TOO FAT TO WORK
By Richard E Sall MD
People with obesity work in most occupations and businesses. Being overweight or obese may cause little or no inconvenience to a person's career. Over time, however, a disability may occur from obesity.
The BMI is an equation that calculates your height and weight to determine your weight status -- a score below 25 is considered normal, 25 to 30 is overweight, and over 30 is obese.
If you go by BMI standards, 97 percent of the NFL are overweight, and over half are obese; and California Gov. Arnold Schwarzenegger and Brad Pitt are categorized as overweight, along with 65 percent of the country.
When obesity becomes severe, it can inflict bodily pain and affect normal daily activities. A person with severe obesity may find their ability to perform their chosen occupation so compromised that they qualify for disability.
Obesity is on the rise. Weight loss is a challenge that goes beyond merely warning people about the fat content of a cheeseburger and fries. The fat and jolly stereotype has disappeared in favor of the thin and beautiful as the happiest people in the land (but the extremely thin models may have a different type of food disorder).
The fastest-growing group of obese Americans consists of people who are at least 100 pounds overweight. The proportion of individuals with clinically severe obesity increased from 1 in 200 adults in 1986 to 1 in 50 adults in 2000; and now 1 in 20 adults. The rapid growth in the proportion of Americans with clinically severe obesity has enormous implications for the nation’s health care system. Severely obese people are more than twice as likely as people of normal weight to be in fair or poor health and have about twice as many chronic medical conditions.
Weight also has a dramatic effect on people’s ability to manage five basic activities of daily living: bathing, eating, dressing, walking across a room, and getting in or out of bed. Moderate obesity is associated with a 50 percent increased probability of having limitations on these abilities; severe obesity is associated with a 300 percent increased probability.
The National Institute of Health Clinical Guidelines recognizes three levels of obesity:
- Level I - BMI 30.0-34.9 (Obese)
- Level II - BMI 35.0-39.9 (Moderately severe obesity)
- Level III – BMI greater than or equal to 40 (Severe obesity)
In Social Security Disability, decision makers are more likely to give significant consideration to Levels II and III obesity as a limiting factor in obesity claims. This is especially true for Level III, which is considered “extreme" obesity, and indicates the greatest risk for obesity-related impairments. SSA will find that obesity is a “severe” impairment when, alone or in combination with another medically determinable physical or mental impairments, it significantly limits an individual's ability to do basic work activities.
Obesity may cause exertional, postural, and manipulative limitations depending on the level of obesity and where the weight is carried.
The ability to manipulate may be affected by the presence of adipose tissue in the hands and fingers. The ability to tolerate extreme heat, humidity, or hazards may also be affected.
Obesity may also affect an individual's social functioning due to loss of mental clarity and any underlying mental impairment such as depression.
Residual Functional Capacity assessments must consider an individual's maximum remaining ability to do sustained work activities in an ordinary work setting on a regular and continuing basis. A “regular and continuing basis” means 8 hours a day, for 5 days a week, or an equivalent work schedule.
In November 1995, an Ohio dock worker had worked as a truck driver/dock worker for 5 years when he injured his knee when one of its rungs broke on a ladder. After 6 months--the company limit--he tried to return to work, but the employer's doctor ruled him an unsafe worker because of his weight--405 pounds. That doctor noted that the worker was short of breath after a few steps and pronounced him unsafe to do his job. He was eventually terminated.
He sued for violation of his rights under the Americans with Disabilities Act (ADA), and the Equal Employment Opportunity Commission (EEOC) sued the employer in a federal district court in October 2002.
A judge there ruled for the employer, finding that morbid obesity that does not have a physiological cause is not a disability under ADA, nor was the employee substantially limited in any major life activity.
On appeal, judges said that morbid obesity with no physiological cause is not is protected by ADA. So they affirmed the district court judge's ruling, dismissing the case again. EEOC v. Watkins Motor Lines, U.S. Court of Appeals for the 6th Circuit, No. 05-3218 (9/12/06).
In October, 2004, a 6-foot-2 and 340 pounds man applied for an assistant signalman position in Richmond, Calif., at Northern Burlington Santa Fe (NBSF), a national railroad company.
After applying for the job, interviewing, and passing a battery of physical and mechanical tests, Schmidt got an e-mail from NBSF offering him the job, contingent on a few more tests. Schmidt passed the background check, the drug screening, filled out a medical questionnaire and took a physical.
Shortly thereafter, Schmidt received another e-mail from NBSF saying their job offer was being rescinded. Schmidt had failed his medical examination. Although he does not have high cholesterol, high blood pressure, diabetes or any other diseases commonly associated with obesity, Schmidt's Body Mass Index (BMI) was above 40, disqualifying him due to "obesity."
Obesity is not protected under the anti-discrimination laws.
Fat people don't need to be reminded that they have a problem. Overweight people are rarely happy about their obesity. They have mirrors and bathroom scales like other people do.
Fat people also have a sluggish metabolism that stores fat on purpose. Humans have dieted for thousands of years and our bodies have become efficient machines, storing fat for those long periods of starvation.
Modern science has only begun to understand the complex interrelationship among the factors that contribute to obesity in some people: high fat diets, depression, genetic causes, cultural effects, hormonal issues and lifestyle factors. They have yet to identify simple ways to help people break out of the vicious circle of weight gain and poor self-esteem.
Richard E Sall MD
Business Health Network
9500 Stockdale Highway, Suite 101
Bakersfield, CA 93311
Diplomate, American Board of Preventative Medicine, Occupational Medicine
Diplomate, American Board of Forensic Medicine
Diplomate, American Board of Surgery
Qualified Medical Evaluator #969780 State of California
Consultant for the Medical Board of California
Medical Consultant for the U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation