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No matter what Trump’s doctor says, we should all know our waist circumference

A 2017 study found that people with a normal BMI who carry excess weight around their middle are at greater risk of premature death from any cause than people who are overweight or obese.

President Donald Trump’s reported height (6-foot-3) and weight (239 pounds) gives him a body mass index of 29.9.
REUTERS/Jonathan Ernst

At a press conference Tuesday, White House physician Ronny Jackson told reporters he did not measure President Trump’s waist circumference during the president’s annual physical last week. He said he felt there was no reason to do so.

Media pundits and others have questioned why Jackson omitted that measurement, particularly given the fact that the doctor acknowledges the president’s reported height (6-foot-3) and weight (239 pounds) gives him a body mass index (BMI) of 29.9, which is just 0.1 shy of being obese.

Indeed, in recent years a steady stream of scientific studies have pointed to waist circumference as an important assessment tool for determining an individual’s risk of deteriorating health, especially heart disease.

But it may be because the president is obese (that tenth of a point is kind of meaningless) that Jackson didn’t take out the tape measure and wrap it around the president’s waist. Yes, the result would have helped sate the public’s curiosity on the matter, but would it have provided any additional useful medical information? Specifically, would it have changed the doctor’s recommendation to Trump to get more exercise, improve his diet (no more Starbursts and Big Macs) and shed 10 to 15 pounds?

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I doubt it.

Also, research has shown that a too-big waistline — generally defined as more than 35 inches for women and more than 40 inches for men — is most strongly associated with poor health for people with a normal BMI.

What the research shows

My concern about this whole “girther” issue is that because of Jackson’s seeming lack of concern regarding President Trump’s waist circumference, some people will think they don’t have to worry about their own girth.

The evidence says otherwise. For example:

  • In 2009, Swedish researchers found that middle-aged women who carry a lot of fat around their waist are more than twice as likely as their smaller-bellied peers to develop dementia after the age of 70.
  • A 2010 study, involving 100,000 men and women aged 50 and older, reported that having a too-big waistline, no matter what people’s BMI category, was associated with increased risk of premature death by respiratory disease, heart disease and cancer (in that order). 
  • A 2012 study involving data from more than 340,000 Europeans reported that people who were overweight and had large waists were as likely to develop type 2 diabetes as people who were clinically obese.
  • In a 2017 study, researchers found that people with a normal BMI who carry excess weight around their middle are at greater risk of premature death from any cause than people who are overweight or obese. But the study also found that big-bellied people, no matter what their BMI, were at increased risk of heart disease.

A different kind of fat

These are all observational studies, so they don’t prove that belly fat is linked to disease and early death. But, as explained by researchers at Harvard University, there are good scientific reasons for believing in that connection:

[A]bdominal fat comes in two different forms. Some of it is located in the fatty tissue just beneath the skin. This subcutaneous fat behaves like the fat elsewhere in the body; it’s no friend to health, but it’s no special threat either.

Fat inside the abdomen is another story. This visceral fat is located around the internal organs, and it’s the true villain of the piece. One of the earliest explanations for this was that visceral obesity was linked to overactivity of the body’s stress response mechanisms, which raise blood pressure, blood sugar levels, and cardiac risk.

A newer explanation relies on the concept of lipotoxicity. Unlike subcutaneous fat, visceral fat cells release their metabolic products directly into the portal circulation, which carries blood straight to the liver. As a result, visceral fat cells that are enlarged and stuffed with excess triglycerides pour free fatty acids into the liver. Free fatty acids also accumulate in the pancreas, heart, and other organs. In all these locations, the free fatty acids accumulate in cells that are not engineered to store fat. The result is organ dysfunction, which produces impaired regulation of insulin, blood sugar, and cholesterol, as well as abnormal heart function.

These explanations are not mutually exclusive; all may help account for the hazards of visceral fat. All in all, clinical observations and basic research results agree that excessive fat inside the abdomen is a major contributor to cardiovascular disease.

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So, get out the tape measure. Measure just above your navel, right after you breathe out.  (In other words, don’t “cheat” by pulling in your abdomen while doing the measuring.)

The president may not know his waist circumference. But you should know yours.

FMI: You’ll find more information about how to measure your waist circumference on the Centers for Disease Control and Prevention’s website.