BMJ  2006;333:44 (1 July), doi:10.1136/bmj.333.7557.44

Letter

Obesity association clarifies definitions of obesity and links with drug firms

EDITOR—Your reports referring to childhood obesity definitions in the USA and the International Obesity Task Force (IOTF) contained errors.^{1 2} The task force is part of the International Association for the Study of Obesity (IASO), this year celebrating its 20th anniversary as the body uniting researchers, clinicians, health professionals, and others concerned with obesity worldwide.

The IOTF has no role in the childhood obesity expert group convened by the American Medical Association, the Centers for Disease Control, and the Health Resources and Services Administration. You report a proposal to adopt the 85th and 95th centiles as reference points for overweight and obesity in children. In the USA these cut-off points are termed "at risk" and "overweight."³ Your readers may judge whether this is an effort to "expand the definition" of obesity and whether your imputation of some attempt to exaggerate the obesity problem has any foundation.

You refer to William Dietz, head of the division of nutrition and physical activity at the Centers for Disease Control, Atlanta, who served from 1998 to 2000 as the first chair of the IOTF working group on childhood obesity. This group developed the IOTF cut-off points widely used for international comparisons of childhood overweight and obesity. This approach, relating children's growth curves and cut-off points to the World Health Organization's adult body mass index criteria, was first published in the BMJ. It has been observed to underestimate rather than expand obesity prevalence, when compared with the standard centiles, but is not proposed for use in the USA.^{4 5}

Your report made erroneous reference to the IOTF having cash amounting to more than £1m (1.45m; $1.83m)—a sum that our annual report clearly indicated represented the combined reserves of IASO, a rapidly growing international medical organisation providing services to associations with 10 000 members in more than 50 countries, which is also seeking to meet the growing demands for engagement in many global initiatives.

Like many charitable medical societies, IASO receives income from its members, from its scientific publications, and from conference activities, and it receives occasional donations towards specific projects from pharmaceutical companies. IASO received foundation support to lead the Global Prevention Alliance, with other international non-governmental organisations concerned with obesity and related chronic diseases. We would be delighted to receive "millions" to support our work to promote strategies for the prevention of obesity, particularly among children, given the urgency and enormity of the public health challenge.

International Association for the Study of Obesity, London NW1 2NS nrigby{at}iaso.org

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Competing interests: NR is an employee of the International Association for the Study of Obesity.

References

1. Moynihan R. Expanding definitions of obesity may harm children. BMJ 2006;332: 1412. (17 June.)[Free Full Text]
2. Moynihan R. Obesity task force linked to WHO takes "millions" from drug firms. BMJ 2006;332: 1412. (17 June.)[Free Full Text]
3. McCarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obesity 2006;30: 598-602.[CrossRef][Medline]
4. 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.[Abstract/Free Full Text]
5. 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;73: 1086-93.[Abstract/Free Full Text]

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Expanding definitions of obesity may harm children

Ray Moynihan
BMJ 2006 332: 1412. [Extract] [Full Text] [PDF]

Establishing a standard definition for child overweight and obesity worldwide: international survey

Tim J Cole, Mary C Bellizzi, Katherine M Flegal, and William H Dietz
BMJ 2000 320: 1240. [Abstract] [Full Text] [PDF]

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Author's note

Ray Moynihan
bmj.com, 13 Jul 2006 [Full text]