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Letters to the Editor Issue 239

by Letters(more info)

listed in letters to the editor, originally published in issue 239 - July 2017

Waist-To-Height Ratio More Accurate than BMI in Identifying Obesity, New Study Shows

Calculating a person’s waist-to-height ratio is the most accurate and efficient way of identifying whether or not they are at risk of obesity in clinical practice, a new study by Leeds Beckett University shows. The research, published in the latest edition of PLOS ONE journal, aimed to improve the way that obesity is currently measured and classified by examining the whole-body fat percentage and visceral adipose tissue (VAT) mass (the fat stored around the abdominal region where most of internal organs lie) of a group of 81 adults (40 women and 41 men). It aimed to find the most accurate way of predicting this measurement in a clinical environment and set cut-points for obesity.

Obesity WSA

researchers, led by Dr Michelle Swainson, Senior Lecturer in Exercise Physiology in the Carnegie School of Sport at Leeds Beckett, found that 36.5% more adults would be classified as obese using whole-body fat data (one in two participants) rather than body mass index (BMI) (around one in seven participants, or 13.5%). The team gathered accurate whole-body and abdominal fat data using a total body dual energy X-ray absorptiometry (DXA) scanner - a highly accurate way of measuring body composition and fat content. They then calculated five predictors of whole-body fat and VAT, which could be easily replicated in a GP’s office, fitness centre or at home, comparing the results to those of the DXA scan and determining which simple predictor of obesity is the most accurate.

The five predictors tested were: BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and waist-to-height ratio0.5 (WHtR0.5). Dr Swainson explained: “The conventional measurement of obesity used by GPs is BMI. Although there are benefits to this method, there is concern that a lot of people are being classified as obese by BMI when they are not or are being missed by this classification when they need to be referred for help. This is most definitely the case when people have a ’normal’ BMI but high abdominal fat that is often dismissed. Whole-body fat percentage, and specifically VAT mass, are associated with health conditions including insulin resistance, type 2 diabetes and cardiovascular disease, but are not fully accounted for through BMI evaluation.

“Carrying fat around the abdominal area has been shown to be an independent predictor of all-cause mortality in men and women. Put simply, it is more important, especially for cardio-metabolic conditions, that your belt notch goes down than the reading on the scales.”

The results showed that the best predictor of both whole-body fat percentage and VAT in both men and women was waist-to-height ratio (WHtR). The simple waist circumference divided by height measurement is not a new method of obesity classification but despite evidence supporting its use, it is still not routinely measured in clinical settings. Cut-points for predicting whole body obesity were 0.53 in men and 0.54 in women. The cut-point for predicting abdominal obesity was 0.59 in both sexes.

BMI had weak support as a predictor for whole-body fat percentage in both men and women but was a plausible alternative for the prediction of VAT mass in women. The waist-to-hip ratio (WHR), a measure regularly recommended by fitness instructors and used in clinical practice but which, was found to be a very poor predictor of obesity according to both measures.

Dr Swainson said: “Our WHtR cut-points align broadly to current guidelines that adults and children should keep their waist circumference to less than half their height. In current clinical practice, it is common to calculate BMI for an indication of whole-body fat and waist circumference for abdominal obesity.

“Our research has shown that WHtR is a more accurate alternative to these two measures and also a more time-efficient measure. By introducing this alternative, and more accurate, measure into clinical settings, more men and women would potentially be referred to programmes, such as weight management, to receive help in improving their health. We have also shown how these simple measurements may be used as surrogates by GPs and other health care professionals when DXA scans are unavailable or inaccessible.

“Even in a small sample of adults, our results provide further evidence that alternative measures are fundamental to the more accurate identification of obesity, therefore ensuring that individuals are referred to the most suitable therapeutic approach to reduce risk of obesity-related conditions.”

The study was conducted with Dr Karen Hind, Costas Tsakirides and Dr Zoe Rutherford at Leeds Beckett University’s Carnegie School of Sport, and Professor Alan Batterham at Teesside University.

