Trump's cardiovascular, weight issues mirror most of America

WEST PALM BEACH, Fla. -- After results of President Trump's annual physical were released last month, pundits and comedians had their predictable fun, snarkily questioning the accuracy of his listed height (6 feet, 3 inches -- which Politico reported is 1 inch taller than what appears on his New York state driver's license) and weight (239 pounds).

After all, 1 more pound and the president's body mass index (BMI) would be 30 -- which the United States Centers for Disease Control lists as "obese" -- rather than the merely "overweight" 29.9 that he officially registers on the BMI chart.

Nevertheless, Trump is among the estimated two-thirds of American adults who are either obese or overweight. Being overweight or obese puts a person at greater risk for cardiovascular disease, type 2 diabetes and, according to the American Association for Cancer Research, 14 different types of cancer.

Of course, because BMI does not take into account body composition, it's a notoriously unreliable tool for determining health, fitness and ideal body weight. BMI is calculated by dividing a person's weight (in kilograms) by height (in centimeters) squared. A BMI between 19 and 25 is considered healthy.

So, by the CDC's calculations, Tim Tebow's 6-foot-3-inch, 250-pound physique makes him obese.

Where the president falls on the BMI chart is irrelevant, says cardiologist Dr. David Wolinsky of Cleveland Clinic Florida -- especially when it comes to his cardiovascular health, for which Trump takes a daily cholesterol-lowering medication and over-the-counter aspirin.

"There's no one test or measurement that we can point to and label a person healthy or unhealthy," he said. "Rather, we consider a combination of factors."

Wolinsky assesses patients' cardiovascular risk factors in the following order:

-- Traditional risk factors (high blood pressure, high cholesterol, diabetes, history of smoking, family history of cardiovascular disease).

-- Epigenetics (essentially, one's own unique gene pattern -- which the president's physician, Dr. Ronny Jackson, casually referenced in ascribing Trump's "overall excellent health," despite poor dietary and exercise habits, to having "just great genes").

-- Metabolic syndrome (this is an array of conditions -- including high tryglycerides, high LDL cholesterol, high blood sugar, high insulin resistance and excess abdominal fat -- that can have a ripple effect throughout one's organs).

Jackson acknowledged recommending to Trump that he lose "10 to 15 pounds."

But beyond what a doctor's scale says, myriad research has shown that intra-abdominal -- or "visceral" -- fat carries risks to long-term health.

Visceral fat differs from subcutaneous fat -- which is the visible, pinchable kind on the skin's surface and settles on the lower portion of the torso, at the waist and hips. As long as a person is at a reasonable weight, subcutaneous fat rarely impacts overall health.

Conversely, visceral fat accumulates deep within the abdominal cavity, settles between vital internal organs, and affects how the entire body functions.

According to a recent article published by the Harvard University Medical School, "Research suggests that fat cells -- particularly abdominal fat cells -- are biologically active. It's appropriate to think of fat as an endocrine organ or gland, producing hormones and other substances that can profoundly affect our health ... (and) disrupt the normal balance and functioning of these hormones."

So, how can one tell if one is at increased risk for visceral fat accumulation?

Experts say overweight people with a so-called "A shape" (upper belly bulge) accumulate more visceral fat than those with a "pear shape" (wide hips).

For those in the former category, take solace in knowing that the Harvard article also says "visceral fat yields fairly easily to exercise and diet."

Wolinsky said Cleveland Clinic Florida believes strongly in "the Mediterranean diet, which is low in saturated fats, sugar and simple carbohydrates and emphasizes lean protein and fresh fruits and vegetables."

According to Jackson, the notoriously exercise-averse Trump was more receptive to the dietary recommendations than the one for increased physical activity.

With this being national Heart Health Month, the president has an opportunity to set a great example for the tens of millions of overweight and obese Americans by taking his doctor's recommendations to, well, heart.

Steve Dorfman writes for The Palm Beach Post. Email: sdorfman(at)pbpost.com.

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