Lesson from President Trump: Healthy Obesity?

Health Writer
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According to CNBC coverage, President Trump’s January 2018 medical evaluation revealed he is in excellent health. He weighed in at 239 pounds (but wants to lose weight). His previous health evaluation (in 2016) revealed a weight of 236 pounds (he is 6 feet 3 inches tall), an HDL of 63, LDL 94, triglycerides 61, blood sugar 99, blood pressure 116/70 and liver, thyroid, heart and colon exams were unremarkable which means no health findings that would indicate a problem. The January 2018 examination revealed an LDL of 143 and a blood pressure of 122/74. The “few pounds of weight gain” documented during this recent examination may actually be more ominous (obesity), if his height is actually 6 foot 2 inches as some suggest. Would you call this health report card representative of excellent health?

It’s important to highlight President Trump’s habit of 12 diet Cokes daily, and a diet that is comprised largely of selections from McDonald’s and Kentucky Fried Chicken and also pizza. Other than golf (he rides the course) he has been quoted as saying that “exercise is misguided.”

If President Trump measured the extra inch, at a weight of 239 his BMI is 29.87 which is just shy of a diagnosis of obesity. If he is one inch shorter, then his BMI is 30.69 and he would be diagnosed with obesity. Putting BMI aside, if you look at the President, he carries weight in his abdomen, and it appears that his waist size is likely above 40 inches, which is considered the “safe” cut off for increased risk of health consequences in a man. Reflecting back on the doctor’s excellent health assessment – Is there such a thing as healthy obesity?

The term mostly used is metabolically healthy obesity or MHO. BMI has been challenged in the past as a singular measure of obesity because it cannot differentiate between lean muscle and fat deposits in certain individuals. When clinicians discuss metabolic disorder, they are likely using criteria of obesity accompanied by other health conditions which include: cardiovascular disease, diabetes hypertension and high cholesterol. There are, however, some doctors that identify metabolic disorder if the patient has obesity accompanied by just two of the four health conditions, for example, CVD and hypertension. Here’s the kicker – not everybody with obesity has metabolic disease. That may be due to a combination of genetics and a lifestyle that is generally healthy despite not supporting weight loss.

If you qualify as having MHO, you may still experience early mortality. It’s possible that despite not exhibiting clear evidence of disease, there are processes percolating at a cellular level, due to obesity that hasten death or are precursors to frank disease. MHO also presents problems because though the medical term exists, there’s really no agreed upon criteria to define MHO. What is clear is that low level inflammation which often is present in certain health situations including obesity may inevitably raise the risk of developing certain diseases, though it may not be present initially in individuals who are classified as MHO.

Theories that support the concept of metabolically healthy obese individuals include:

  • These individuals have less dangerous or subcutaneous fat and not the dangerous deep fat that can wrap around organs
  • These individuals may burn fat more efficiently than others
  • These individuals may have certain innate proteins that protect the body and counterbalance the effects of obesity
  • These individuals may eat healthy food but eat too much and may be physically active but not follow specific recommended exercise prescriptions

Let’s be clear that at a given moment, someone can have obesity and be free of the clinical signs that would indicate metabolic disease. That does not mean that they are healthy. Research suggests these individuals carrying significant excess weight are at much higher risk for cancers, joint problems and kidney disease even if they appear healthy from a cardiac perspective. Further research of MHO could provide more understanding with regards to links between obesity, inflammation, instigation of disease process and metabolic status. Currently, most clinicians feel that weight loss is indicated if a person is diagnosed with obesity.

Health status can change and MHO can easily become obesity with disease at a later age. We do not want to encourage obesity among youth, since they will live with that obesity for decades, and the likelihood is that associated diseases will ultimately develop.

President Trump takes statin medication, which helps to control cholesterol, specifically LDL levels. His 2018 cholesterol profile shows an uptick in total cholesterol and LDL. Our 46th President is eating a very unhealthy diet and weighs too much, especially given likely exposure to daily stress. His exercise attitude needs an adjustment. A recent study suggests that exercise can outweigh the health effects of severe obesity – this is likely true in overweight individuals as well. Experts believe that obesity will inevitably “get you” in terms of negative health consequences.

A prudent lifestyle prescription for President Trump should include:

  • Set (reasonable) weight loss goals since you are a goal-oriented person
  • Slowly wean off diet soda and replace with healthier spritzers (use fruit infusers to flavor sparkling water)
  • Start a walking program and walk in the morning and late afternoon
  • Stand and pace when you take the numerous daily phone calls to reduce sitting time
  • Have walking meetings on the grounds of the White House
  • Start a weight-training program
  • Hire a chef who can creatively recreate your favorite fast foods in healthier format and try a Mediterranean Diet or DASH Diet
  • Have vegetables at every meal and three servings of fruit daily
  • Add fish to your weekly diet
  • Have a handful of nuts in the afternoon to boost protein and healthy fat intake
  • Meditate for a few minutes daily to de-stress
  • As leader of a nation and as a father and grandfather, be a model of healthier eating and exercise habits.

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