National Obesity Forum

The National Obesity Forum (NOF) is a registered charity (charity number 1109600) established by medical practitioners in May 2000 to raise awareness of the growing health impact that being overweight or obese was having on patients and the National Health Service (NHS).

Their website states "The NOF is particularly concerned with the lack of focus on prevention and structured management of overweight and obese individuals in primary care and the knock-on effects this has on society. Obesity, as a disease, and as a social-economic issue, has widespread ramifications, not just for the health service, but also for industry, education and government."

Aims and Objectives of the NOF are

• To create recognition of obesity as a serious medical problem
• To provide education and training on obesity management
• To produce guidelines for obesity management within primary care
• To provide a network for health professionals and an obesity management support and information resource
• To convince Government and healthcare works to give obesity a high priority nationally and locally.
• To raise the profile of obesity via medical and lay media channels
• To highlight the health inequalities of obesity
• To promote quality clinical care via an annual "Best Practice Awards"

Drug industry front group?

According to Robert Thomson the Editor of the Times in 2006:

The Obesity group is supported by the National Obesity Forum. In January, the President of the National Obesity Forum, Dr Ian Campbell, quit claiming it had become too dependent on drug company funding. The forum lists GlaxoSmithKline UK ltd, Slim Fast Food Ltd, Tanita UK Ltd, Sanofi-Aventis Ltd as amongst their “partners".

Britain's leading anti-obesity campaigner has quit the pioneering organisation he founded, claiming it has become too dependent on drug company funding. Dr Ian Campbell, a GP who has won acclaim for his groundbreaking work to help patients who are seriously overweight, resigned as president of the National Obesity Forum.

In his resignation letter, he makes a series of claims about its performance, internal management and a 'loss of direction' caused by the influence of its big pharmaceutical backers.Campbell alleges the forum is too attached to 'ineffective' medical methods for treating people once they become obese - including the administration of weight- loss drugs - rather than working with government to devise radical ways of stopping them gaining excess weight in the first place.

Campbell told The Observer last night that he was 'greatly saddened by the forum's loss of direction'. Its trustees' eagerness to secure continued drug company funding meant it had tailored its messages to suit them, he said. 'Four of the forum's five trustees strongly support the medical weight loss management approach, which stresses the treatment of obesity. That is only one aspect of the obesity debate.

'We need to move from raising awareness about obesity to taking action to prevent people becoming obese, and the forum should be working to help government tackle this problem', he said.

It also emerged last week that the forum's board tried to muzzle Campbell by threatening him with an injunction and a claim for damages if he continued to make 'disparaging or derogatory statements' about the forum or approached any of its sponsors.

Dr Colin Waine, the forum chairman and a visiting professor at University of Sunderland, refused to discuss Campbell's unexpected departure. 'That's an internal board matter. I don't want to go into the details about why he left,' he said.

Asked why Campbell had been sent a lawyer's letter, Waine replied: 'That's not anything we want to broadcast in the media.' Waine denied there had been serious disagreements over the forum's direction, saying its objectives had been the same since 2000.

Dr Howard Stoate, a GP and Labour MP for Dartford who is co-chairman of the all-party parliamentary group on obesity, said: 'I'm very sorry that Ian is leaving the forum. He's been very important and has been extremely influential in raising obesity up the political agenda to the point where the government is taking it much more seriously. That's due in some measure to the work of the forum and Ian personally. He's been a driving force.'

'Five years ago obesity was seen as a social and cosmetic problem. Now it's seen for what it is: a major public health problem that shortens lives, causes serious ill-health and is a huge burden on the NHS.' Dr Susan Jebb, of the Medical Research Council's Human Nutrition Research centre at Cambridge University, said Campbell and the forum had done much to ensure that health professionals took obesity far more seriously.

'When Ian set up the forum in 2000 people in primary care weren't talking about obesity. It wasn't on their radar. He has created a body of people involved in the NOF who have woken up to the fact that obesity matters and that primary care is in the frontline,' said Jebb.

Justification for medication

In Oct 2007 David Haslam, the Director of the NOF, wrote an article justifying the use of medication for weight loss.

