Obesity and Disabilities

About 48.9 million people, or approximately 19.4 percent of the non-institutionalized civilian US population is disabled. Almost half of those people, 24.1 million, are severely disabled.

More than one-third of adults in the US, about 35.7 percent, are obese according to clinical criteria. More than 1 in 20, about 6.3 percent, meet the criteria for extreme obesity.

There is a considerable amount of overlap between obesity and disability in the US. Here is a guide to understanding how obesity affects health and disabilities, obesity and Social Security Disability decisions, the different routes to qualifying for disability benefits because of obesity and related health issues, and how obesity and the ADA intersect.

The basics of obesity

An adult whose weight falls in a range that is more than is generally considered to be healthy for their height is either overweight or obese. These ranges are determined by body mass index or BMI. BMI is calculated based on height and weight and typically correlates with the amount of body fat.

People with BMIs of 25 to 29.9 are considered to be within the overweight range. People with BMIs of 30 or more are considered to be within the obesity range. People with BMIs of 40 or more are considered to be within the morbid obesity range.

The overweight and obese ranges also correspond with increased likelihoods of certain health problems and diseases such as heart disease and diabetes. Genetic factors are the primary influencing factor behind obesity, but environment and behavior also play important roles.

According to the Journal of American Medicine (JAMA), about one-third of all American adults are obese, and almost seven percent are morbidly obese. According to the National Institutes of Health (NIH), rates of morbid obesity are on the rise.

Obesity, disabilities, and practical consequences

Obesity may cause a range of health complications:

  • Can cause difficulty maintaining an active lifestyle
  • Can restrict or even prevent movement in cases where body weight causes severe enough strain on breathing, heart, joints, and lungs
  • Can influence development of type II diabetes
  • May facilitate heart disease
  • Can cause stroke
  • Linked to certain kinds of cancer

Obesity can sometimes be caused by other medical conditions. In these cases it is a symptom of other health problems that itself carries health consequences. Some endocrine system disorders, genetic disorders, and mental illnesses can cause obesity.

Obesity: the financial costs

Obesity can lead to more frequent absences from work. This is particularly true for people who work in physical jobs, because obesity is likely to cause joint problems, back pain, and mobility issues, in addition to more serious problems like circulatory issues, heart disease, and uncontrolled diabetes. According to research from Duke University, workers with obesity are injured on the job twice as often and miss about 13 times more work days annually on average than their “normal” body weight co-workers.

Excess or frequent absences can mean a lower paycheck and less stability at work. Ultimately more severe obesity can also result in a loss of earning and an inability to perform many kinds of work. However, there are also other financial costs to consider.

Unfortunately, medical costs are one of the primary expenses connected to a high BMI because obesity is a significant factor in the cause and/or development of so many health problems and disease processes. According to the Centers for Disease Control and Prevention (CDC), obese people are forced to shoulder yearly medical expenses that are $1,429 higher on average than those of people in “normal” weight ranges.

When obesity causes coronary artery disease, depression, uncontrolled diabetes, or other serious health problems, more medical costs are the result. Unfortunately, as with many other people struggling with serious health problems and physical limitations, the ability to work is not always a given, so income and medical insurance are not always reliable, further complicating the ability to pay for these kinds of medical bills.

If this is your situation, trying to get disability benefits and/or state or federal health insurance coverage may be part of the answer.

Challenges for people with disabilities that can lead to obesity

It isn’t always easy for people with disabilities to control their weight, eat fresh, healthy foods, and be physically active. There are many reasons for this:

  • Healthy, fresh food choices are often more expensive than fast foods and other convenience food choices, and people with disabilities are more likely to experience poverty.
  • Many people with disabilities experience difficulty with swallowing or chewing food, or tolerating its texture or taste.
  • Medications can contribute to changes in appetite, weight loss, and weight gain.
  • Ability to exercise can be affected by physical limitations including pain and a lack of energy.
  • Environments that are conducive to exercise are often not accessible; for example, exercise equipment, parks, and sidewalks are often made only for people without disabilities.
  • A lack of money, transportation, and other financial resources can also make staying active more difficult.

Disability benefits for obesity

A diagnosis of obesity is not by itself enough to qualify for disability benefits. However, there are some circumstances under which obesity may cause enough health problems and limitations in a person’s daily activities to meet the medical eligibility requirements for Social Security disability. Typically, these include cases of very high BMIs that make moving, walking, and doing everyday tasks like bathing, dressing, housekeeping, and food preparation impossible.

In many other cases, obesity is one of several health issues that work together to cause a constellation of health problems that together meet the criteria for disability benefits. In these cases obesity and related health conditions such as diabetes, heart disease, joint disorders, stroke, or even rare genetic disorders render the applicant unable to complete a number of daily activities.

Social Security Disability (SSD) benefits are intended to help people with disabilities pay for their medical bills and everyday living expenses. They also help qualify recipients for other aid, such as state and federal health insurance coverage and sometimes Supplemental Nutritional Assistance (SNAP), also called food stamps.

Medically qualifying for disability benefits

The disability manual for the Social Security Administration (SSA) is called the Blue Book. The Blue Book contains the standard listings that are used to review SSD benefits applications. There is no obesity listing in the Blue Book, so there is no automatic medical qualification based on obesity. However, this does not mean that an application based on obesity cannot be approved under a Blue Book listing.

If your obesity is caused by another medical condition, you may be able to qualify for a disability by closely matching or meeting the listing for that condition. For example, endocrine disorders such as diseases of the thyroid, as well as mental illnesses such as anxiety, brain injuries, depression, and mood disorders can cause excessive weight gain. If you can match one of those listings, you may qualify that way.