Further Information

For further details please contact Carrie Braithwaite in the Communications team at Leeds Beckett on Tel: 0113 812 3022;   


Plans for Habitat and Wildlife Conservation Should Consider Lyme Disease Risk

Lyme disease - an infection contracted from the bite of an infected tick - is an important emerging disease in the UK, and is increasing in incidence in people in the UK and large parts of Europe and North America. A new study, published in Philosophical Transactions of the Royal Society B, found that some types of conservation action could increase the abundance of ticks, which transmit diseases like Lyme disease.

The research - led by the University of Glasgow in collaboration with Scottish Natural Heritage, the James Hutton Institute and Public Health England - examined how conservation management activities could affect tick populations, wildlife host communities, the transmission of the Borrelia bacteria that can cause Lyme disease and, ultimately, the risk of contracting Lyme disease. The study found that managing the environment for conservation and biodiversity has many positive effects, including benefits for human health and wellbeing from spending time in nature; however the researchers suggested that there should be consideration of disease vectors such as ticks and mosquitoes in conservation management decisions.

Lead author Dr Caroline Millins, from the University of Glasgow’s School of Veterinary Medicine and Institute of Biodiversity, Animal Health and Comparative Medicine (BAHCM), said: “We identified several widespread conservation management practices which could affect Lyme disease risk: the management of deer populations, woodland regeneration, urban greening and control of invasive species.

“We found that some management activities could lead to an increased risk of Lyme disease by increasing the habitat available for wildlife hosts and the tick vector. These activities were woodland regeneration and biodiversity policies which increase the amount of forest bordering open areas as well as urban greening.

“However, if deer populations are managed alongside woodland regeneration projects, this can reduce tick populations and the risk of Lyme disease.”

Deer are often key to maintaining tick populations, but do not become infected with the bacteria. Previous research by co-author Lucy Gilbert of The James Hutton Institute has shown that greatly reducing deer densities by exclusion fencing or culling can reduce tick density and therefore Lyme disease risk.

Senior author Dr Roman Biek, University of Glasgow’s BAHCM, said: “Widespread management activities can potentially teach us a lot about how changes to the environment can affect the chances of humans coming into contact with ticks and with the pathogens ticks transmit. We recommend that monitoring ticks and pathogens should accompany conservation measures such as woodland regeneration and urban greening projects. This will allow appropriate guidelines and mitigation strategies to be developed, while also helping us to better understand the processes leading to higher Lyme disease risk.”

Co-author Professor Des Thompson, Principal Adviser on Science and Biodiversity with Scottish Natural Heritage, commented: “This is the sort of vital research we need to act on in order to advise Government on the best practices for enhancing wildlife whilst minimising risks to human health. The Scottish Government’s 2020 plan for Scotland’s Biodiversity requires this integrated approach, bringing human health and wildlife management sectors together.”

The paper, ‘Effects of conservation management of landscapes and vertebrate communities on Lyme borreliosis risk in the United Kingdom’ is published in the journal Philosophical Transactions of the Royal Society B. A link to the paper, which was funded by the Biotechnology and Biological Sciences Research Council (BBSRC), can be found here:

About Lyme Disease

Lyme disease can result in a number of clinical signs. A common early symptom which is present in some but not all cases is an expanding skin rash often around the site of a tick-bite, also known as an ‘erythema migrans’ rash. Other symptoms are less specific and include headaches, flu-type symptoms and aching joints. Lyme disease can be treated with antibiotics. The best way to prevent Lyme disease is to reduce your risk of tick bites and check for ticks after walking or cycling in known tick areas.  For more information on how to prevent tick bites and Lyme disease you can visit Public Health England’s website

Further Information

For more information contact Elizabeth McMeekin or Ali Howard in the University of Glasgow Communications and Public Affairs Office on Tel: 0141 330 4831; 0141 330 6557;  or


NHFA Health Freedom Leaders Report on  Minnesota Measles Cases and Background

Minnesota is currently experiencing an outbreak of measles. Most of the cases are in the Somali community. In response to the measles cases in their community, Somali parents are being encouraged by the Minnesota Department of Health, medical centers and facilities, as well as the conventional general media outlets, to have their children obtain the MMR (Mumps, Measles, and Rubella) vaccine. But a number of Somali parents have declined the vaccines because they have experienced their children suffering severe adverse effects, including life-long permanent injury, from vaccines, particularly the MMR vaccine.  

