Via TPM:
Dr. Connie Mariano, who publicly expressed concern about Christie’s presidential prospects given his obesity and overall health, said that he reached her by phone after a Wednesday press conference at which the outspoken governor called her a “hack who wants five minutes on TV” and questioned how she could make judgments about his health before even meeting him. During an interview with CNN earlier this week, Mariano said she feared Christie could suffer a heart attack or stroke should he make it to the White House. The tenor of the subsequent phone conversation, Mariano said, was largely the same as the press conference.
Dr. Connie Mariano should have found something else to talk about. She was wrong. Gov. Christie is right. Full stop.
Dr. Mariano does not know Gov. Christie’s health information. She knows he is overweight, and that is all. She knows general health risks, but not his specifically. She had no business pronouncing about what particular risks accrue to his running for President. She does not know them.
One of the most disgraceful public displays I have ever seen from a fellow physician was Bill Frist’s appalling claim to know Terri Schiavo’s mental state based on a videotape. Not only was it well out of his area of expertise as a transplant surgeon, but he didn’t examine the patient. It was absolutely shameful, and he knew it. And of course, it was no surprise that he was wrong.
Dr. Mariano’s comments are scarcely better. She hasn’t examined Gov. Christie, reviewed his medical records, or apparently even met him. She has no business commenting on his health.
Says Dr. Mariano:
“It was hard to get anything across. I don’t think he realized who he was talking to. I think I’m qualified to make a comment.”
No, you’re not. Not really. Pretty much everyone knows the general risks associated with being overweight. Your medical training does not give you all that much added authority to comment. You don’t know the patient. You should shut up.
But how do you really feel?
Yes she should not have spoken up about this. Making one persons weight a semi-political issue a bad , bad idea. Christie didn’t do himself any good at not making himself look like a bit of hot head though.
Perhaps, but I think “You responded too energetically to a smear” is a weak sauce complaint. Christie temperament is one of the concerns I have about him (as president), but this didn’t bother me.
I think he was in the right in terms of the doc STFU about his weight. If he thinks calling her was going to do any good then i wonder a bit about him and his blood pressure. This is one of those things where his call raised more talk about the issue
“Christie didn’t do himself any good at not making himself look like a bit of hot head though.”
but that’s part of his whole schtick. it’s his deal.
Christie didn’t do himself any good at not making himself look like a bit of hot head though.
I know he’s working the Jersey tough guy persona, but he would have come off as much more presidential had he calmly addressed the issue instead of blowing a gasket. I’m sure he knows his weight is an issue that might give some voters pause, and one that will no doubt come up if he runs. He needs to develop a thicker skin.
A thicker skin wouldn’t stretch so easily around all that extra weight.
[Applause]
Medical ethics aside, it occurred to me when I read this story that even though they are so close semantically, there is a world of difference between a CNN expert saying “Christie’s weight might be an issue for voters” and “Christie is too fat to be president.”
“Too fat to be president” was exactly the message I got from it.
And even more, “Fat people can’t/shouldn’t be permitted to do X.”
Frankly, the idea never occurred to me.
(I did think Cheney was a bit too satanic to be VP)
Okay. I will grant you everything you’ve said here. And this doctor-lady has no standing whatsoever to issue any prognosis on the Governor. But hear me and be clear: I can still choose to NOT vote for Governor Chris Christie for any reason I choose, including because he is FAT. And if the reasons I choose to NEVER vote for him include his obesity, it is perfectly valid for my reasons to include concerns about possible health complications while in office, as well as the visceral feelings of disgust I experience when I have to look at the rolls of fat under his pants, around his jowls and face and his profile. I would NEVER vote for a Republican–even a “moderate” like Christie wants to be portrayed. So I guess you’re right: the FAT question is moot.
Would you vote for a similarly-sized Democrat?
oy
No, you have to vote for him now! A democrat said something they shouldn’t have, so now you have no choice. It’s the rules.
But of course, You!
Nobody will be following you into the voting booth to perform a Vulcan mind meld to confirm the legitimacy of your reasons for voting.
