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Can trump be in "Excellent health" if he's borderline obese?

On Tuesday, the President’s doctor announced the results of Donald Trump’s physical exam. Apparently, Trump's “overall health is excellent,” White House physician Ronny Jackson, M.D., said at a press conference.

But Jackson had to give Trump a little extra advice: cut out the junk food and drop a few pounds.

He recommended Trump kick it up a notch in the exercise department, too. “He would benefit from a diet that is lower in fat and carbohydrates and from a routine exercise regimen,” Jackson reported.

Indeed, much has been made in the press of Trump's weight: according to health stats shared by the White House, he's 6 foot 3 inches tall and weighs 239 pounds.

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That puts the President's body mass index (BMI) at 29.9 — in the overweight category, according to a BMI calculator for adults on the CDC website. It is just shy of crossing the line into the obese range, which is classified as a BMI of 30 or higher.

To be fair, some experts say you can't get a full health picture based on a person's BMI (the ratio of height to weight), because it doesn't take into account things like body fat, body shape, bone density, race, sex, or lean muscle (a stat Trump's doctor didn't share). But Trump's weight has prompted some to wonder if his reported weight is accurate, or if his physician's statement is actually true: is it possible to be in excellent health if you're borderline obese?

There’s actually a longstanding debate among health experts over whether or not carrying additional weight around is dangerous if you’re in otherwise good health.

“It’s called the Fat but Fit paradox,” says Jennifer Kuk, Ph.D., an obesity researcher and an associate professor at York University School of Kinesiology and Health Science, in Toronto.

“Most people think that when you gain weight, your health degenerates. And when you look at risk factors for heart disease, diabetes, and cancer you can see weight is a risk factor,” explains Kuk. As Men's Health previously reported, these risks come into play with high BMI when extra weight is due to extra fat, not extra muscle.

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That said, this doesn’t hold true for everyone. “Not everyone with obesity develops those conditions,” Kuk says. In fact, the authors of a June 2017 editorial in the medical journal BMJ, entitled “The Fat but Fit paradox: what we know and don’t know about it,” wrote that studies have demonstrated that the risk of dying from cardiovascular disease and other causes in obese people who are fit, “is not significantly different from their normal-weight and fit counterparts.”

Other recent research suggests “fat but fit” is a myth, though, and could lead to heart troubles over time.

A 12-year European study of 17,640 people looked at associations between body weight, metabolic health — which includes high cholesterol, high blood pressure, and difficulty controlling blood sugar levels, called insulin resistance — and heart disease.

The researchers found that obese people who were metabolically healthy – "fat but fit" – had a 28 percent higher heart disease risk compared with their normal-weight, metabolically healthy peers.

"We conclude that there is no such thing as being healthy obese," said Camille Lassale, an epidemiologist from Imperial College London's School of Public Health (now based at University College London) who led the research, according to CNN.

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Either way, the more active a heavy person is, the better, Kuk says.

It's also worth noting that Trump has a history of elevated LDL cholesterol, and currently pops 10 mg of the statin Crestor a day. His total cholesterol has gone up from 169 last year to 223 this year (his “bad” cholesterol has risen, too), so his doc wants to up his dose in order to cut his cholesterol even further and decrease his cardiac risk, Jackson said.

So, Trump might improve his health if he follows his doctor’s orders and ramps up his exercise program in 2018. He may even want to take a cue from his predecessor who was known for his love of a good, heart-pumping game of basketball now and again.

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