John Stuart Garrow, born Dundee, 19 April 1929, died 2 South Cave, near Hull, Yorks, 22 June 2016
John Garrow, who died in June, will be well known to all but the youngest members of the Nutrition Society. As professor of nutrition at Bart’s, he was an expert on obesity, a trenchant critic of nutribabble and a beacon of light in a world of nutritional misinformation. He designed the weight/height charts that show at a glance where any individual stood on the scale between underweight and obesity. He invented the waistline-cord method of keeping slim after a person achieved their target weight, and pioneered jaw wiring as being as effective and less invasive than gastric bypass surgery – although serious gluttons could and did eat melted chocolate through their clenched teeth.
John Stuart Garrow was born in Dundee; his parents were public health doctors. His mother, Helen, qualified in 1918 in St Andrews, where a philanthropist had funded bursaries for women medical students. The family moved to London, and he went to Highgate School, playing for them at ‘junior Wimbledon’.
Garrow qualified MBChB from St Andrews University in 1952 and took a training post in Jamaica, then still a British colony. At the University College Hospital and the Medical Research Council’s Tropical Metabolism Research unit in Kingston, he came face to face with malnutrition, often severe. Along with the unit’s head, Professor John Waterlow, he published extensively relating to water and electrolyte metabolism. This led to safer re-feeding regimens and lives saved, and it earned him an MD degree from St Andrew’s University.
In Jamaica, he published further research on malnutrition, kwashiorkor, trypanosomiasis, protein metabolism in wound healing and potassium metabolism. He helped develop two devices: calibration of an instrument to measure K and the random-zero sphygmomanometer, designed to outsmart the introduction of errors by the human instinct to round a measurement up or down.
In Jamaica he experimented on himself in many ways; this included using the dye Evans’ blue as a tracer for human plasma albumin. He was light blue from the dye when he met Katharine Thicknesse, an English paediatrician who had gone out there to work. They collaborated in clinical and research work and got engaged. Originally from Wigan, she was the daughter of a clergyman, Cuthbert Thicknesse, later dean of St Albans.
Garrow spend 5 years in Jamaica, returning with Kate to the UK to marry and do his military service. At the RAF Institute for Aviation Medicine in Farnborough, Hants, he studied the effects of acceleration on antidiuretic hormone secretion. The work involved being spun in a centrifuge, which he claimed was better than testing aircraft ejector seats. The work earned him a PhD from St Andrews. Demobbed after 3 years, he spent a year as honorary registrar in the professorial medical unit at University College London before returning to Jamaica in 1961 for a further 5 years, and he was there for Jamaica’s independence in 1962. By then he was acting director of the Medical Research Council’s Tropical Medicine Research unit. He joined an expedition to the Andes to investigate altitude sickness and serum K concentration. He was invited because of his inventiveness, and succeeded in designing, constructing and operating a portable centrifuge to spin down blood for analysis at high altitude before it froze.
In 1969, aged 40 years, he was appointed head of the Medical Research Council’s Nutrition Research unit at the newly formed but now defunct Clinical Research Centre attached to Northwick Park Hospital, Harrow. Presciently noting that Britain’s main nutritional problem was obesity, he devoted the remaining 18 years of his career to studying it. A former colleague, immunologist David Webster, said of Garrow:
He was a quiet and courteous man who did not push his views on obesity until he had good data from the expensive physiological chamber that was purpose built for him to measure precisely what went into, and out of fat people held in it. In the end he came to the conclusion that fat people got fat because they ate too much and did very little; an important conclusion because there was a view in the 70s that these people had some mysterious problem in accumulating fat from thin air. I suppose studying obesity was considered a bit fringe in those days and few people foresaw the public health impact it has today.
In 1987, aged 58 years, he was appointed inaugural Rank Professor of Human Nutrition at London University, based at Barts, and was also working at the London and St Mark’s hospitals. He worked long and diligently at his research, clinics and food policy committees. He would get up in the night, said his daughter, to work on his textbooks, a co-authored monograph on Electrolyte Metabolism in Severe Infantile Malnutrition (1968), Energy Metabolism and Obesity in Man (1974, 1978), Treating Obesity Seriously: A Clinical Manual (1981) and Obesity and Related Diseases (1988). With Philip James, he edited several editions of Human Nutrition and Dietetics.
He was a committee member of the Medical Journalists’ Association and chairman of HealthWatch, a charity-promoting medical evidence, originally the Campaign Against Health Fraud, which remained close to his heart after retirement.
When the television personality Dr Gillian McKeith promoted her enzymatic ‘living food powder’ in her book Living Food for Health, Garrow challenged her. He wrote her an open letter in the HealthWatch newsletter, offering to place £1000 with an independent stakeholder – and that she might do the same – if she ran a clinical trial of the powder on the 1500 patients on her waiting list. As a placebo control, he suggested some of the powder be heated to destroy the enzymes; this also destroyed vitamin C, which could be added. If the powder worked, this would be apparent in the people who took the supposedly active substance. If the powder worked, she would receive his £1000 and a fulsome apology; if not, he would keep her stake. He got no response from McKeith but a threatening phone call from her lawyer husband, Howard Magaziner, accusing him of defamation and promising legal action. Garrow said, ‘Sue me’.
Affable and relaxed, Garrow was a man of a few but well-chosen words. He once said, ‘I’m a simple minded man, and …’ before going straight to the point. When asked if obesity could be caused by a low metabolic rate he replied, ‘Yes’, adding, … ‘but I have never seen it in the clinic’. He made herculean attempts to counter nutritional misinformation and was unfazed by threatening letters both from industry and ‘food terrorist’ activists. He was a good boss. His former registrar at Northwick Park in 1977/78 was Peter Wilmshurst, now a consultant cardiologist in Shrewsbury, who wrote:
John gave me a research study leading to my first paper, published in 1980. It was Wilmshurst PT, Crawley JCW. The measurement of gastric transit time in obese subjects using 24Na and the effects of energy content and guar gum on gastric emptying and satiety. British Journal of Nutrition 1980; 44: 1-6.
John Crawley worked in nuclear medicine at Northwick Park, but you will see that John Garrow is not an author. John devised the research, funded it and got ethics approval, but said that he had not done enough to be a co-author. It was my first paper so I did not realise how unusual that is. Unlike many other academics John insisted in taking less credit than he deserved.
His outside interests were constructing beautiful gardens, sailing and windsurfing. He loved playing and mending cellos, making things, including his own windsurfer and enduring toys for his children.
Aged 83 years, he recognised his general decline and the onset of vascular dementia and moved to a village near Hull to be near his daughter Diana, a general practitioner (GP). He monitored his cognitive decline by charting the progressively lower levels at which his computer could beat him at chess. He remained independent until the last weeks of his life and died at home, cared for by his family.
Kate Garrow, who became a GP, died in 1988. He is survived by his children Jen, Meg, Diana and Alan, eight grandchildren and two great grandchildren.