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President Donald Trump revealed this week that he is taking the drug hydroxychloroquine as a preventive measure against COVID-19 — a move that many experts, in the absence of evidence, find concerning. But when asked about his decision to start taking the drug, U.S. Speaker of the House Nancy Pelosi ignited a separate debate: one about his weight.
"As far as the president is concerned, he's our president and I would rather he not be taking something that has not been approved by the scientists, especially in his age group and in his, shall we say, weight group — morbidly obese, they say,” Pelosi told CNN’s Anderson Cooper on Monday night. “So, I think it's not a good idea."
Trump, in a subsequent interview with White House reporters, dismissed her claims. (At the time of publishing, neither the White House nor Pelosi had responded to Yahoo Life’s request for comment).
But the controversy seems to have raised important questions, not only about Trump’s weight and the definition of morbid obesity — but how that overlaps with the coronavirus pandemic.
According to the latest health information about the president (released last February), Trump weighs 243 pounds and stands six foot three, putting his body mass index (weight in kilograms divided by height in meters) at just over 30. Dr. Karl Z. Nadolsky Jr, an endocrinologist and clinical assistant professor of medicine at Michigan State University, says that only qualifies him as obese.
“Morbidly obese,” he adds, is an outdated term. “[Trump] definitely has obesity but he doesn't have what anybody should call ‘morbid’ obesity,” says Nadolsky. “We don't really use that anymore — and even when it was used it was used for a BMI over 40.”
Dr. Caroline Apovian, director of the nutrition and weight management center at Boston University School of Medicine, as well as a professor of medicine there, agrees. “We don’t like that term,” Apovian tells Yahoo Life. “It’s a really disparaging and denigrating term.”
Instead, Nadolsky says he and other experts in the field rely on a set of measurements created in 2016 by the American Association of Clinical Endocrinologists (AACE), which lists three different levels of obesity: “Stage 0, stage 1 and stage 2.” The stages are determined not only by BMI but by obesity-related complications such as obstructive sleep apnea and type 2 diabetes.
This is an important addition. “The disease of obesity is more than BMI,” Nadolsky tells Yahoo Life. “BMI is just a surrogate for screening and classifying. It historically does a good job of categorizing [fat tissue], but on an individual level, everyone is different. So you might have someone with a BMI of 30 who is a healthy, shredded linebacker. On the other hand, you might have a fairly thin person with a BMI of 25 but they have a lot of abdominal obesity. Well, that’s a much higher risk.”
The AACE’s guidance, on top of taking into account comorbidities, includes waist circumference — another major risk factor. “Waist circumference does a better job at predicting future risk,” says Nadalsky. Although some extra weight around the waistline can simply be what’s called “superficial fat,” it may also signal fat building among major organs like the liver and pancreas.
The Centers for Disease Control and Prevention has similarly moved away from the term morbidly obese, but lists three slightly different categories on its site, known as classes. Class one obesity refers to individuals who have a BMI of 30-34, class two are those with a BMI of 35-39 and class three refers to those with a BMI of 40 or higher, which is referred to as “extreme or severe” obesity.
The CDC notes that obesity is now one of leading causes of death in the U.S, and can put Americans at risk of many other health issues, including the coronavirus. According to the American Society for Metabolic and Bariatric Surgery, an estimated 78 million Americans are affected by obesity in the U.S., 24 million of whom are severely obese. Fueled by genetics, lack of access to healthy food and certain behaviors, the condition has been linked to dozens of life-threatening health consequences, including type 2 diabetes, heart disease and stroke.
Apovian says it’s boils down to where the fat is located. “If you have excessive body fat in the wrong places — meaning you’re storing it in areas where fat is not supposed to be, like the organs, that can cause inflammation and damage,” she says. “Fat is a protective organ, but it’s only protective when it’s for cushioning, like the gluteal area and the thighs. Only in areas that are primed for it.”
Apovian notes that the issue of obesity is a particularly relevant topic in the midst of the coronavirus pandemic, where the three leading conditions seen in those hospitalized with coronavirus —diabetes, chronic lung disease and cardiovascular disease — are all linked to obesity.
“We think that the chronic state of inflammation that many people have, those with diabetes (or pre-diabetes), hypertension, metabolic syndrome and fatty liver, those are the people who when they get COVID-19 go into cytokine storm,” says Apovian. “Their immunity is already prepped to have a response. That’s why they’re more at risk.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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