When former White House physician Dr. Connie Mariano expressed concern that Chris Christie's weight may make him unfit for office and could be a deciding factor in his potential presidential candidacy in 2016, the New Jersey Governor came out swinging.
During an interview with CNN, Mariano said that Christie could suffer a heart attack or stroke during his tenure. "I'm worried about this man dying in office," she said.
His response? Take a family history. According to an AP and HuffPost report, Christie told the doctor to "shut up" unless she had personally examined him and learned about his family history of heart risk. Undeterred, Mariano responded (via an interview with Bloomberg), saying that "you don't have to be a doctor to see that he is obese."
Who is right? And is it possible to be healthy and obese? As Christie said on The Late Show with David Letterman, "I'm basically the healthiest fat guy you've ever seen in your life."
"Obesity leads to an increase risk of diabetes, high blood pressure, high cholesterol. Those are risk factors for heart disease, but so is smoking and family history," Dr. Robert Michler, chairman of Cardiovascular and Thoracic Surgery at Montefiore Medical Center, told HuffPost. "Hundreds of thousands of people who are obese reach old age and even die without having a heart attack or stroke."
It's an important distinction: Obesity is not a condition that causes heart attacks directly. Instead, it increases the risk of developing chronic conditions like major heart disease, high cholesterol and hypertension and those, in turn, often result in heart attack and stroke. Does the obese Christie, 50, have a higher chance of developing one of these conditions and of subsequently dying of a cardiac event? Yes. But that doesn't mean he will.
According to New York University's Langone Weight Management Center, about 300,000 Americans die each year from obesity-related complications, though 35.7 percent of the U.S. population is obese (about 112 million people), according to the latest estimates from the CDC.
And, as a recent study in the Journal of the American Board of Family Medicine found, obesity in and of itself is not a good predictor of health status. They found that during a six year period, obese study participants were no more likely to die than their healthy-weight counterparts if they didn't have one of the chronic diseases associated with obesity, like Type 2 diabetes or hypertension.
Early death may not be the primary outcome of obesity, but illness abounds. Obesity is associated with heart failure, coronary heart disease, hypertension, Type 2 diabetes, high cholesterol, sleep apnea and other respiratory problems, and even some cancers. It also exacerbates other conditions, like asthma, for which Christie has previously been hospitalized.
Although we don't know the governor's BMI or weight information, it is relevant to his overall heart attack risk. According to NYU Langone, an obese person has an average of six times the heart disease risk as a non-obese person. And that risk increases depending on how obese you are. In the Framingham Heart Study, a famous, longitudinal study of overall cardiac risk, researchers found that for every increment increase in an adult man's BMI, there was an associated five percent increased risk of heart failure.
What's interesting is that obese heart failure patients have better outcomes and are less likely to die than heart failure patients with a healthy weight -- something that doctors refer to as the "heart failure paradox," explains Michler.
Stroke risk, which Mariano also expressed concern about, increases with BMI, as well: for every increment increase of BMI, the risk of ischemic stroke goes up four percent and the risk of hemorrhagic stroke increases six percent.
Despite his bluster and understandable dismay that a doctor who hasn't examined him would speculate about his health, it seems as though the risks of remaining so profoundly overweight have begun to sink in. "I have been remarkably healthy," Christie told Letterman. "My doctor continues to warn me my luck is going to run out relatively soon. So, believe me, it is something that I am very conscious of."