In conversation with.... Philip James
Author: Professor Philip James
Honorary member of the London School of Hygiene and Tropical Medicine. Member of the steering committee for World Obesity/Policy and Prevention, chair of Presidential Council of Global Prevention Alliance
For World Obesity Day, we had the pleasure of sitting down with Dr Philip James and talking about obesity and how we can overcome the biggest challenge.
Find out how he started his career, what lead him into the obesity field and more.
World Obesity - For those that don’t know you, Philip, could you give us a glimpse into your background and who you are?
Philip James - I am a London trained scientist and doctor who started off working on the problem of malnourished children with the Medical Research Council in Jamaica. I then, on my return to the UK, taught Nutrition to doctors from across the world at the London School of Hygiene and Tropical Medicine. As a physician I worked as a consultant and academic researcher in gastroenterology, acute medicine and then metabolic disease including obesity and this led to my being asked by the MRC to establish a research centre to work on obesity and clinical nutrition problems in Cambridge. I was then asked by the government of Scotland and the UK to take over the Directorship of the Rowett Research Institute, which was at that time (1982) the World's biggest nutrition research institute in Aberdeen. I had already become heavily involved in public health aspects of nutrition and was constantly asked how we should tackle obesity. I therefore set up the International Obesity Task Force, transferred it to London, led the WHO recognition of obesity as a major public health problem and established the central offices for both IASO (now World Obesity Federation) and the European Association for the Study of Obesity (EASO).
WO - What made you want to tackle obesity?
PJ - On returning to the UK from Jamaica and a year in Boston, I wondered what nutritional problems there might be to tackle in the UK and considered the then unusual problem of obesity in middle-aged women. My application for a grant turned into a request by the Department of Health and the Medical Research Council to develop a government report on our current understanding of obesity. This was the first integrated view of obesity in the early 1970s as I established a clinic to try to understand the problems that beset obese patients. We had already established in this government publication that obesity was potentially a public health problem and this work led to the MRC asking me to establish a new team at the Dunn Nutrition Unit in Cambridge to work out how to look at the problem of obesity and why people some became overweight.
WO - You have been one of, if not the founding fathers of obesity. How do you think the landscape has changed since the early days when you first started out?
PJ - Forty-five years ago when I started work on obesity, this was a mysterious problem being tackled by only 4 or 5 medical scientists in the United States, UK, France and Sweden. Nothing was really known about the condition, its causes and management except that insurance companies had, for years, been setting higher premiums for heavier people taking out life insurance policies. Now the whole understanding of obesity has been transformed with far more known about the extent and rapidly escalating obesity rates, their causes, the science of how the body reacts to different foods and physical activity, the impact of obesity on health and its clinical and public health management.
WO - Do you think it has become easier or harder to influence change?
PJ - It is now much easier to influence change because governments are being presented with new extraordinary evidence that obesity costs the world two trillion dollars a year, equivalent to the cost of all warfare and terrorism. Furthermore, the number of premature deaths and the colossal burden of disease and economic handicaps being induced by obesity are now affecting almost every country on earth. These problems are becoming worse and leading public health experts as well as the World Health Organisation and different international organisations are now calling for immediate action to both prevent obesity and improve its management in both children and adults.
WO - There are many different interventions being trialled around the world. Which ones stand out to you?
PJ - It is now clear that simply helping people to lose weight is not enough because most individuals promptly regain the weight lost, indicating that the primary causes of their condition are not being dealt with. So what interests me most now are different approaches to the individual and community prevention of obesity. It is now clear that both high sugar and high fat levels in the diet are very conducive to weight gain so the challenge is how to change the everyday diet to reduce the energy density of the diet. In France and Finland they have completely changed the nature of food being provided in schools and banned the provision of soft drinks. There is preliminary evidence from France of a reduction in childhood obesity, but other evidence shows that local community action to change the way in which communities help children to eat sensibly and be active are also important and effective. Old as well as new analyses by Health Economists also show clearly that changes in the relative price of foods induce changes in the purchasing of food and eating habits of almost all people in society, other than the very wealthy. So the French and Mexican governments have introduced soft drink taxes Furthermore new standards are now being set, for example in South Africa, to force a change in the composition of foods being sold. One of the biggest challenges, however, is to have governments recognise that the latest evidence clearly demonstrates that you need many different initiatives, at an individual, community and societal level to achieve an effective reduction in national obesity rates.
WO - This year we are celebrating the first World Obesity Day. The emphasis is on overcoming the biggest challenge and acting now. What do you think needs to happen for a sustained push to meet WHO’s 2025 targets? WHO's aim is to get to these specific targets, which would be a good thing globally. Once we are there though, in your mind, what would need to happen
PJ - The evidence is clear that in most populations in the world, obesity rates are increasing rapidly. To stop this epidemic requires coherent government action. Whilst improving clinical management is important, we need also to tackle the primary drivers of obesity. For several decades we have developed many mechanical and computer-linked aids which minimise our need for physical activity at work and in the home so our needs for food have progressively fallen. We need to increase physical activity but the evidence is that spontaneous physical activity as well as leisure time activity is important. To induce increases in spontaneous activity requires major changes in urban planning as it has for 70 years been geared to simply confining people in favour of car use. However, we will never return to the old demands for physical work so we need to improve the quality of foods and drinks throughout society. We should start with foods and drink provided by any government-supported institution - e.g. work canteens and government offices, not just schools and hospitals. In addition we have, for decades, been subsidising the production of meat, milk, fats, oils and sugar. We have also helped in the development of ultra processed foods that are now sold using very sophisticated marketing techniques by food companies. To reverse this half-century of government support for inappropriate foods is a huge challenge so we need to change policies throughout the food chain as well as labelling foods and menus with a 'Traffic light' style of labelling to highlight those foods and meals that are high in fat, sugar and salt. Marketing of inappropriate foods needs to be penalised and taxed so we change the whole priorities on food – the cost of ill health from these industrially driven initiatives is enormous.
WO - It is difficult for Health Care Providers to bridge the knowledge gap that is needed for them to be able to tackle obesity. How do you think they could gain the tools needed to better treat their patients?
PJ - We already know that people lose weight more effectively if they have recurrent support throughout the long process of losing weight and adapting to eating very differently on a long-term basis. This therefore needs to involve their whole family environment. Very few doctors have recognised so far that most patients need a system of care with good advice on their diet, on household purchases and how to change their habits, recognising that the most vulnerable people in society are those genetically predisposed to obesity who therefore need to have a different way of life from the average person if they are going to maintain their newly slimmed state. We have not worked out schemes for nurturing this process well-enough.
WO - What would you say to those who are trying to bring about change?
PJ - Whether dealing with individual doctors, schools, hospitals or the community, we need to recognise that you have to gain the confidence of the key people responsible and have practical solutions that are co-ordinated - with suitable publicity justifying our actions. On a national basis the idea that there is a single magic bullet to deal with the problems of obesity is one which, although beloved by politicians, you need to emphasise is ridiculous and contrary to all the evidence. Therefore an integrated plan has to be developed with public scrutiny of the initiatives being taken and you need to establish a system for assessing the effectiveness of change on an annual basis. Simply presenting the facts and the dimensions of the problem is not enough; one needs to engage opinion-leaders and the community to demand change and demonstrate that there are long-term societal and economic benefits which come from tackling what, for many individuals, is a terrible affliction.