Somali parents have reached out to Minnesota vaccine safety groups and leaders and have begun to share their stories. Vaccine leaders from National Health Freedom Coalition (NHFC), National Health Freedom Action (NHFA), Vaccine Safety Council of Minnesota (VSCMN), and Vaccine Awareness Minnesota (VAM), have listened to these accounts, and have begun educating Somali parents about their right in Minnesota to make their own decisions about vaccinations for their children.

Minnesota has a fast-growing immigrant community, including over 40,000 people of Somali descent.[i] Many Somali parents have shared that since coming to America, they have had the terrible experience of seeing their children suffer severe adverse effects from vaccines, particularly the MMR vaccine.    More and more parents are reporting the same thing - an alarming reaction to the vaccine, with fever, diarrhoea and vomiting, seizures, and regression of functions.

Vaccine safety leaders have heard from Abdirisak Jama, whose son suffered a seizure in the car on the way home from getting his MMR shot. His son "lost everything," all of his current capabilities, according to his father. Abdirisak's son is now 14 years old, needs complete care, and has no ability to speak. They heard from the parent of a child who developed diarrhoea within hours of the vaccine, diarrhoea that never really ended. He lost his ability to eat foods, eventually needing constant naso-gastric tube for feeding, and eventually died.

They heard about Somali children who were talking according to their age level, up until the day they got the MMR vaccine, and that was the last day that these children ever spoke.   This has happened so frequently that the MMR vaccine became known in the Somali community as "the vaccine that makes your child stop talking".

In response to these experiences, the vaccine safety advocates and the Somali community members discussed the need for more research into the high incidence of vaccine injuries in the Somali community. 

In 2010, a study was launched by the University of Minnesota’s Institute of Community Integration called The Minneapolis Somali Autism Spectrum Disorder Prevalence Project”.[ii] The study was designed to answer the question: “Is there a higher prevalence of ASD in Somali children who live in Minneapolis versus non-Somali children?”. The results of the study showed that about 1 in 32 Somali children aged 7-9 years was identified as having Autism Spectrum Disorder.  This was in contrast to the overall rate of the study estimated at 1 in 48, with the White population at 1 in 36, the Black (non-Somali) population at 1 in 62, and the Hispanic population at 1 in 80. The study also indicated that males were more likely to be identified as having ASD than females in all racial and ethnic groups in Minneapolis.[iii] The Minnesota Department of Health’s view of the study stated that there was no statistically meaningful difference between the two estimates of Somalis and Whites. [iv]

In 2012, the Minnesota Legislature authorized a study by the Minnesota Department of Health on the experiences of having a child with autism among the Somali community. The study was intended to understand “cultural- and resource-based aspects of autism spectrum disorders (ASD) that are unique to the Somali community.” With the approval of the Minnesota Department of Health, the study was extended to also include the Hmong and Latino communities. The study was not intended to assess the prevalence or incidence of autism spectrum disorders or the causes of these disorders. [v]

Notably, in 2013, a research study was completed at the Mayo clinic on Somali recipients of the rubella vaccine (one component of the MMR) and led by Dr Gregory Poland MD. The results showed that Somali individuals receiving the vaccine had an immune response twice as great as Caucasians and that a non-Somali, African-American cohort ranked next in immune response, still significantly higher than Caucasians, and Hispanic Americans in the study were least responsive to the vaccine.[vi] This study may shed some light on the high rate of adverse reactions in Somali individuals to the MMR vaccine. 

Despite reports of vaccine injuries, in 2015, a bill was introduced in the MN legislature that would make it more difficult for Minnesota parents to act upon their right to decline vaccines by applying for an exemption for entrance to day care or school.   This bill would have changed Minnesota’s long standing law protecting the right of parents to decline childhood vaccines for their children before entering school by filling out an exemption form stating they decline based on conscientiously health beliefs. The bill would have required that before an exemption could be obtained, a parent would first have to go to a doctor and listen to his/her presentation on vaccination information that was consistent with Center for Disease Control (CDC) guidelines. In Minnesota, strong opposition to the bill was mounted. Somali parents worked side by side with non-Somali parents from Vaccine Safety Council of MN, National Health Freedom Action and National Health Freedom Coalition, and Vaccine Awareness Minnesota to reinforce the importance of parental choice on vaccination and on all medical procedures. The bill was defeated and did not pass. 