On the other hand, while some health problems can cause obesity, obesity itself may cause other serious health complications. These include severe and potentially life-threatening issues such as coronary artery disease, degenerative arthritis, diabetes, heart disease, and stroke, to name just a few. If your BMI has led to other health problems, those problems may allow you to qualify under the listing for those conditions if they meet the listed level of severity for that condition.

The Blue Book is confusing to work with because it is written for official use. It contains lots of jargon, including complicated medical language, and descriptions of body systems, tests, and illnesses. To be sure you’re understanding the Blue Book listings and collecting the records you need, work together with your healthcare provider.

Residual functional capacity analysis

If you cannot meet a Blue Book listing, you still may qualify for disability benefits. To qualify you’ll need to undergo additional review. SSA will assess “functional reports” submitted by you, your healthcare provider, and sometimes by other people in your life such as caregivers, family members, or friends. These reports and the review of the reports make up SSA’s “residual functional capacity” or RFC analysis. RFC analysis is what SSA uses to assess cases that don’t fit squarely into existing categories.

Functional reports must thoroughly describe your emotional, mental, and/or physical limitations. In the case of obesity and related disabilities, these reports must prove to SSA that your obesity and any complications that are related severely limit your ability to complete everyday tasks and activities. For purposes of SSA disability benefits, everyday tasks and activities include:

  • Bathing, getting dressed, and grooming
  • Shopping for food and cooking
  • Keeping house, yard work, caring for yourself and your children or pets

You may wonder why these functional reports focus so much on your personal life instead of your work life. The reason is that SSA takes information about what you can and cannot do in your everyday life and applies it to analysis about what kinds of work you can and cannot do. For example, if you cannot lift things, balance, stand, or walk without help, the SSA understands that you cannot work in a physical job.

However, to be approved for disability benefits under an RFC, the SSA must decide that you’re unable to do any sort of work in any job—even a job that is below your educational or training levels and previous work history levels. In other words, if you are capable of doing any kind of work at all, SSA will find that you are not disabled.

Applying for benefits based on obesity

It isn’t easy to qualify for benefits based on obesity, particularly if you cannot meet a condition listed in the Blue Book. Be prepared to seek out help from an advocate or attorney who is well-versed in SSA disability work. You will likely need to file appeals, especially if you must qualify through an RFC analysis.

Whichever route you take, you must back up your application with ample, complete medical records and documentary evidence showing each and every medical issue and complication caused by your obesity. The SSA may need to review many kinds of records, including:

  • Body Mass Index (BMI) reports, including how your BMI percentage was calculated
  • Heart function and stress test results
  • Hospitalization reports, if applicable
  • Records from evaluations of breathing complications
  • Imaging results, x-rays, MRIs, and results of any other tests which evaluated back problems, joint function, and other musculoskeletal complications
  • Lab work showing cholesterol levels, diabetes, kidney values, and liver values
  • Your doctor’s physical exam notes
  • Records from your psychological evaluations
  • Sleep study results
  • Surgical records, if applicable

You can apply for Social Security Disability benefits online at any time via the SSA’s website or at any Social Security office.

Does the ADA consider obesity a disability?

The Americans with Disabilities Act of 1990 (ADA) ensures equal opportunity in employment for and prohibits discrimination against people with disabilities. The specific provisions of the statute say that:

No covered entity shall discriminate against a qualified individual on the basis of disability in regard to job application procedures, the hiring, advancement, or discharge of employees, employee compensation, job training, and other terms, conditions, and privileges of employment.

ADA, 42 U.S.C. §12112(a).

The portion of the provision that is subject to interpretation is what constitutes a “disability” according to the ADA. The ADA says that a disability is (1) a physical or mental impairment that substantially limits one or more major life activities of such individual, (2) a record of such an impairment or (3) being regarded as having such an impairment. 42 U.S.C. §12102(1).

The statute then breaks this down even more. First, a “major life activity” can include bathing, caring for oneself, eating, hearing, lifting, seeing, standing, walking, sleeping, etc. A “major life activity” can also mean the ability of a bodily function to operate adequately, such as the brain, digestive system, immune system, respiratory system, etc. 42 U.S.C. §12102(2).

Second, a “record of such an impairment” just means that you must be able to have medical records to support your claim.

Third, you can still be disabled under the ADA even without medical records if you are “regarded as having such an impairment.” This means that if you are discriminated against because you are disabled, or even because people perceive that you are, you satisfy this definition. 42 U.S.C. §12102(3). If your workplace, for example, discriminates against you based on their belief that you are mentally ill, whether or not you have a diagnosis, you probably are seen to have a disability under the ADA. Furthermore, if you have an actual, obvious or noticeable physical or mental impairment and your employer discriminates against you because of it, then you are probably covered by the ADA.

Conclusion

In recent years the EEOC has found that obesity can support claims for disability benefits. This is part of a larger trend that is beginning to recognize several things. First, obesity is very common, and carries with it serious challenges and expenses that many people simply cannot manage without assistance. Second, as our understanding of genomics expands, it has become clear that genes play an important role in obesity. This recognition is slowly helping obese people battle stereotypes and blame that they cope with every day.

If you are struggling with medical issues and lack of functionality in your everyday activities due to obesity or obesity-related health issues, you’re certainly not alone. Disability benefits and insurance may be what helps you pay off medical bills, purchase medical and mobility equipment such as power wheelchairs and power scooters, and otherwise get or stay active and productive. In fact, if this kind of mobility equipment is what makes work possible for you, you are more likely to be able to get this kind of accommodation.

Reach out to an expert in the field today for more information.