International Association for the Study of Obesity and China

Only 10 years ago, the World Health Organization (WHO) held its first expert consultation to consider the global problems of obesity, its complications, prevention and management (1). At that time, many policy makers considered obesity to be a problem affecting only affluent countries, with no need for WHO, with its focus on the developing world, to become involved. This was particularly true, given the seemingly much more immediate problems of infectious disease, especially the challenges of HIV, malaria and tuberculosis in Africa and some parts of Asia. To persuade WHO of the need for a broader perspective, the International Obesity TaskForce (IOTF), set up with the International Association for the Study of Obesity (IASO) in 1995, amassed as much data from the ‘developing world’ as possible and, by 1997, produced a major report for the WHO consultation. This report revealed that obesity was emerging throughout the world, but at the meeting it was already clear that the Asian representatives considered a body mass index (BMI) of 25 too high to be considered acceptable, yet some US experts were initially content to consider a BMI of 27 as an acceptable limit of the ‘normal range’. However, the adoption of BMI 25 as the upper limit was maintained from the earlier WHO report (2) in response to much earlier analyses of mortality figures from US insurance statistics, together with a recognition that risks of comorbidity increase significantly when BMI exceeds 25. At that stage, the available data were predominantly Western, and there was a clear need to have a more rigorous assessment of these issues from the major population centres of the world and in particular from China and India. Recognizing that appropriate norms in Asia had yet to be determined, a meeting was convened in Hong Kong in 1999, involving the WHO Pacific Region Office, IASO and IOTF, where new criteria for both BMI and waist circumferences were suggested for Asians (3). These proposed reference points were based on very preliminary data from Hong Kong. In early 1999, I had the privilege of visiting China to consider the problem of obesity with Professor Chunming Chen, with whom I co-chaired the first WHO consultation on diet and the prevention of chronic disease in 1990 (4). This consultation considered how to integrate these issues with the persisting problem of malnutrition. That this issue is as relevant today as it was then will become evident in a careful reading of this supplement. By the mid-1990s, China was already undergoing profound changes, but the information available to the international community was very limited. Therefore, in 1999, Professor Chen convened a group involving all the principal medical societies concerned with this issue, and during the European Congress on Obesity in Milan in 1999, the IOTF convened a conjoint Chinese/WHO workshop with the then WHO Assistant Director General Professor Chen. This established a template for comparing the comorbidity rates at different BMIs and waist circumferences, and this approach stimulated a whole set of new analyses, which led to the first supplement on Asian BMIs in Obesity Reviews (5), and provided much of the data for the WHO expert consultation held in Singapore in 2002 (6). In November 2006, IASO participated in a meeting in Beijing, which set the scene for addressing what is already recognized as a huge political and medical challenge for China. It became clear that both China and the international community could benefit from the perspectives that emerged from the meeting. IASO is delighted to facilitate the publication of this supplement, with its review of new data and analyses of the problem in China. International as well as Chinese approaches are considered and illuminate the profound and disturbing implications for health of fundamental changes in physical activity and food systems, brought about by China’s astonishing economic development. This document is a valuable addition to the literature and of benefit to IOTF in its policy analyses for governments and for IASO with its concern to document and assess the causes,