- Email: [email protected]
Foresight report on obesity
Correspondence
As those responsible for the quantitative analysis for the Foresight Tackling obesities: future choices report,1 we feel the need to respond to the misleading impression left by Andrew Jack’s Comment.2 A quick perusal of the press coverage the report generated shows that Jack was seemingly alone in taking such a trenchant position. It is regrettable that his comments were published in The Lancet, with its worldwide influence: they could diminish the usefulness of the report and its methods. Jack refers to the predictions of future obesity levels as “guesstimates” and thus displays ignorance of the extensive analyses carried out to develop these predictions. The quantitative modelling report3 is thus diminished with a single ill-chosen word, yet Jack offers no hint of how he would have done it better. Although it was beyond the remit of the report to make policy recommendations, it clearly shifts the balance of responsibility, albeit not wholly, from the individualistic paradigm that has dominated publichealth policymaking to one of collective responsibility. It places the gauntlet firmly at the feet of Government (and not just the Department of Health) and of the stakeholders with power to influence the obesogenic environment. It advocates prevention rather than treatment, and social change rather than pharmaceuticals, where Jack’s interests clearly lie. Jack also seems to regret the lack of a rapid response from Government, which chose to highlight the report through Secretary of State Alan Johnson’s statement to the House of Commons and Lord Darzi’s similar statement to the House of Lords. The Government clearly wanted, unlike Jack, time to fully digest the report before delivering a meaningful reaction. All those involved with this report are aware that there are no easy solutions to the challenge of obesity and its associated chronic diseases. We all await the Government’s response with interest and also hope www.thelancet.com Vol 370 November 24, 2007
that this report will prove valuable to readers throughout high-income and increasingly middle-income countries who face similar challenges. We declare that we have no conflict of interest.
Klim McPherson, *Tim Marsh, Martin Brown [email protected] Nuffield Department of Obstetrics and Gynaecology, Research Institute, Churchill Hospital, Oxford, UK (KM); and National Heart Forum, Tavistock House South, Tavistock Square, London WC1H 9LG, UK (TM, MB) 1
2 3
Foresight. Tackling obesities: future choices— project report. London: The Stationery Office, 2007. http://www.foresight.gov.uk/Obesity/ obesity_final/Index.html (accessed Nov 9, 2007). Jack A. Obesity plan lacks foresight. Lancet 2007; 370: 1528–29. Foresight. Tackling obesities: future choices— modelling future trends in obesity & their impact on health. London: The Stationery Office, 2007. http://www.foresight.gov.uk/ Obesity/obesity_final/Index.html (accessed Nov 9, 2007).
Author’s reply A humble layman struggling to find meat hidden in the flab of the Foresight report I may be; a cynic I am not. Nor am I only interested in pharmaceuticals, any more than I would presume Klim McPherson and colleagues to have no interests in life beyond their job titles. I share the view that obesity has many interrelated causes, prevention is key, and governments have a large role to play.1 I am not convinced we needed 2 years of Foresight research to tell us that. The document did indeed receive media coverage, including from me,2 but could have generated still greater quantity and value had it been clearer and more far-sighted in its conclusions. I did not intend to turn readers away with my Comment. I encourage them to read the report and judge for themselves the obesity system map,3 which looks more like a spilled plate of spaghetti than anything of use to policymakers. Scientists struggle to model accurately very precise biological mechanisms, so how is it possible to measure (or use with any confidence) a purported 4·5–5 out of 5 link between such vague terms
as “effort to increase efficiency of production” and “desire to maximise volume”; or to correlate “TV watching” with “tendency to graze”, but not at all with “alcohol consumption”? If David King’s 250 Foresight “scientists, health professionals…and policymakers” cannot come up with “specific integrated policies”, we ought to change the participants. Despite his claim that this is instead a job for government, Foresight’s own official website says its aim is to “identify effective interventions”. One senior scientist told me officials prevented him from writing more precise advice. A panel without such power seems of limited use. And if “the evidence for successful prevention strategies is limited”, maybe the money already spent on Foresight should have gone to studying such pilot policies and launching new ones to speed up understanding. As to “guesstimates” on the costs of obesity, I was simply expressing scepticism about the accuracy of all such long-term forecasts, which catch journalists’ eyes but would be valuably supplemented by clearer policy advice. If, in 2050, the costs of obesity to the UK National Health Service really run to £6 billion (I suspect they will be much higher), I will eat the entire Foresight report, unpalatable though it is. Let us hope that, long before then, we have moved from calls for more research to policies based on evidence.
For the Foresight website see http://www.foresight.gov.uk/ Obesity/Obesity.html
I am the pharmaceuticals correspondent for the Financial Times.
Andrew Jack [email protected] Financial Times, London SE1 9HL, UK 1
2
3
Anon. Prevention not cure. Financial Times 2007; Nov 2. http://www.ft.com/cms/s/0/ 1981011c-88e6-11dc-84c9-0000779fd2ac. html?nclick_check=1 (accessed Nov 12, 2007). Jack A. Obesity trends ‘will take 30 years to reverse’. Financial Times 2007; Oct 17. http:// www.ft.com/cms/s/0/7513ae0a-7c4b-11dcbe7e-0000779fd2ac.html?nclick_check=1 (accessed Nov 12, 2007). Foresight. Tackling obesities: future choices— project report. London: The Stationery Office, 2007: 90. http://www.foresight.gov.uk/ Obesity/obesity_final/Index.html (accessed Nov 12, 2007).
