Tag Archives: Obesity

Donald Trump’s BMI: getting the measure of the man.

I find myself fascinated by a pointless lie because it is inescapably tragic. All it can do is diminish the person in the eyes of others. And this brings us to Donald Trump’s height. In January 2018, the Physician to the President, Ronny L. Jackson MD asserted that Donald Trump was 6’3″ tall (1.90m). This is so unlikely to be true, that it stretches credulity. There is no reason for Jackson to lie spontaneously about a patient’s height, and it seems probable that he was encouraged to add a few inches by the President himself.

When asked to self report height both men and women in the US tend to overstate it.  Burke and Carman have suggested that overstating height is motivated by social desirability — you can never be too tall. There is ample evidence of Donald Trump’s (misplaced) search for the socially desirable with respect to his hair, his tan, his ethnicity, his intelligence and now his height.

In 2018 we learnt that Donald Trump was officially not quite Obese (body mass index (BMI) <30), and in 2019 he had nudged over the line into the obese range (BMI ≥30). Overstating height creates a problem in the calculation of BMI — which is mass (in kilograms) divided by height (in meters squared). Given that Donald Trump is likely shorter than 1.9m (6’3″), and probably closer to 1.854m (6’1″) this will have implications for whether he was really obese in 2018 (not just overweight as stated by his Physician) and just how obese he probably is (Figure 1).

Figure 1: Donald Trump’s BMI in 2018 and 2019 given different assumptions about his height [R-code here].

In 2018 Donald trump was just below the obese category if and only if he was really 6’3″ (1.9m) tall.  At any height less than that he was obese in 2018 and he is obese today.  His most likely true height given comparisons with others (cf, Barack Obama) is 6’1″, and this puts him comfortably in the obese range.

Misrepresenting one’s height does not create a problem if the lie is reserved for others — except perhaps in a political sense. Problems arise if one deludes oneself. Telling others that you are taller and healthier than you really are is one thing; if you lie to yourself you cannot properly manage your health.

 

 

 

Fat on the success of my country

When I first visited Ghana in the early 1990’s, there was a very noticeable relationship between BMI and wealth.  Rich people were far more likely to be overweight and obese than poor people.  That visit took place about ten years after the 1982-1984 famine.  Some of the roots of the famine lay in natural causes resulting in crop failure and some lay in local and regional politics, and it was small children that bore the brunt of it.  Less than ten years after the famine it was perhaps unsurprising to see that (on average) the thinnest were the poorest, and the fattest were the richest.

Working in Australia in the early 2000s, however, there appeared to be exactly the opposite relationship.  It appeared that the poorest were more likely to be overweight or obese and the wealthiest, normal weight. This observation was certainly borne out at an ecological level when my colleagues and I found an unmistakable relationship between area level, socioeconomic disadvantage, and obesogenic environments — fast food chain “restaurants” were more likely to be found in poorer areas.

So which is it?  Are the poor more likely to be overweight and obese, or is it the rich?  One of the challenges in working out this relationship is that it appears to be different in different countries.  Neuman and colleagues conducted a multi-level study of low-and middle-income countries (LMICs) looking at this very problem using DHS Survey data.  They found an interaction between country-level wealth, individual-level wealth, and BMI.  Unfortunately, the study was limited to LMICs because the DHS surveys do not operate in high-income countries. While it would be tempting to extrapolate the interaction into high-income countries, without the data, it would just be a guess.

We don’t have the definitive answer, but a recent paper by Mohd Masood and me, based on his PhD research, provides some nice insights into the issue.  We were able to bring together data from 206,266 individuals in 70 low-, middle- and high-income countries using 2003 World Health Survey (WHS) data.  The WHS data are now getting a little old, but it is the only dataset we knew of that provided BMI and wealth measures from a sample of all countries, using a consistent methodology, all measured over a similar period of time.

 

Mean BMI of the five quintiles of household wealth in countries ranging from the poorest to the richest (GNI-PPP). [https://doi.org/10.1371/journal.pone.0178928]

The analysis showed that as country-level wealth increased, mean BMI increased in all wealth groups, except the very wealthiest group.  The mean BMI of the wealthiest 20% of the population declined steadily as the wealth of the country increased.  In the wealthiest countries, the mean BMI converged for the poorest 80% of the population around a BMI of 24.5 (i.e., near the WHO cut-off for overweight of 25).  The wealthiest 20% had a mean BMI comfortably below that, around 22.5.

It is obviously not inevitable that as the economic position of countries improves, everyone except the very richest put on weight.  There are thin, poor people and fat, rich people living in the wealthiest of countries.  Nonetheless, the data do point to structural drivers creating obesogenic environments. My colleagues and I had argued, at least in the context of Malaysia, that the increasing prevalence of obesity was an ineluctable consequence of development. The development agenda pursued by the government of the day decreased physical activity, promoted a sedentary lifestyle, and did nothing to moderate the traditional fat rich, simple carbohydrate diet associated with the historically rural lifestyle of intensive agriculture.

We really need more data points (i.e., a repeat of the WHS) to try and tease out the effect of economic development on obesity in the poorest to the richest quintiles of the population.  I would suspect, however, that countries need to think more deeply about what it is they pursue (for their population) when they pursue national wealth.