" Some of the most toxic compounds known to man have been used as drugs to combat excess weight... In the 1930s, ... – amphetamines – were introduced to manage obesity. ....It eventually became clear that the drugs were addictive, abusable, and had potentially fatal side-effects including heart valve defects and primary pulmonary hypertension. The weight loss they induced was short term, and rapidly regained... Unfortunately, however, modern anti-obesity agents have been tainted by the memory of their discredited predecessors even though a huge portfolio of major trials proves their tolerability and efficacy, not only as weight loss agents, but also as cardiometabolic risk modifiers. Obese individuals may be desperate to lose weight... and require quick fix remedies... Physicians prefer slow, gradual weight loss, at 1-2lb per week, with the aim of 5-10% weight loss, for reasons of health improvement, and risk modification – precisely what modern drugs confer.

First-line treatment of overweight and obesity will always centre upon nutritional and activity advice. Drugs are only appropriate when initial remedies have proved inadequate, and should always be an adjunct to lifestyle changes, and prescribed according to NICE guidelines. The ideal candidate for weight loss drugs is an overweight or obese individual with co-existent diseases or risk factors; the person whose cardiometabolic risk is raised, and can be successfully modified by treatment...

Orlistat,..., was the first modern agent to be introduced, and ... Sibutramine, ...was the next to be introduced, and like orlistat, shows benefits over and above weight loss alone. The major sibutramine weight loss study is the STORM trial2, which also demonstrated improvements in lipid profile and HbA1c. The results of the sibutramine SCOUT trial are eagerly awaited, to see for the first time whether the assumed reduction in cardiovascular events and premature mortality actually occurs with weight loss. Contrary to popular opinion, the preliminary results from the lead-in to the study reveal that, in hypertensive patients, blood pressure is reduced with sibutramine.

Rimonabant trials demonstrated effective weight loss, and reduction in waist circumference ....

Rimonabant has recently hit the headlines because concurrent antidepressant use and mental health disorders have been upgraded from warnings to contraindications. There is no question that rimonabant causes mood alteration in a small minority of cases; sometimes described by patients as irritability or boredom; but overt depression is rare, suicidal ideation much rarer still. However, it is perfectly reasonable to exclude such individuals from treatment, as they were excluded from most of the trials, and it is inappropriate to induce mood changes in an already depressed individual.

As with ... other drugs that manage chronic conditions, weight loss agents only work while the drug is being continued. On stopping, weight regain will tend to occur, unless sustainable lifestyle changes have occurred during the spell on medication, but rather than implying some inadequacy in the drug, the opposite is true; however successful a drug may be, it only works if it is being taken. There is a valid argument to be made that treatment should be long term, .... and in the cases of orlistat and rimonabant, this is allowed for in the drug’s licence. It is extremely difficult to ensure that patients adhere to long-term lifestyle change, as they live in an environment that promotes the exact opposite. All three anti-obesity agents have excellent patient support programmes, which use literature, web-based material and phone lines to promote lifestyle change. As many members as possible of the primary care team should be involved in promoting and maintaining healthy living.

• Orlistat is manufactured by Roche Products Ltd and GlaxoSmithKline UK Ltd
• Rimonabant is manufactured by Sanofi-Aventis Ltd
• Sibutramine is manufactured by Abbott Laboratories

NOF Statement - Anti-Obesity Medication

On the 16th November 2007 the NOF released a press statement that stated " The NOF remains convinced that the use of anti-obesity medication, in line with NICE guidance, is justified in serious medical condition. Many studies have shown that the three currently available drugs cause significantly greater weight loss than placebo. Any assessment of effectiveness most go beyond levels of weight loss and consider the reduction of obesity related risk factors. All three currently available drugs favourably influences most risk factors.

The NOF agrees that long term outcomes studies are needed, but point out these will take many years to yield the necessary information. At present we have to deal with the obesity epidemic using current knowledge.

While the NOF's preferred position is prevention, it has to point out that despite clear warnings dating back to the 1976 when (obesity levels 6% in men and 7% in women) successive governments have lacked the political will and courage to take effective preventive measures.

The result is that in this country about a quarter of the population is obese and is at high risk of many of the major killers in modern society, coronary heart disease type 2 diabetes and many cancers.

In the absence of an effective preventive strategy this means that health professionals are left with life style advice and anti-obesity medication as the only means of helping vulnerable people at high risk of life threatening diseases.

The NOF therefore reiterates its belief that the appropriate use of anti-obesity medication is both cost effective and fully justified on clinical grounds."

Dr Colin Waine Chairman - National Obesity Forum .

Debate over obesity drugs efficacy

On the 19 Nov 2007 it was reported that a new study showed that anti-obesity treatments frequently failed to promote weight loss.