You might choose to vote against Gov. Christie because he is still far more conservative than you on most political issues. (That would be my reason for almost certainly voting against him.) Or because he’s Roman Catholic. Or because he’s a Capricorn. Who knows?
So it’s your right to vote against him for astoundingly juvenile reasons such as how fat he is and how he looks. Nobody will know… unless, of course, you embarrass yourself by telling us so.
Wait…he’s a capricorn!!! Why didn’t you say that…..fish him them.
You can vote whatever way you want for whatever reason you want. You can vote against Barack Obama because he’s black or vote for him for the same reason. Ditto Romney’s religion or Christie girth. It’s not up to oothers to respect the decision making process.
I do applaud you for dropping the pretense mid-post that your vote here actually has much to do with health. The honesty is appreciated.
When he sits around the governor’s mansion he SITS AROUND THE GOVERNOR’S MANSION.
Amirite?
He’s certainly a walking advertisement for NJ cuisine. …. White Castle’s, Diner food, philly cheese steaks, good italian bakeries, etc.
To be more serious, I look at Christie and I say “I know whether he has a vice, and I know what it is. And… it’s one I don’t disapprove of and, depending on the week I’ve had, one I can approve of for myself.”
Those skinny bastards who run for office? Who in the hell knows what they’re up to.
Think again! I’m Going To Vote Cassius In ’14! Et tu, voter?
Gaius Baltar 2014. You know who he stands for!
Anything in a skirt?
Himself. Always and only himself.
Yon Ryan has a lean and hungry look.
Hungry? That’s what that expression is?
“Curl? Under 200, high 190s.”
Now that the election is over and the danger has passed, I can go back to thinking he looks dreamy without guilt.
I have a question y’all might be able to answer: Isn’t it customary for presidential nominees to release a health report of some sort? I seem to recall something like that. If we’re not, it actually strikes me as a pretty good idea.
I think they do release info about their check up and physicals.
100% right, but there’s no comparison to Frist unless she’s asking the government to take over feeding him.
Agree. While she shouldn’t have made a public statement about Christie’s health, Frist’s sin was far more egregious.
Perhaps I conflate the two situations too much. I agree that what he did was much, much worse. The whole Schiavo affair was one of the major moments in my growing realization that I could never, ever vote for the party that perpetrated it again.
That said, I really do think using one’s position as a prominent physician to pronounce (in relative ignorance) on the health of a potential presidential candidate, potentially giving voters an erroneous reason to support another candidate because your words stuck in their heads, is pretty damn bad.
25 comments in and nobody’s yet mentioned Taft? Slackers.
Taft will starting a vigorous exercise program this summer
It’s certainly not the place of someone else’s doctor to make a diagnosis of someone else’s patient. It’s horrible manners.
But America’s too fat. We know what obesity leads to in terms of health outcomes. If someone saw a twelve year old boy forced to carry around an eighty pound pack every day we’d say something about it — but when that twelve year old boy is carrying around eighty pounds of fat, there’s nothing to say. We know the fate of smokers, heavy drinkers, all sorts of bad personal choices lead to bad outcomes.
Granted, it’s not my place to say that boy is in trouble. It’s certainly not the place of Connie Mariano to say anything about Chris Christie. But let’s not pretend Chris Christie isn’t obese and headed for trouble. The larger question seems to be: are we ever entitled to say anything? John Boehner smokes: the unwritten rules say can talk about that fact. But if Chris Christie’s morbid obesity is off limits for some reason, will someone elucidate that reason for me?
America’s too fat.
Yeah, it’d be great if we could trim off some of the extra poundage around our Bible belt.
I guess it comes down to whether you think that a person is unfit to be POTUS if they are fat.
Sure, a fat person can be POTUS. That’s not the point I’m making, though. We do talk about smoking, charge people more on their insurance, pass laws against them in entire cities. Somehow smoking can be condemned. Fat people face discrimination, too. But we don’t treat fat people like we treat smokers: nobody passes laws against them or charges them more for insurance.
