How obesity report was undermined by the quest to grab public's attention

When the Commons health committee published its reflections on Britain's obesity epidemic two weeks ago it provoked an immediate media feeding frenzy.

When the Commons health committee published its reflections on Britain's obesity epidemic two weeks ago it provoked an immediate media feeding frenzy.

The revelation that a three-year-old girl had become the youngest casualty of the epidemic made headlines both here and abroad.

It was contained in the second paragraph of the 146-page report and was clearly placed to add drama to the central message that the Government, the food industry and parents had to wake up to the threat.

But the row over the true cause of the girl's obesity has ended up overwhelming what the health committee described as its "most comprehensive inquiry ever".

MPs on the all-party committee, chaired by the veteran Labour MP for Wakefield, David Hinchliffe, had spent a year hearing 14 sessions of oral evidence, studying 150 memoranda and consulting five specialist advisers. They visited the US cities of New York, Atlanta and Denver, as well as Belgium, Finland and Denmark - but not, alas, Whitechapel in east London, where their celebrated case was treated.

The report prompted one newspaper to dispatch reporters to comb cemetery records in east London in an attempt to identify the unfortunate girl whose body mass index was 39.5 when she died, roughly equivalent to a weight of six stone, or more than twice the normal weight for a girl of her age. Others bombarded the Royal London Hospital, from where the story had emerged, with offers worth tens of thousands of pounds for the parents' story. The offers were declined.

Then it emerged that the girl was not, after all, a victim of the "obesogenic" environment - one which encourages over-eating and sedentary behaviour. Instead, she had a rare genetic defect which affected the appetite control mechanism located in the hypothalamus in her brain. The result was she had a ravenous appetite immune to the efforts of her parents to control it and unaffected by junk food advertising, school sports policy or government behaviour.

MPs on the health committee were criticised by the scientists who diagnosed the girl's condition for using her case inappropriately and in a way which unfairly put the blame on her parents.

Some newspapers, which identified the girl as from a Bengali family, accused her parents of "stuffing her to death" while others said the case was a "wake-up call" for parents. Letters to the Daily Mail said the parents should be charged with child neglect.

Yet siblings of the girl who died are understood to be of normal weight, indicating that the fault did not lie with the parents.

So how did the health committee end up with egg on its face after publishing its most successful report in years, in terms of the media coverage it received and the public debate it provoked?

The story of the three-year-old was brought to the health committee's attention by a respiratory physician, not an obesity specialist. Sheila McKenzie, consultant paediatrician at the Royal London Hospital, described in a one-page memo to the committee how the girl had "died of heart failure secondary to extreme obesity" and she was treating four other children for "severe obstructive sleep apnoea", in which they stop breathing periodically while asleep because of their obesity. "In other words they are being choked by their fat," she wrote.

Dr McKenzie, who qualified in 1969, made no mention of genetic factors in her memo, although she had sent a blood sample from the girl to specialists at Addenbrooke's in Cambridge for the genetic diagnosis which revealed the defect.

Despite this, in her memo Dr McKenzie focused on the social drivers of obesity and ignored genetic factors. She said the "only solution" to childhood obesity was to reduce the availability of fatty, sugary foods and increase sport and exercise.

A colleague described her as "one of a number of well meaning physicians who grew up in an era before genetics who does not have a clue what we are talking about." The colleague said she had used the case of a girl with a genetic defect to highlight a problem that the girl did not represent.

Dr McKenzie was not summoned to give oral evidence to the committee, an omission which the MPs now say was a mistake, and has refused to be interviewed since. She is said to have been shocked by the prominence given to her evidence.

The Barts and London NHS trust declined to give any details of Dr McKenzie's past career or present position, including her responsibility for the obesity service, which she runs jointly with the department of children's nutrition. In a three-line statement, the trust said she had submitted her evidence "in good faith". Mr Hinchliffe dismissed claims that his committee's report had been hijacked by political lobbyists and refused to accept that the case of the girl had been misrepresented, blaming the row on a disagreement between "the two groups of doctors concerned".

Ian Campbell, chairman of the National Obesity Forum, which gave evidence to the committee, said: "The story of the three-year-old girl was blown out of proportion. It was used to gain a bit of drama and it certainly worked but in retrospect it should probably not have been used. Dr McKenzie was caught up in something that was beyond her wildest expectations. I feel sorry for her."

But he added that the report's central message that obesity was a killer should not be lost in the controversy.

"There are cases the report could have used of eight-year-old children developing type-2 diabetes and a 14-year-old who needed surgery for life-threatening obesity. We must not let this row distract attention from the root point that we do have a serious problem."

HEALTH COMMITTEE'S SEARCH FOR EVIDENCE

US TOUR, October 2003:

New York

Meetings with world diabetes expert at Obesity Research Centre; doctors at New York Presbyterian Hospital

Atlanta, Georgia

Meetings with representatives from Coca-Cola; David Morehouse, former surgeon general; experts from the Centres for Disease Control

Denver, Colorado

Meetings with representatives from Colorado Physical
Activity and Nutrition Programme; Department of Education; Department of Transportation; the Healthy Foods/Five-a-day project

EUROPEAN TOUR, December 2003:

Brussels

Meetings with EU commissioner for health and consumer protection; representatives from the Confederation of the Food and Drink Industries of the EU

Finland

Meetings with Minister for Public Health; officials from Ministry of Social Affairs and Health; Professor Ailsa Risannen at Helsinki University Central Hospital

Denmark

Meetings with the chief medical officer and officials from the Ministry for the National Board of Health