BMJ Researchers reviewed data and concluded orlistat, sibutramine and rimonabant were of only ‘modest’ help in long-term weight loss. Average weight loss was less than 5%, below the thresholds for recommending a continuation of therapy by NICE. NICE advises anti-obesity drugs should be discontinued if patients have not lost at least 5% of their initial body weight after three months.

Study leader Professor Gareth Williams, professor of medicine at the University of Bristol, said the studies showed the jury was still out on the long-term efficacy and safety of anti-obesity treatments. He added that they should not be given to patients who cannot lose weight through lifestyle changes alone

‘If patients can’t get on and take responsibility for their own lives, then flinging a pill at them is not going to do any useful work at all,’ he said.

Professor Williams also warned of ‘insidious collateral damage’ if GSK was successful in its bid to make orlistat available over the counter in Europe.

Dr David Haslam, chair of the National Obesity Forum, slammed the BMJ meta-analysis for being ‘full of errors’ and called it a ‘very bad’ paper. ‘Five percent weight loss is very clinically significant. What they are doing here is actually looking at average weight loss and some may not lose any weight but others may lose 10 or 20%.’Dr Haslam supported moves to make Orlistat available over the counter.

children

The NOF runs a series of activities for children under a programme called MEND. MEND, which is sponsored by the lottery and J Sainsbury Plc, is a "unique, holistic programme.. specifically designed over 5 years by leading experts. Our programme combines the elements that recent medical research has shown are essential to effectively overcome overweight and obesity:

• Mind: understanding and changing unhealthy attitudes and behaviours around food
• Exercise: adequate, safe and above all fun exercise
• Nutrition: enjoyable, practical activities that teach children about healthy eating and daily meal planning to improve the whole family's diet."

People

The NOF Trustees

Dr Colin Waine Dept of Primary care, Univ of Sunderland, Chair | Dr David Haslam GP, Hertfordshire Clinical Director | Jane DeVille-Almond Practice Nurse Education | Shamil Chandaria Honorary Patron | Karan Thomas Training Consultant | [[Dr Jonathan Pinkney Consultant BSc, MB BS, MD, FRCP. | Dr Ashley Adamson Senior Lecturer BSc, SRD, PhD, RPHNutr | Tam Fry Honorary Chairman, Child Growth Foundation | Paul Sacher Research Director, MEND Programme | Helen Johnson Parliamentary Affairs Executive team member | Maria Voce Office Manager, Company secretary, Executive team member

Partners

• All-Party Parliamentary Group on Obesity
• Department of Health
• National Institute of Clinical Excellence
• Royal College of Paediatricians
• Association for the Study of Obesity
• National Audit Office
• Korean Academy of Family Physicians
• National Association of Primary Care
• Roche Products Ltd
• Abbott Laboratories
• Slim Fast Foods Ltd
• Safeway Foods plc
• Tanita UK Ltd
• Sanofi-Aventis Ltd - see Sanofi-Aventis Group
• Mantis Surgical Equipment Ltd
• GlaxoSmithKline UK Ltd
• Canderel
• British Meat Nutrition Education Services
• Rosemary Conley Enterprises
• Carlton TV Ltd
• The Obesity Awareness and Solutions Trust

PR agencies

• Helen Johnson Public Affairs

Affiliations

• Obesity All Party Parliamentary Group, provides support to the Group

Finances

The NOF is a registered charity and is a company limited by guarantee.

For the year ending March 2008, the NOF's accounts showed income of

• £1,000.00 from Abbott Laboratories
• £,5000.00 from unnamed sources

For the year ending March 2007, the NOF's accounts showed income of

• £30,000.00 from Sanofi-Aventis Ltd
• £30,00.00 from Abbott Laboratories
• £20,000.00 from Roche
• £,5000.00 from unnamed sources

For the year ending March 2006, the NOF's accounts showed income of

• £90,000 from Sanofi-Aventis Ltd
• £70,000 from Abbott Laboratories
• £23,807 from unnamed sources.

Roche Products Ltd were also listed a donor.

Contact details

Address: First Floor 6a Gordon Road Nottingham NG2 5LN

Tel: 0115 846 2109 Email: info@nof.uk.com website: http://nationalobesityforum.org.uk

Their website is funded by

Abbott Laboratories Canderel Roche Products Ltd Sanofi-Aventis Ltd MeatandHealth.com