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A big, fat lie

DII small banner By Warren R. Heymann, MD
Feb. 17, 2019

At my heaviest, circa 1997, with my daughters Andrea, Deborah, and our (sorely missed) late puppy Heidi. 

“Packing on the pounds, aren’t you, doc?”

What a lovely greeting that patient gave me that morning more than twenty years ago.

Sheepishly, I admitted it. The conversation continued, from this man who clearly had his own weight issues — “You better take it off now. Once you’re over 50, your knees will be shot, and there’s no way you’ll get it off.”
I knew he was right. Since that time, I exercise virtually every day for at least 30 minutes — using the elliptical machine or taking brisk two mile walk (a great way to listen to Dialogues in Dermatology!). Once a week I have a personal trainer for an intense half-hour session. The happiest minute of my week is 6:31 AM Wednesday morning when the torture ends.

The statistics on obesity are staggering. According to the CDC, the percent of adults aged 20 and over with obesity is 39.8% (2015-2016). Appoximately18.5%, (13.7 million) of children in the United States are obese. (1) The cardiovascular, metabolic, oncologic, endocrinologic, and orthopedic complications of obesity are well known. Dermatologists confront manifestations of the metabolic syndrome presenting as acanthosis nigricans, acrochordons, cellulitis, psoriasis, hidradenitis suppurativa, acne, and hirsutism (2).

The Body Mass Index references are: 1) Underweight (< 18.5); 2) Normal or healthy weight (18.5 – 24.9); 3) Overweight (25 – 29.9); 4) Obese (30 – 39.9); 5) Morbid obesity (> 40).

This week, I was struck by the headline “At 243 Pounds, Trump Tips the Scale Into Obesity” (3). The following is an excerpt from the article:

Despite telling his doctor that he would like to lose 10 to 15 pounds, President Trump gained weight over the past year and is now officially obese.

The president was weighed last week as part of his annual physical, and is now at 243 pounds, according to Dr. Sean Conley, the White House physician, a four pound gain since last year’s physical. At 6 feet 3 inches tall, Mr. Trump now has a body mass index of 30.4. Anything over 30 is considered obese.

Dr. Conley, a Navy commander and the director of the White House medical unit, reported Mr. Trump’s weight without comment in a memorandum describing some results of the physical that was released by the White House. After a team of 11 specialists examined the president for four hours at Walter Reed National Military Medical Center, Dr. Conley said the president was in “very good health” and was expected to remain so “for the remainder of his presidency and beyond,” but did not release any other details.

In this respect, I empathize with President Trump. I love to eat. After our Cooper Medical School of Rowan University presentation for the Philadelphia Dermatological Society, our division celebrated with a wonderful Italian meal — I couldn’t resist a second scrumptious cannoli.

I respectfully disagree with the White House physician. By definition, the President is not at a healthy weight; he may not have any acute medical problem now, but he is at risk — to say with confidence that he expected to remain so “for the remainder of his presidency and beyond,” is a prediction that may not be true.

It does not serve the public well to diminish the risk of obesity — a scourge on our nation’s health. No amount of White House spin can alter that reality. That is the truth — the whole truth and nothing but the truth.

Imoisii OE, et al. Screening and referral for childhood obesity: Adherence to the U.S. Preventive Services Task Force recommendation. Am J Prev Med 2019; 56: 179-186.
Uzuncakmak TK, et al. Cutaneous manifestations of obesity and the metabolic syndrome. Clin Dermatol 2018; 36: 81-88.
Karni A, Altman LK. At 243 pounds, Trump tips the scale into obesity. New York Times.

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