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Yes, Size Matters--Editorial

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Obesity related image Photo: Getty Images

The President quit smoking. Yup, it's true. The First Lady said so during a press conference last Tuesday. Later in the day, Robert Gibbs, the Press Secretary, confirmed that the President has worked hard to kick the habit.

Well, only the Secret Service knows for sure whether or not the President is still sneaking a few puffs. But, regardless, I admire his accountability to himself, his family and to the public. Obama has 'fessed up to his vice. “This is not something that he’s proud of – he knows that it’s not good for him,” Gibbs told reporters. Obama hasn't tried to rationalize his behavior or made excuses. And, he hasn't implied that simply cutting back is good enough. He has plainly said that smoking isn't good for him...or for anyone else.

Compare that to Surgeon General Dr. Regina Benjamin. Lets call it like it is...she's fat. And, so are 63 percent of Americans. But, the real question is: Is she accountable to herself and, more importantly, to the public? Is she helping address the obesity epidemic...or is she fueling it?

Having a svelte figure is not, and should not, be a prerequisite to being "America's doctor." Many who have defended the Surgeon General argue that her job is to make health care and policy decisions for the country -- "not to look hot in a pair of skinny jeans." Good point, great sound bite, but clearly a defensive stance. No one expects her to be thin--just realistic and evidence-based about her current weight.

Experts estimate that Benjamin is at least 40 pounds overweight and wears a size 18. Women in this size range report a BMI between 32-34, and using standard American size charts, her waist measurement is estimated at 34.5 inches. She is not a little overweight or in a gray zone. Benjamin squarely falls into the obese category and likely has an abdominal girth that is dangerously close to, if not over, a critical threshold. (FYI...a waist size greater than 35 inches in women and 40 inches for men is considered high risk.)

There is no question that she needs to lose weight. However, when asked about her weight issues in interviews, she rationalizes by focusing on her treadmill endurance and her goal of climbing Mount Kilimanjaro. "The goal isn't to lose weight," Benjamin frequently says. "It's to be healthy and enjoy it."

Same skeleton...with and without excess fat.
Take a look at this picture of a body with and without excessive fat. It's painful just looking at it. And, Benjamin doesn't have a weight loss goal? Really? Not even 5-10% of her body weight? What kind of a message is this? What if Obama said that the goal was not to stop smoking but to be healthy? The subliminal message: Its okay to be overweight, oops, obese.

Just to be clear: We shouldn't judge her on whether or not she actually loses weight. The reality is that Benjamin is unlikely to ever achieve a normal BMI just like Obama is likely to "fall off the wagon" within 6-12 months, But, she should walk the talk and face the facts. No excuses. No rationalizing.

Too personal? Not anyone's business? Am I being too harsh? Clearly an opinion some of you may have right now. Okay...regardless of whether she conquers her own weight problem or talks about, she should at least be straightforward with the the public about the health risks associated with obesity.

During Benjamin's confirmation hearings, she said, "being healthy and being fit is not about a dress size. It's about how fit you are at that moment in time." And, in a January 7, 2011 interview in the NYT Magazine, Benjamin said, "My thought is that people should be healthy and be fit at whatever size they are."

Translation for the American public: "It okay to be fat. The Surgeon General said so."

Benjamin's position is supported by data that shows that cardiorespiratory fitness (defined as exercise capacity) is a strong and independent predictor of cardiovascular disease mortality and may mitigate the increased risk of death associated with obesity. In other words, she is promoting the perspective that overweight people who are "fit" may be healthier than those who are thin but sedentary.

Don't get too excited and start eating more Twinkies. This unbalanced view ignores other well-documented studies showing that weight, and particularly abdominal girth, is an independent risk factor for cardiovascular disease. In addition, do I need to remind you that excess weight is associated with a multitude of other conditions including sleep apnea, infertility, arthritis, depression anxiety, and certain cancers? Less commonly known is that obesity can lead to non-alcoholic fatty liver disease--an asymptomatic condition, that can lead to liver fibrosis or cirrhosis. In children, obesity contributes to poor academic performance, bullying and low self-esteem. The list goes on and on.

So, while getting fit is associated with reducing some health risks, failing to tackle the fat problem is linked to many more.

No, you can't be obese and healthy just like you can't be a smoker and be healthy. The Surgeon General has a responsibility to educate Americans based on evidence-based medicine rather than politically correct messages. And, while every public figure deserves their privacy, she should take a lesson from her boss and stop dodging the issue.

Dr. Benjamin, your "prescription" to Americans is delivering a dangerous message.
America..size matters.

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Interesting connection to BMI. A recent study with mild/moderate depression patients also found a significant link between depression (onset/duration/TRD) and a patient BMI over 30. It seems that patients with elevated BMI are often deficient in folate status (several studies). This is perhaps the first significant biomarker the will help physicians more effectively treat depression. Experts unveiled and discussed these principles during 2011 U.S. Psych Congress (November, Las Vegas). Use of the active form of folate (L-methylfolate) has been shown to overcome such a folate deficiency and spur the increased production of all three mood neurotransmitters: serotonin, dopamine and norepinephrine. Your thoughts?

December 13, 2011 - 12:41pm
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