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Philip James

A man on a mission

Professor Philip James is the co-founder of the International Obesity Task Force and current president of the International Association for the Surgery of Obesity.

Professor Philip James.

Why did you decide to enter medicine?

I came from a small village in Wales where you could either become a teacher, a minister of religion, a solicitor or a doctor. All my family were teachers so I opted to become a medic.

I went to the University College Hospital (London, UK) in the early 1960s, where I studied science and then medicine. I told my boss at the time, Lord Rosenheim, that I thought that medicine was terrible, that doctors were using medieval approaches to their clinical problems and did not have a clue what was causing them.

I said that I was leaving and commented that I may go abroad to do some research. He promptly arranged for me to get a job with the Medical Research Council in Jamaica! 

This position enabled me for the first time to learn about nutrition. At this stage I was a paediatrician dealing with gastroenterological problems, and I spent this part of my career developing new lumen tubes for measuring absorption.

It was at this time I also helped generate the data for the glucose-saline treatment of children with diarrhoea, which has been hugely beneficial to countless children around the world.

Who have been your greatest influences and why?

“We still have to convince people that if you reduce your weight just a bit you can prevent a whole host of obesity-related health problems. In Finland, they have cut the national rate of obesity and diabetes by identifying people with glucose intolerance. This work is very significant and establishes the case for national programmes against obesity.” Professor Philip James

Without question, the single greatest influence was Lord Rosenheim. He was a brilliant doctor who worked incredibly hard. He was not pompous or filled with self-importance, he admitted immediately if he didn’t know anything and most importantly, he only believed in the very highest quality of work.

He looked after many complicated patients. Quite often they were former Belsen or Auschwitz prisoners as he was Jewish, and this taught me that you need to treat people exactly the same, but some people require sensitive care for special problems. All of these principles I still try to uphold everyday.

What experience in your training has taught you the most valuable lesson?

The first time I took charge of a clinical group in Cambridge establishing the MRC Dunn Clinical Nutrition Centre. It was at this time that I realised just how difficult it was to manage a group of doctors with different personalities, working on very diverse projects with distinctive demands and requirements. 

Tell us about one of your most memorable career experiences?

Probably when I was phoned by the shadow minister for agriculture, when Tony Blair was leader of the opposition. At that time there was a major news story about the e-coli epidemic and all these horrid implications such as food poisoning and toxicology. 

This was also at the time when Bovine spongiform encephalopathy (BSE, mad-cow disease) was still very much in the headlines.

 

The shadow minister for agriculture said he had several questions to ask:

Firstly, could I advise the Labour Party on what to do about these big clinical problems and how to prevent them? I said yes, of course. 

Secondly, could I make it (advising the Labour Party) public? I said yes, if any political party contacts me, I will do all I can do to help.

Thirdly, can you meet Tony Blair tomorrow? I was supposed to be moving house that day from Cambridge to Aberdeen, as I was directing The Rowett Institute of Nutrition and Health at the time. So I arranged for my son to move house for us and agreed to meet Tony Blair in Inverness the following day.

Within the hour I was being briefed by Alistair Campbell who wanted something on a Food Standards Agency that was “as straight as a die” - something that the public would trust. 

Two hours later I was Talking to the BBC, The Times, and the Telegraph as well as appearing on Radio 4’s ‘Today’ programme the following morning. Needless to say, the whole thing blew up with hours. That was my most searing experience.

You helped to established the International Obesity Task Force in 1996. How has it evolved over the past 15 years?

We started the Task Force as we were continually being asked to appear on the television and the radio to tell all doctors that they had to take obesity seriously. I said that making endless appeals to doctors was completely the wrong way to go about it and that the World Health Organisation (WHO) should become involved. Having worked with the WHO as an academic-medic for a few years, I knew how to go about it.

The International Obesity Task Force essentially put global obesity on the world map for the first time. Then, one of the first tasks was to identify the criteria for defining childhood obesity, as no proper definition existed.

However, what really changed the medical and governmental approach was when the Task Force published a report following three years of calculating how much of a health problem in terms of diabetes, cancer, heart disease etc obesity really was. Suddenly, obesity became the sixth highest risk factor in the world, it was truly ground-breaking.

Subsequently, the Task Force has developed strategies for governments around the world to help them combat obesity and helped the UK Chief Scientist to develop he ForeSight Report (2007) that looked at the underlying social and economic causes, and the  costs of obesity in the UK.

The Task Force has also helped to develop a European platform to work with the European Union and push the food industry to help combat the obesity epidemic.

The Task Force's original report to the WHO included waist measurements for clinical practice and the criteria for bariatric surgery. The data were subsequently used by the National Institutes of Health in the United States. Indeed, Dr Pi-Sunyer (Chair of the First Federal Obesity Clinical Guidelines), insisted that I attend the report’s launch as many people in the US were angry because the TaskForce was defining a BMI over 25 as overweight, when the Americans wanted the BMI at over 28. 

So, over the past 16 years we have been on a rollercoaster ride. But, the Task Force has had some excellent people on-board. In particular, Neville Rigby, a former journalist who worked with us for ten years and whose insights into public relations and lobbying proved invaluable. 

How should we tackle the obesity pandemic?

Some colleagues of mine from the Organisation for Economic and Cooperation and Development in Paris have looked at this very issue and have calculated health economic costs. They report that we need to completely change our approach to both the prevention and management of obesity. As a result, we have assisted the French and Nordic governments in restricting how the food industry markets their products to children. 

On a clinical basis, we still have to convince people that if you reduce your weight just a bit you can prevent a whole host of obesity-related health problems. In Finland, they have cut the national rate of obesity and diabetes by identifying people with glucose intolerance. This work is very significant and establishes the case for national programmes against obesity.

I personally believe that the UK’s National Health Service is ill prepared for the obesity epidemic and that bariatric provisions are insufficient given the huge demands for those resources. However, the government today is not willing to face up to the magnitude of the problem.

You are currently president of the International Association for the Study of Obesity, what are the aims of the organisation?

The IASO was originally established as an academic grouping assigned with the task of improving research into and educating professionals about obesity. We are now an English charity, so must operate within a certain remit. Our aims are now to change the medical and governmental approaches to the treatment and management of obesity. 

What are you current areas of research?

I have been heavily involved with salt and, along with Claudio Sanchez-Castillo, developed the lithium technique tracker method that showed 85% of salt in the UK diet comes from processed food. As a result, we have developed strategies to reduce salt intake and therefore the rates of hypertension, which is now considered the top risk factor across the world.

I am also working with the World Action on Salt and Health (WASH) and Consensus Action on Salt and Health (CASH) on how to reduce the salt intake in poor countries, where they do not have a lot of processed food but still have high levels of salt intake.

Away from surgery, how do you relax?

By reading the newspapers. I am an obsessive reader! I have been fortunate enough to travel to most parts of the world, but for a holiday we enjoy cycling in France and have been there for the last 13 years.