IOTF -The International Obesity Task Force- was originally convened in 1995 by Professor Philip James to prepare the first scientific research report on the global epidemic of obesity. Subject to the scrutiny of eleven subcommittees and scores of international experts, this report eventually served as a working draft for the first WHO expert consultation on obesity held in Geneva in 1997. The report established the criteria for assessing obesity, and was distributed to all health ministers at the World Health Assembly in 1998. Its eventual publication as an official WHO Expert Technical Report in 2000 entitled ‘WHO TRS 894 Obesity: Preventing and Managing the Global Epidemic’ marked a turning point in governments' acceptance of what was described by WHO as "the biggest unrecognized public health problem in the world".
To cope with the numerous challenges this initial report revealed, in 1998 IOTF established several working parties as follows:
The communications group, chaired by Prof Stephan Rossner, promoted the first WHO publication as a landmark contribution to the world’s public health agenda, and engaged in activities to dramatically increase public focus on the health consequences of obesity globally.
• 1998 – supported the new US National Institutes of Health Guidelines on Obesity; the Rio Consensus; the WHO European, Pan American, Middle East and Western Pacific offices to strengthen their focus on prevention; and a major discussion with 53 health ministers in Barbados at the Commonwealth Health Ministers Meeting, for which it was granted formal NGO status within the Commonwealth system.
• 1999 – the Asia-Pacific regional coordination office was set up by Dr Tim Gill in Sydney, followed by support for the launch of a regional task force initiative at the IV Latin American Congress Buenos Aires, Argentina.
• 2000 – backed FLASO’s Rio Declaration at the Latin American Healthy Weight Summit in July, a Pacific Region policy workshop with WHO WPRO in Samoa in September, and an IOTF/PAHO Caribbean Region policy workshop in Barbados in October.
• 2003 – made a major presentation to EU health ministers in Milan in 2003, delivering the policy report ‘Obesity in Europe 2 – Waiting for a green light for health’.
• 2005 – established the EU Platform on Obesity, a collaboration with the Health Commission of Europe and the European Food Industry to engage in developing solutions to obesity.
• 2006 – collaborated with WHO Europe to prepare a 52 member state Ministerial Conference on Obesity in November, contributing chapters and the summary for a WHO Technical book on obesity in Europe, and arranged an NGO consultation for WHO Europe's ministerial development of a European Obesity Charter.
• 2007 – provided advice and analyses for the main advisor to the Caribbean Prime Ministers, and presented the challenge of prevention and management at a CARICOM summit meeting in Trinidad in September 2007, resulting in the Port of Spain Declaration.
Chaired by Bill Dietz, the childhood obesity working group devised a new international standard for specifying overweight and obesity in children, revealing the astonishing emergence of childhood obesity in the early 1980s and its explosive increase since. Other important outputs of this group include:
• The preview report of the IOTF childhood obesity working group was presented to WHO in January 2004, and published formally in Obesity Reviews in May 2004.
• The EU Platform for industrial collaboration was established on the basis of IOTF's analyses of the childhood obesity epidemic particularly affecting children in the Mediterranean countries.
• The British Medical Association, with the help of IOTF’s Tim Lobstein, published a report ‘Preventing Childhood Obesity’ in June 2005. Along with recommendations for school and community programmes, the document notes the need to address inequalities and the pervasive influence of marketing on children’s food choices.
• In May 2006, IOTF was represented at the WHO forum and consultation on marketing to children in Oslo, following which an IOTF Working Group drafted the Sydney Principles, a set of rights-based principles to protect children against exposure to commercial promotions of obesogenic foods and beverages.
• A draft code, ‘Recommendations for an International Code on Marketing of Foods and Non-Alcoholic Beverages to Children’ was developed by IOTF and Consumers International in 2008.
Management: Asian obesity classification
This group, chaired by George Bray, recognised that individual medical care needed to improve. A workshop on anthropometry and risk indicators in Asians convened with the WHO in 1999 revealed that in these populations the medical impact of even modest weight gain was greater than in others. As a result, the management group devised new criteria for Asians endorsed by the WHO, assigning a lower cut-off point for normal weights. The IASO-IOTF-WHO WPRO Report, Redefining Obesity in Asia-Pacific was published in February 2000. Since then, in association with the George Institute in Sydney, IOTF has been involved in detailed major population analyses on the validity of these initiatives, with criteria relating to the propensity towards diabetes and hypertension. In May 2002 IOTF published a comprehensive analysis of Obesity and Metabolic Risk in Asians as a supplement in Obesity Reviews 3.