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1755
As those responsible for the quantitative analysis for the Foresight Tackling obesities: future choices report,1 we feel the need to respond to the misleading impression left by Andrew Jack’s Comment.2 A quick perusal of the press coverage the report generated shows that Jack was seemingly alone in taking such a trenchant position. It is regrettable that his comments were published in The Lancet, with its worldwide influence: they could diminish the usefulness of the report and its methods. Jack refers to the predictions of future obesity levels as “guesstimates” and thus displays ignorance of the extensive analyses carried out to develop these predictions. The quantitative modelling report3 is thus diminished with a single ill-chosen word, yet Jack offers no hint of how he would have done it better. Although it was beyond the remit of the report to make policy recommendations, it clearly shifts the balance of responsibility, albeit not wholly, from the individualistic paradigm that has dominated publichealth policymaking to one of collective responsibility. It places the gauntlet firmly at the feet of Government (and not just the Department of Health) and of the stakeholders with power to influence the obesogenic environment. It advocates prevention rather than treatment, and social change rather than pharmaceuticals, where Jack’s interests clearly lie. Jack also seems to regret the lack of a rapid response from Government, which chose to highlight the report through Secretary of State Alan Johnson’s statement to the House of Commons and Lord Darzi’s similar statement to the House of Lords. The Government clearly wanted, unlike Jack, time to fully digest the report before delivering a meaningful reaction. All those involved with this report are aware that there are no easy solutions to the challenge of obesity and its associated chronic diseases. We all await the Government’s response with interest and also hope www.thelancet.com Vol 370 November 24, 2007
that this report will prove valuable to readers throughout high-income and increasingly middle-income countries who face similar challenges. We declare that we have no conflict of interest.
Klim McPherson, *Tim Marsh, Martin Brown [email protected] Nuffield Department of Obstetrics and Gynaecology, Research Institute, Churchill Hospital, Oxford, UK (KM); and National Heart Forum, Tavistock House South, Tavistock Square, London WC1H 9LG, UK (TM, MB) 1
2 3
Foresight. Tackling obesities: future choices— project report. London: The Stationery Office, 2007. http://www.foresight.gov.uk/Obesity/ obesity_final/Index.html (accessed Nov 9, 2007). Jack A. Obesity plan lacks foresight. Lancet 2007; 370: 1528–29. Foresight. Tackling obesities: future choices— modelling future trends in obesity & their impact on health. London: The Stationery Office, 2007. http://www.foresight.gov.uk/ Obesity/obesity_final/Index.html (accessed Nov 9, 2007).
Author’s reply A humble layman struggling to find meat hidden in the flab of the Foresight report I may be; a cynic I am not. Nor am I only interested in pharmaceuticals, any more than I would presume Klim McPherson and colleagues to have no interests in life beyond their job titles. I share the view that obesity has many interrelated causes, prevention is key, and governments have a large role to play.1 I am not convinced we needed 2 years of Foresight research to tell us that. The document did indeed receive media coverage, including from me,2 but could have generated still greater quantity and value had it been clearer and more far-sighted in its conclusions. I did not intend to turn readers away with my Comment. I encourage them to read the report and judge for themselves the obesity system map,3 which looks more like a spilled plate of spaghetti than anything of use to policymakers. Scientists struggle to model accurately very precise biological mechanisms, so how is it possible to measure (or use with any confidence) a purported 4·5–5 out of 5 link between such vague terms
as “effort to increase efficiency of production” and “desire to maximise volume”; or to correlate “TV watching” with “tendency to graze”, but not at all with “alcohol consumption”? If David King’s 250 Foresight “scientists, health professionals…and policymakers” cannot come up with “specific integrated policies”, we ought to change the participants. Despite his claim that this is instead a job for government, Foresight’s own official website says its aim is to “identify effective interventions”. One senior scientist told me officials prevented him from writing more precise advice. A panel without such power seems of limited use. And if “the evidence for successful prevention strategies is limited”, maybe the money already spent on Foresight should have gone to studying such pilot policies and launching new ones to speed up understanding. As to “guesstimates” on the costs of obesity, I was simply expressing scepticism about the accuracy of all such long-term forecasts, which catch journalists’ eyes but would be valuably supplemented by clearer policy advice. If, in 2050, the costs of obesity to the UK National Health Service really run to £6 billion (I suspect they will be much higher), I will eat the entire Foresight report, unpalatable though it is. Let us hope that, long before then, we have moved from calls for more research to policies based on evidence.
For the Foresight website see http://www.foresight.gov.uk/ Obesity/Obesity.html
I am the pharmaceuticals correspondent for the Financial Times.
Andrew Jack [email protected] Financial Times, London SE1 9HL, UK 1
2
3
Anon. Prevention not cure. Financial Times 2007; Nov 2. http://www.ft.com/cms/s/0/ 1981011c-88e6-11dc-84c9-0000779fd2ac. html?nclick_check=1 (accessed Nov 12, 2007). Jack A. Obesity trends ‘will take 30 years to reverse’. Financial Times 2007; Oct 17. http:// www.ft.com/cms/s/0/7513ae0a-7c4b-11dcbe7e-0000779fd2ac.html?nclick_check=1 (accessed Nov 12, 2007). Foresight. Tackling obesities: future choices— project report. London: The Stationery Office, 2007: 90. http://www.foresight.gov.uk/ Obesity/obesity_final/Index.html (accessed Nov 12, 2007).
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1755