The social effects of being fat far outweigh anything we do to smokers.
No way, not even close.
Try telling that to a morbidly obese guy trying to compete with an Obama doppleganger for a job, woman or smile from a stranger on the street. I think you’ll find that a candidate for a high profile job will find if he smokes at home no one will care much, while an obese person will be quickly shown the door.
Smokers tend to confuse “people don’t want me doing something annoying in front of them” with “I’m being persecuted.”
Oh wait… Did I just get he meaning of your comment backwards?
Smokers tend to confuse “people don’t want me doing something annoying in front of them” with “I’m being persecuted.”
Likewise, people who make puns.
Today, you got it right. Though I take mild issue with your last paragraph, the social hazard and expense and inconvenience of smoking is minor compared to what we do with the obese.
Dag nabbit. One of these days my phone and I are going to have an understanding. Anyway, last paragraph aside, we are in agreement, Tod.
Boy, it’s like we’re married.
I think it’s the social effects of superficiality. The unrealistic idea that being “ideal” will make you somehow happy. That physically meeting societies norms somehow makes you a better human being. Not better as in “good”, better as in “ideal”. Then in order to feel “good” (as good as we think we should now that we are the human physical ideal) we denigrate those who don’t embody those same ideals.
If they do something I consider socially unacceptable they must in all aspects of their humanity be unacceptable. So it is socially acceptable for me who embodies (at least in my own mind) those ideals to point out (bully) those who don’t.
This isn’t directed towards any comments made on here and may even be the thoughts of someone who has seen some commercials lately that have made them wonder if as a society we are not going too far towards self absorption and superficiality. I really just didn’t know where to put this comment and this seemed the best place.
Unless you have more access to Christie’s medical records than Dr. Mariano, you’ve no idea whether he, personally, is headed for trouble. There are, in aggregate, risks to obesity, but that doesn’t mean any individual is headed for trouble.
I’m obese (going by BMI, I’m technically morbidly obese, but my doctor agrees that that’s deceptive given my build: I’m carrying a lot of fat, but not that much). Nevertheless, as of my last physical, my labs are not only normal, but my lipid panel is significantly better than average for my age cohort. But for some reason people prefer to judge by weight rather than serum cholesterol.
Okay, there are, in aggregate, risks to obesity. That’s enough said. An aggregate is composed of many individual measurements. Emphasis on the many. We know what high BMI says to lower survival rates and we could only know that in the aggregate. But cardiac strain and concomitant ischemic stroke aren’t always a function of serum cholesterol. It’s absolutely beyond debate that obesity is associated with heart disease. Obesity literally stretches the atrium of the heart. It reshapes the rest of the heart. The metaphor of the little boy carrying an eighty pound sack around is fairly exact.
Now I agree with Russell, if I was a physician, I wouldn’t go around diagnosing people. But I do not need a 12-lead ECG and a cardiologist consult to tell me Chris Christie’s heart is doing a lot more work than it was designed to do.
Chris Christie’s heart is doing a lot more work than it was designed to do
Which makes him almost unique among today’s GOP.
“But I do not need a 12-lead ECG and a cardiologist consult to tell me Chris Christie’s heart is doing a lot more work than it was designed to do.”
You can say that, based on available evidence, the probability that Chris Christie will have cardiac trouble is higher than that of the average man of his age. That’s what phrases like “association with” and “in the aggregate” mean: a change in probabilities, not certain knowledge about specific individuals.
No. That is is already having cardiac trouble. You really do not seem to grasp the implications of obesity on the heart. Every single obese person is in the same predicament as an overloaded vehicle. Not some, not some association: the statistical probability is at 1. Absolutely every single obese person.
Absolutely every single obese person.
I believe you overstate things. Obesity and heart disease do not have a 1:1 association. If you have evidence to the contrary, please cite.
Russell – is this a semantics thing? Blaise used the term “trouble”, not “disease”. Since an obese person’s heart must work harder to supply blood for increased bodymass, the heart is almost by definition under constant strain, even if the heart/blood/cholesterol/arteries are otherwise in good shape, no?