The need for improved clinical management of overweight and obese patients led this group, chaired by Peter Kopelman, to develop the SCOPE (Specialist Certification of Obesity Professional Education) programme. Through live and online training courses, medical professionals can be accredited for their improved knowledge of the latest obesity related research, treatments and policies. The first phase of the IOTF SCOPE programme was unveiled, in conjunction with EASO, at the European Congress on Obesity in Helsinki 2003. Originally designed for use in Europe, this programme is now used in Latin America and South Africa, with plans to develop and adapt it further for Asian, Middle East and North American use, and to broaden its offering for nurses, nutritionists/dieticians, pharmacists and fitness professionals.
This group, chaired by Shiriki Kumanyika with major assistance from Boyd Swinburn, was instrumental in articulating the need for a logical approach to evaluating multiple environmental contributors to weight gain, as well as a strategy to combat them. Swinburn’s ANGELO model and the Prevention Group's "causal web" of societal and environmental influences affecting obesity have both had profound influence on policy makers globally.
In 2002 IOTF members contributed to the WHO expert consultation to revise the WHO 797 report on Diet, Nutrition and the Prevention of Chronic Diseases. Chaired by Prof Ricardo Uauy (then chair of IOTF’s childhood group), with Prof Shiriki Kumanyika as vice-chair, the resulting WHO TRS 916 report served to convince health ministers that new and broad-ranging strategies were required across all realms of society to develop environments more conducive to improved nutrition.
In the same year an extensive IOTF review of physical activity concluded that 60-90 minutes of daily activity was needed to avoid unhealthy weight gain. The associated background documents led FAO and WHO to increase the energy requirements for optimum physical activity. IOTF support for the Global Strategy on Diet, Physical Activity and Health at WHO's executive board on behalf of the Global Alliance helped to offset US opposition and win unanimous approval of the strategy at the World Health Assembly in May 2004. IOTF chairman Prof Philip James became founding signatory to the formation of the EU Platform on Diet, Activity and Health in May 2005, where the IOTF provided a briefing paper Obesity in Europe 3.
At a WHO consultation on research priorities for non-communicable disease in 2008, Professor Philip James provided a paper, ‘A Prioritized Global Nutrition Research Agenda for Prevention and Control of Non-communicable Diseases’ with a special emphasis on obesity. He argued that WHO nutritional profiling guidelines were urgently needed, and only if these are based on global rather than Western criteria can progress be made in public health diet and nutritional policies.
Numerous government reports addressing preventative action such as the UK Foresight Report and the series of US Institute of Medicine reports on childhood obesity have had major IOTF input.
The global burden of obesity
This group, chaired by Ian Caterson, quickly became the core group dealing with WHO's Millennium analyses on the global burden of disease, for the first time estimating the impact of raised BMI on health. This revealed that the adult world's ideal average BMI was 21, with risk of diabetes, high blood pressure and abnormal blood lipids rising rapidly even within the upper normal range. Excess weight gain was found to be the 6th largest contributor to the world's disabilities and premature deaths, and by 2006 excess weight had become the 3rd largest cause of ill health in the affluent world. IOTF was responsible for the obesity component of the World Health Report on health burdens in October 2002.
Obesity links to global malnutrition, and the new food challenge
In the late 1990s the UN's Standing Committee on Nutrition appointed a commission to investigate the lack of sufficient progress in tackling the global prevalence of childhood protein energy malnutrition (PEM). This group, chaired by Philip James, discovered that a radical new approach was needed to improve the social, economic and nutritional status of those who were suddenly confronted with a dual challenge of deprivation-induced malnutrition and an explosion in access to Western foods high in fat, sugar and salt. In March 2000 IOTF supported the UN Commission’s report on the Nutritional Challenges of the 21st Century (Ending Malnutrition by 2020: an Agenda for Change in the Millennium), which set out the life cycle approach to health, the importance of maternal health, and the influence of early nutritional imprinting on metabolism and later abdominal obesity and chronic diseases.