WPHNA World Public Health Nutrition Association

Your resource

Scroll down for access to previous contributions to World Nutrition, from its first issue in May 2010, to its 31st issue last month. This archive also links you to all regular columns from their beginnings, to last month. Currently these are by Claudio Schuftan, Geoffrey Cannon and Reggie Annan, and now also Philip James.

Access pdf of last month's WN editorial here
Access pdf of last month's WN commentary here

19th century direct action. Rudolf Virchow took to the Berlin barricades in 1848 (left), and (right) John Snow inactivates the Broad Street pump in 1854

Last month's WN editorial was about the place of direct action in the service of public health. Two 19th century examples are illustrated by the pictures above. In 1848 Rudolf Virchow, a pathologist who became a founding father of modern epidemiology, took to the barricades in the streets of Berlin (left) as part of the 1848 European revolt of oppressed workers and peasants. His action in defiance of the Prussian armed forces, was in protest against the immiseration and disease suffered by communities in Upper Silesia, whose conditions he had been charged to investigate. The rising was put down, yet its tricolour shown in the picture is now Germany's national flag.

No, it is not OK to be obese

Philip James's column last month was another blockbuster. Studies issued by the US Centers for Disease Control Center for Health Statistics, of which the principal investigator is CDC veteran Katherine Flegal, persistently conclude that it is best to be overweight, and even somewhat obese. Her studies apparently show that 'Compared with people with BMIs between 18.5 and 25.0, which is the World Health Organization range for 'normal' or 'acceptable' body mass, 'overweight' people with BMIs from 25 up to 30 had death rates expressed as 'hazard ratios' of 0.94, which is to say a 6 per cent lower mortality. This was statistically significant. Actually even being 'grade 1 obese' with BMIs of 30 up to 35,had a 'hazard ratio' of 0.95, but this 5 per cent lower rate...was not quite statistically significant in showing a benefit of even being obese.

Amazing data from the US Centers for Disease Control: it seems to be best
to be overweight or perhaps even somewhat obese, as shown in this graphic

'To realise how astounding these findings are, see the graphic above. In numbers, at 32.5 BMI, midway between 30 and 35, a man of 1.80 metres or 5 foot 11, weighs 105 kilograms or 232 pounds (16 stone 8 pounds), and a woman of 1.70 metres or 5 foot 7, weighs 95 kilograms or 207 pounds (14 stone 11 pounds)'.

In a blistering analysis, Philip James shows that these apparently amazing results are an artefact of the most basic type. He says: 'Public health nutritionists with experience and knowledge of real world conditions, most of all outside the most privileged and economically wealthy countries, are liable to feel initially confused and dismayed by inevitably influential paradoxical judgements coming from a US federal government agency'.

He concludes: 'There is I suggest, a great deal to be said for relying on what still remains a pretty transparent and accountable UN system, where the realities and needs of less resourced countries whose people can't afford to be treated for disease for much of their lives are fully taken into account. There is a very worrying tendency for groups, funded particularly in the US either by the government or more recently by multi-billionaires, to assume they should now determine global health as well as global warming and indeed global economic policies. Carefully developed evidence and reliable policies and actions, produced in a global context, are being contradicted by interested parties outside the UN. These either use novel complex approaches which dazzle and bemuse onlookers but may not relate to reality, or else present a narrow view based on very questionable evidence, poor reasoning, and apparent ignorance of what goes on in the wider world'.

The editors