Obesity and Disability

Obesity and Disability

POSITION STATEMENT

January 2015

 

Co-signatories: The Obesity Care Continuum, including The Obesity Society, Obesity Action Coalition, American Society of Bariatric Physicians, Academy of Nutrition and Dietetics, and the American Society for Metabolic and Bariatric Surgery

 

Overview

Obesity is not a personal choice but a disease with serious health consequences. This understanding is key to reducing discrimination against people with obesity.

Although obesity may not always be a disability by itself, it can lead to health problems that constitute a disability. This recognition should help form the foundation for employers to offer considerations to employees affected with health disabilities due to obesity.

 

Recommendations

  1. The Obesity Care Continuum strongly opposes discrimination based on a person’s body weight and supports federal and state policy measures to protect people with obesity from workplace discrimination.
  2. The Obesity Care Continuum urges employers to recognize that while people with obesity are not inherently disabled, obesity can at times lead to disability.

 

Background and Statement of the Problem

The Obesity Care Continuum has long supported protections for individuals affected by the disease obesity as it relates to providing protections in the workplace. The December 2014 decision by the European Court of Justice to uphold these rights in an individual case has highlighted the need for clear policy in the US.

The EU court ruled that obesity can be considered a disability under certain circumstances. The EU decision related to a case of a child-care worker who claimed he had been fired from his job because of his weight. The court ruled that although obesity was itself not a disability, the disease can lead to health problems that constitute a disability. The step taken by the European Union is yet to be taken by the United States in regards to weight discrimination protection in the workplace.

 

What is the Evidence?

Acquiring obesity is not a personal choice, but a disease with serious health consequences.

Obesity is not merely a reflection of lifestyle choices and is a far more complex condition than relating to willpower or eating less and exercising more. In most cases, obesity is chronic and challenging to treat.

Moreover, among family studies, approximately 50 percent of the risk of obesity can be inherited1. Compare that to 25 to 56 percent heritability for breast cancer2, 3 or 34 to 53 percent heritability for heart disease, and it is evident that obesity is not a simple matter of choice4.

 

Individual decisions are not always sufficient to reduce weight and maintain weight loss long term.

While lifestyle interventions (diet and exercise) can be effective for weight loss and for improving health-related comorbidities, in many individuals, long-term maintenance of weight loss is often challenging5. Pharmacotherapy or surgical weight-loss treatment can produce significant health benefits; however, these options are recommended and accessible to only a small percentage of individuals with obesity and, similar to lifestyle interventions, partial weight regain is possible6. Taken together, current weight-loss treatment options help manage the condition but do not cure it, underscoring the urgent need for research and development of effective strategies for meaningful and long-term weight loss.

In light of the scientific understanding about this complex disease, The Obesity Care Continuum strongly discourages discrimination based on a person’s body weight under any circumstance, including in the workplace.

 

Obesity can lead to disability.

Obesity is a medical disease7, 8 that puts individuals at risk for more than 30 health conditions, which can limit mobility9 and reduce overall health thus leading to disability. Some of these weight-related comorbidities include: heart disease, degenerative joint disease, respiratory conditions (e.g. asthma, sleep apnea), type 2 diabetes, high cholesterol, hypertension, gallstones, fatty liver disease, gastroesophageal reflux disease, stress incontinence, heart failure and numerous cancers10. Others that can further contribute to reduced mobility include musculoskeletal and joint problems11, 12.

While people with obesity are not inherently disabled, it can at times lead to disability. The Obesity Care Continuum appeals to employers that they should treat such individuals with the same respect they would afford individuals with other diseases.

 

REFERENCES

  1. Bray GA, Bouchard C. Handbook of obesity : epidemiology, etiology, and physiopathology. 3rd ed. Boca Raton: CRC Press; 2014.
  2. Czene K, Lichtenstein P, Hemminki K. Environmental and heritable causes of cancer among 9.6 million individuals in the Swedish Family-Cancer Database. Int J Cancer. May 10 2002;99(2):260-266.
  3. Schildkraut JM, Risch N, Thompson WD. Evaluating genetic association among ovarian, breast, and endometrial cancer: evidence for a breast/ovarian cancer relationship. Am J Hum Genet. Oct 1989;45(4):521-529.
  4. Katzmarzyk PT, Perusse L, Rice T, et al. Familial resemblance for coronary heart disease risk: the HERITAGE Family Study. Ethn Dis. Spring-Summer 2000;10(2):138-147.
  5. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). Jan 2014;22(1):5-13.
  6. Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. Jun 2008;18(6):648-651.
  7. Obesity as a Disease. 2013; http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page. Accessed January 5, 2015.
  8. TOS Applauds AMA for Recognizing Obesity as a Disease. 2013; http://www.obesity.org/news-center/tos-applauds-ama-for-recognizing-obesity-as-a-disease.htm. Accessed January 5, 2015, 2015.
  9. Vincent HK, Vincent KR, Lamb KM. Obesity and mobility disability in the older adult. Obes Rev. Aug 2010;11(8):568-579.
  10. What is Obesity. 2014; http://www.obesity.org/resources-for/what-is-obesity.htm. Accessed January 7, 2015.
  11. Hartz AJ, Fischer ME, Bril G, et al. The association of obesity with joint pain and osteoarthritis in the HANES data. Journal of chronic diseases. 1986;39(4):311-319.
  12. Liu PY, Ilich JZ, Brummel-Smith K, Ghosh S. New insight into fat, muscle and bone relationship in women: determining the threshold at which body fat assumes negative relationship with bone mineral density. International journal of preventive medicine. Nov 2014;5(11):1452-1463.