Put another way, an overclocked system component may not be fried or even misbehaving, yet – but unless it was overclocked intentionally, it can be said to be performing out of spec, which indicates trouble; and unless allowances are made, it may fry.
I can’t believe an MD is asking me for a citation for obesity and cardiac function. Obesity and cardiac function.
O de Divitiis;
S Fazio;
M Petitto;
G Maddalena;
F Contaldo;
M Mancini
Abstract
We studied 10 obese volunteers, mean age 36.5 +/- 10.3 years, who weighed 123.56 +/- 28.7 g and were 69.96 +/- 22.5 kg overweight. The subjects did not have diabetes, arterial hypertension or signs of cardiac and respiratory failure or disease and all underwent right- and left-heart catheterization. cardiac output and stroke volume were high, according to increased oxygen consumption and to the degree of obesity. Ventricular end-diastolic and atrial pressures ranged from normal to high and correlated with body weight, signs of volume overloading and reduced left ventricular (LV) compliance. The mean pulmonary artery pressure was elevated and correlated well with weight, pulmonary resistance being normal; mean aortic pressure did not correlate with weight, and systemic arterial resistance tended to have a negative correlation. The LV function curve showed impaired ventricular function, particularly for the heaviest subjects, in whom Vmax and the ratio of the stroke work index to LV end-diastolic pressure were reduced. These indexes correlated well with each other and both correlated negatively with the degree of obesity. In contrast, maximal dP/dt was normal and did not correlate with excess weight. These observations show that depressed LV function is already present in relatively young obese people, even if they are free from signs of cardiopathy and other associate diseases. The degree of impairment of heart function seems to parallel the degree of obesity.
This is a good point. I’m not, to look at me, “overweight,” even though I could stand to lose a few pounds. Still, I have high cholesterol, and the fault probably lies, in my case, with what I choose to eat (it doesn’t seem to be hereditary).
My point is, I have something of a health issue largely due to choices I’ve made, but I don’t get judged on it by complete strangers because they have no way of knowing by looking at me. However, an “obese” person gets so judged regardless of whether he or she has a lot of health problems or whether he or she is “obese” because of choices or some physiological issue.
A study that covers all of 10 people. Who are on average more than 100% above their ideal weight. Based on the reported values for weight and assuming ideal body weight is around BMI 22, they have a mean BMI of about 50, which is not exactly representative of even the average morbidly obese person. Which shows a correlation with some data on cardiac function, but does not show a direct correlation with mortality or “trouble” in the sense of actual impairment.
I’m not sure it’s even obvious that the data on cardiac function are measuring something significant. We have a study showing “depressed [left ventricular] function is already present in relatively young obese people, even if they are free from signs of cardiopathy and other associate diseases”, but other studies have shown “measures of left ventricular performance obtained at rest do not accurately reflect exercise tolerance and symptomatic status of patients with congestive heart failure” (Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure http://www.sciencedirect.com/science/article/pii/0002914981902861).
The degree of impairment of heart function seems to parallel the degree of obesity.
From the sixth link down on your citation page, Blaise.
