. The 'medicalisation' of obesity, turning it from a social and lifestyle issue into a 'disease', allows it to be 'treated' using such drugs. While the obesity 'experts' urge radical changes in diet and levels of exercise, many also advocate the more widespread availability of such medical treatments. Dr Ian Campbell, chair of the UK National Obesity Forum, is one such expert. Although he stresses that medication is not the answer for the majority of overweight and obese people, he sees them as playing a potentially useful role:
"Losing weight can be incredibly difficult, and I am convinced that there are some patients who, despite their best efforts, cannot lose significant amounts without medication. Research shows that the weight-loss drugs help patients to lose weight and significantly reduce cardiovascular and other health risks."
This may sound reasonable, although many doctors and health professionals have argued strongly that such medical approaches to essentially lifestyle issues are both unwarranted and inappropriate. What Dr Campbell rarely mentions, however, is that his National Obesity Forum includes a number of pharmaceutical companies in its list of sponsors who manufacture the drugs that he suggests can play a significant role in stemming the obesity 'epidemic'. Dr Campbell has also been listed on a help line advertised in Roche's 'Obesity Awareness Campaign' materials — a poster campaign criticised by GPs as being a thinly disguised marketing exercise for Xenical. A report in the Sunday Herald last year (15/6/2003) noted:
"Campbell admitted that, ideally, the obesity awareness campaign would be run by an organisation with no conflict of interest, but insisted that this was not happening. 'I certainly think there is a need for greater public awareness of the health risks of obesity and the potential solutions. Ideally, this would all be forthcoming from some agency that does not have a commercial interest, but the reality is that it is not being done to the degree that we would like. I do think the campaign is justifiable and should be able to point people in the right direction'… Campbell has called for the number of people being prescribed obesity drugs in the UK to be doubled."
Similar, and largely hidden, support by pharmaceutical companies for campaigns aimed at increasing 'obesity awareness' has been apparent in other countries. The 'Healthy Weight Task Force' in Australia, for example, declared itself to be the 'first ever network of primary healthcare professionals to have formed in response to the rising levels of excess weight and obesity'. An article in the Journal of the Australian Consumers Association last year (Vol 93, 2003), however, revealed:
"The taskforce evaluated the available methods of weight loss, including pharmaceutical products and weight loss programs. The findings were presented as a matrix designed to assist healthcare professionals and consumers identify current models of 'best practice'. A pharmaceutical product (Xenical) was considered to be the most effective and appropriate form of weight loss. The findings and educational materials produced by the Healthy Weight Task Force were broadly promoted to the mainstream media and directly to general practitioners. What was not stated in any information provided by the HWT was that the pharmaceutical company, Roche, funded the project. It also did not state that the recommended product, Xenical, was produced by Roche. In fact, this information was only revealed on 'Media Watch', a program broadcast on ABC TV in Australia which examines the media portrayal of current events."
The Australian Society for the Study of Obesity (ASSO) has also been rather shy about revealing its sources of funding. According to its web site:
"Financial support is solicited from a variety of health, community, government and commercial organisations. Donations are accepted as educational or research grants and all financial contributions are subject to defined regulations and audit procedures."
Earlier this year, however, the Australian Financial Review (17/1/2004) revealed that:
"ASSO, which helped kick off the obesity debate in Australia with a 1993 report, is now funded largely by pharmaceutical companies selling obesity drugs and other 'nutrition' products, such as Roche Products, which produces Xenical, and Abbott Laboratories, which promotes Reductil."
ASSO is one of the many organisations world-wide that are affiliated with the International Association for the Study of Obesity (IASO), of which the International Obesity Task Force (IOTF) is a major part. In fact, IASO and IOTF appear as joint 'working names' in the UK Register of Charities. Both the national organisations and the umbrella international bodies receive extensive financial support for conferences and other activities from the major pharmaceutical companies. The Obesity Newsletter published by IASO routinely contains full-page advertisements for Roche's Xenical weight-loss drugs and similar products. The upcoming International Congress on Obesity, to be held in Sydney in 2006, is being organised by ASSO on IASO's behalf. The opportunities for sponsorship of this conference (ICO 2006), which judging by previous sponsors are directed almost entirely in the pharmaceutical and diet food industries, have already been announced (see side bar).
The chair of IOTF, which shares offices and funding sources with IASO, is Professor Philip James — a well-known anti-obesity campaigner and a specialist adviser to the Health Committee's inquiry into obesity. No mention was made in the Committee's report of James' association with the pharmaceutical industry despite the fact that, among many other activities, he was the lead researcher in trials of sibutramine, a weight-loss drug manufactured by the Knoll Pharmaceutical Company, and orlistat (Xenical) made by Roche, and is regularly engaged in what can only be described as PR activities for Roche. Last year he presented the prizes at the Roche Gulf Awards for Obesity Journalism ceremony in Dubai. At this event Roche also took the opportunity to publicise the results of a clinical trial showing that patients taking Xenical were 37% less likely to develop type II diabetes compared with those losing weight through lifestyle changes alone. Strangely, reference to this event on Roche's website seems now to have disappeared. In fact, the whole 'lose.weight-roche.com' web site appears to have been tactfully renamed 'managingyourweight.com'.
So what are we to make of all this? There is no suggestion here that Dr James and his colleagues at IASO and IOTF, and in all of the affiliated organisations, are anything other than sincere in their determination to reduce the burden of obesity worldwide. Nor can there be any quarrel with the search for effective medical treatments for extreme cases of obesity. But, as the Health committee themselves noted, theirs was "a contentious inquiry, with powerful interest groups carefully watching our work." They added: "We are grateful for the objective and expert support we have received from our advisers." Perversely, the weight-loss industry appears to have escaped inclusion in the category of 'powerful interest groups' — something the Committee, in the wake of its disastrous gaffe about children 'choking on their own fat,' may wish to put right.
Peter Marsh and Simon Bradley — June 10, 2004