James said he based this hugely significant decision, one that would define our global understanding of obesity, partly on pre-war data provided by US insurance company Met Life. This data remains questionable, according to Joel Guerin, a US author who has examined the work produced by Met Life’s chief statistician Louis Dublin.
“It wasn’t based on any kind of scientific evidence at all,” Guerin said. “Dublin essentially looked at his data and just arbitrarily decided that he would take the desirable weight for people who were aged 25 and apply it to everyone.”
I was interested in who stood to gain from his report and asked James where the funding for the IOTF report came from.
“Oh, that’s very important. The people who funded the IOTF were drugs companies,” James said.
And how much was he paid?
“They used to give me checks for about [US$]200,000 a time. And I think I had a million or more,” he said.
And did they ever ask him to push any specific agenda?
“Not at all,” he said.
James said he was not influenced by the drug companies that funded his work, but there is no doubt that, overnight, his report reclassified millions of people as overweight and massively expanded the customer base for the weight loss industry.
James rightly points out that he needed the muscle of drugs companies to press home the urgency of the unfolding obesity problem as a global public health issue, but did not he see the moneymaking potential for the drug companies in defining obesity as an epidemic?
“Oh, let us be very clear,” he said. “If you have a drug that drops your weight and doesn’t do you any other harm in terms of side effects, that is a multibillion megabuck drug.”
I asked Gustav Ando, a director at IHS Healthcare Group, how important this decision to define obesity as a medical epidemic was for the industry.
“It really turned a lot of heads,” he said. “Defining it as an epidemic has been hugely important in changing the market perception.”
The drugs companies could now provide, Ando said, “the magic bullet.”
Paul Campos, a legal expert with a special interest in the politics of obesity, saw the decision to shift the BMI downwards as crucial not just in making a giant new customer base for diet drugs, but in stigmatizing the overweight.
“What had been a relatively minor concern from a public health perspective suddenly was turned into this kind of global panic,” he said. “I think when you look at this issue what you see is a combination of economic interests with cultural prejudice which led to a toxic brew of social panic over weight in our culture.”
However, the drugs wheeled out to clean up the epidemic did not turn into the blockbusters the industry had hoped for.
Since the 1950s, the great dirty secret of weight loss was amphetamines, prescribed to millions of British housewives who wanted to lose pounds. In the 1970s, they were banned for being highly addictive and for contributing to heart attacks and strokes. Now drugs were once more on the agenda — in particular, appetite suppressants called fenfluramines. After trials in Europe, the US drugs giant Wyeth developed Redux, which was approved by the Food and Drug Administration (FDA) in spite of evidence of women developing pulmonary hypertension while taking fenfluramines.
Frank Rich, a cardiologist in Chicago, began seeing patients who had taken Redux with the same symptoms. When one, a woman in Oklahoma City, died, Rich decided to go public, contacting the US news show Today.