Cardiac function of 30 patients who were morbidly obese was studied before bariatric surgery. Twelve patients were studied 13 +/- 4 months after surgery. These patients had a mean age of 37.1 +/- 2.9 years and a body mass index of 50.0 +/- 1.4 kg/m2. Cardiac function was measured by echocardiography, radionuclide angiography scanning, and right heart catheterization. To determine the degree of cardiac dysfunction, the patients were studied with exercise and intravenous fluid challenges. Ultrasonography produced evidence of myocardial thickening with an increased interventricular septum in eight patients (32%) and increased left ventricular mass in 17 patients (53%). The radionuclide scan suggested that morbid obesity was associated with a significantly (p less than 0.05) increased end-diastolic volume and decreased left ventricular ejection fraction as compared with patients who were of normal weight. With exercise the patient who was of normal weight had an increase in the end-diastolic volume, stroke volume, and heart rate, but the patient who was morbidly obese only increased heart rate to produce the necessary increase in cardiac output. Right heart catheterization indicated that the relationship of the pulmonary wedge pressure and the left ventricular stroke work index was abnormal in 14 of 29 patients (48.3%) and depressed in six of 29 patients (20.7%) with exercise. One liter of fluid caused an abnormal relationship of the pulmonary wedge pressure and the left ventricular stroke work index in 12 of 30 patients (40%) and a depressed response in 10 of 30 patients (33.3%). Cardiac studies were repeated in 12 patients after a 54.8 +/- 1.9 kg weight loss. Echocardiography indicated a decrease in dilatation (27.3% to 9.1%) and a significant (p less than 0.05) decrease in hypertrophy (45.5% to 0%). After the weight loss, radionuclide and right heart catheterization studies indicated improved cardiac function with reduced filling pressures and increased left ventricular work during fluid and exercise challenges. These results support the presence of obesity-related cardiomyopathy with ventricular dysfunction, which appears to be caused by a noncompliant ventricle. Significant weight loss achieved with gastroplasty results in increased ventricular compliance and improved cardiac function. [Emphasis added.]
Blaise, those percentages ain’t 100%. Am I arguing that obesity doesn’t usually increase cardiac workload and increase the risk of myocardial dysfunction? No. But you overstate your case. It isn’t a 1:1 relationship.
Tell you what, Fnord, here are a few studies. You find me one where the study shows where any competent researcher has shown anything but impaired cardiac function for the obese.
Funny story. From the search page you linked on the very first page, we find “Impact of Obesity on Cardiac Geometry and Function in a Population of Adolescents” (http://content.onlinejacc.org/article.aspx?articleid=1137608). Scroll on down to Table 4, “Cardiac Function in Normal Weight, Overweight, and Obese Adolescents”. For every single value on the table, the range for obese subjects includes the mean value for regular subjects, and range for regular subjects includes the mean value for obese subjects.
That doesn’t mean the obesity isn’t a risk factor for poor cardiac function, of course. But it does mean that some obese people have normal cardiac function (and some people of normal weight nevertheless have cardiac function which is no better than most obese people). It means that your claim that
“Every single obese person is in the same predicament as an overloaded vehicle. Not some, not some association: the statistical probability is at 1. Absolutely every single obese person.”
is simply, empirically false.
Thanks for providing the link to the refutations of your conclusions.
I’m not sure the overclocking metaphor works all that well in this case. A better metaphor might be a computer running more processes than it can efficiently handle, swapping tasks in and out of memory. The operating system knows how to adapt by the increased use of swap space and so does the heart.
The heart is quite capable of doing more work than we give it, routinely: we are long distance runners as a species, running down prey as some Bushmen still do today. Of course, back then, we were lucky to live to 40 or 50. But those who train for endurance events have to watch out for an enlarged heart: too much of any good thing is, well, too much.
But with obesity, as I said earlier, the aorta is distended, particularly the left aorta. It’s easily spotted in the P wave, a characteristic notch there. What’s interesting here is that atrial enlargement usually doesn’t present problems in early life but left atrial enlargement is nearly always present in obesity and it’s more marked the longer you’re obese.
I don’t even pretend to be a cardiologist. My mother the anaesthesiologist taught me to read ECG tapes as a parlour trick and the P wave notch was the very first thing she taught me. I reiterate my point: this has nothing to do with Connie Marino’s bumptious and downright rude statements. Even if Chris Christie is in for a world of hurt if he doesn’t lose some weight, nobody but his physician should be saying anything about it. But I am a software architect and therefore a capacity planner. The Body Mass Index is a measure of height and weight. It is absolutely beyond any discussion or excuse-making or pretending or physician’s manners or any other nicety — to say an obese person’s heart is doing more work as varies his BMI. And the heart, especially the left aorta, adapts to this extra work in un-good ways, as surely as an overloaded computer expands virtual memory by swapping out to disk storage.
Medical advances now allow us to live longer lives.