Somali parents understandably have decided not to give their child the MMR vaccine based on their experiences. In 2007 the MMR rate of vaccinated two year olds for Somali children was 84% and non-Somali children was 88%. But in 2008 rate in the Somali community dropped to 70%, and by 2012 it was 46%.[vii]  In 2017, the rate is 42%.

In April of 2017, measles cases appeared in Minnesota, primarily in the Somali community, primarily in unvaccinated individuals but with some cases in the vaccinated population.  The health care community is reaching out and educating parents about measles, how to identify measles, and how to take good care of children contracting measles so that they safely return to full health with life-long immunity. Vaccine safety groups are supporting the Somali parents in gathering accurate information about measles and measles vaccines and supporting parental decision-making and their rights to be in charge of the decision-making for their children regarding medical procedures.

The Minnesota Department of Health has held many meetings with the Somali community, with faith leaders, and health care professionals to advise people to vaccinate all those who had not received the MMR vaccine. Parents of unvaccinated children have been informed that they would be excluded from day cares and schools where there were outbreaks. Day care centers have been closed for quarantine periods.   

At the Minnesota 2017 legislature, Rep. Mike Frieberg, the author of the 2015 restrictive vaccine bill, renewed his call to pass the 2015 vaccine bill that was designed to make it more difficult to decline vaccines, now known as HF 96. Vaccine safety advocates sponsored a Lobby Day in the 2017 session, and over 60 advocates visited with legislators to speak to them about the importance of maintaining Minnesota's conscientious exemption to vaccine mandates. They worked to raise awareness about the serious concerns regarding vaccines and the multiple vaccination policies for young developing children. They informed legislators that vaccines are not without risk: the federal Vaccine Injury Compensation Program has compensated 469 parents for disability from the MMR vaccine; 59 of those cases were for death following the MMR vaccine. Advocates reinforced the idea that where there is risk, there must be choice.

Vaccine safety leaders informed the Legislators about the CDC misrepresentation in their CDC research on the MMR vaccine, which falsely showed no link between vaccines and autism. Legislators were educated that CDC lead vaccine scientist Dr William Thompson had come forward and admitted that the study had been fraudulently manipulated, and that it actually showed an increase in autism among children given the MMR before 36 months, as compared to earlier than 36 months, particularly in African American children. Legislators were also informed that the CDC will not allow Dr. Thompson to publicly speak unless he is subpoenaed by Congress. Congress has not yet subpoenaed Dr. Thompson.

NHFA and NHFC stand strongly for the right of parents to make final decisions about all medical care for their children, including vaccinations. The parental right to make these decisions is a fundamental constitutional right that we shall forever work to protect. We firmly assert that Minnesota must maintain exemption opportunities for parents to vaccines recommended by the government before admittance to school. We support the right of the state to organize quarantine policies as spelled out under Minnesota law and for citizens to abide by such with due process and the least restrictive infringements on personal autonomy as also spelled out in Minnesota law. We will always hold that ultimately it is the parents that must weigh the risks and benefits of all health care interventions, and decide what is best for their child.

Notes and References

[i] Statistics of Minnesota Somali population

[ii] The Minneapolis Somali Autism Spectrum Disorder Prevalence Project:

[iii] Id. Prevalence project

[iv] Minnesota Department of Health Website:

[v] MDH culture study

[vi] Mayo Clinic Website:

[vii] Minnesota Department of Health, Perspectives on Vaccine Resistance, MMR Vaccine Resistance in Minnesota Somalis, Lynn Bahta, BSN, PHN.

NHFA is a 501(c)4 lobbying organization, therefore your donations are not tax deductible.

Further Information and Source

Please contact National Health Freedom Action on Tel: +1 507 663 9018;


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