Is obesity a disability under the ADA?
In our post of April 25th we discussed a recent court decision that said that it might very well be. We noted in our blog on April 28th that “[t]he issue of obesity and employment discrimination seems to sit on a fault line of sorts, eliciting strong views about the meaning of “disability,” “disease,” and “personal responsibilty.”
The following is an informative debate which has taken place among a number of our readers. Some feel that “if you do not want to be obese, it is your own responsibility to do something about it.” Others feel that cultural/social influences should temper the “personal responsibility” argument.
And still others, like one reader, take a position suggested by the example he provided: “If a young man becomes quadriplegic because he was driving dangerously – or blind because he went bungee jumping and had a retinal detachment – or develops crippling long-term brain injury through repeated concussions while playing sport – I think most of us would still be willing to acknowledge those conditions as ‘disability’ without feeling that we were encouraging risky behaviour, so why set a different standard for obesity?”
BTW — good op-ed piece in the New York Times on “optimism on obesity” – “there is reason to be optimistic: We are moving faster against obesity than we did on the successful effort against tobacco.”
Monica Stevens, owner of an intercultural services corporation in the Detroit area:
“You may be predisposed to something, like obesity, but if you do not want to be obese, it is your own responsibility to do something about it and be careful with what and how much you eat.
Food in the United States is very, very fattening, we all know that. However, some people are very heavy while others look extremely fit. Those who are obese usually eat much more. Some people eat two or three hamburgers at a time, always order the largest soft drink possible (and get additional refills), eat omeletets with five eggs, eat an entire bag of potato chips, and then they wonder why they put on weight!
I do not consider it fair to include obesity in the same category as someone who is paralyzed, autistic, has down syndrome, etc. Those are real tragedies because people born with these disabilities had no say in the matter, but obesity is in many cases self-induced.”
Daniel Lark, NYS Office of Information Technology Services in Albany, NY:
“The problem is the accepted standard measurement for obesity, Body Mass Index ( BMI) . It is strictly based on your weigh to your height. I was 6′ 1″ 230 in High School and could run an under 5.0 40 yard and played other scholastic varsity sports. My BMI would have been 30.3 which means I was considered obese as would 90% of lineman in the NFL. Should they qualify for disability?
Many put on more weight after their careers are over. They have the same appetite but are no longer burning those calories 6 days a week. So it is not just the consumption. The sedentary lifestyle pays a factor. When I see the 500 or 600 pound person on TV who has not been able to walk in a year, I wonder why isn’t the family member that continued to bring them food when they could no longer move, charged with assault? They endangered their life, right?”
Jane Sleeth, ergonomic & accessibility consultant in Toronto:
“Great discussion on both sides of the argument. Air Canada had to pursue this similar discussion a few years ago in the court of law. The decision was that obesity is a disability in some cases but not all. It is interesting to note that in countries where good nutrition and regular fitness is in place there is no obesity epidemic. I also like the description from Monica where the inclusion of some issues as a disability truly does a disservice to those PwD. I look forward to reading more of this discussion.”
Geoffrey Brent, Senior Researcher at Australian Bureau of Statistics, Melbourne, Australia:
“The medical aspects of obesity are a lot more complicated than many are willing to acknowledge. As Daniel noted, BMI is a very unreliable metric. If I recall, there’s also a fair bit of research indicating that “overweight” people who are getting regular exercise will be healthier than “ideal weight” people who don’t.
But leaving that aside … there’s a tendency to treat obesity as a moral weakness caused solely by lack of self-control, and that ignores the role of social influences.
I live in an area that’s pedestrian-friendly and has low street crime. I can walk to and from the train station (that’s 30 minutes light exercise every day) and I can walk my dog at midnight if I choose. I have fresh-food markets near both work and home, and I can afford to buy healthy food from them; I also have a 40-hour week and a short commute, so when I get home I still have energy to cook that food. (I used to commute 5 hours a day, and let me tell you, I didn’t do a whole lot of cooking back then!). And although I work at a desk, which is a risk factor, my employer encourages us to take frequent breaks to stretch and walk around.
I like my food, and I’m not great at exercising. But all those factors above make it MUCH easier for me to look after my health. It would be hypocritical for me to judge somebody who buys McD’s because they’re exhausted after a sixty-hour week and don’t have the energy or money for a healthier option.”
Tom Keeley, Professor in Fukuoka, Japan:
“Geoffrey, your observation is quite valid … it is true that the poor or those working many hours just to get by have a much harder time to find healthy food at an affordable price. That is a social/economic issue that needs to be addressed. Nevertheless, it seems to me that calling obesity a disability lessons the personal responsibility for the condition.
As you point out it is a complex subject. However, over a long period of time if one does not consume more calories than one expends each day it is impossible to become obese. Particularly obese people who do not suffer from the socioeconomic issues you pointed out only have themselves to blame for not taking responsibility for their health.
If you are obese and have the economic and social means to do so, I would suggest becoming a vegetarian for a few years, practicing yoga, and learning about fasting (detox). Once your bowels are cleared then you will get more nutrition and be much healthier (and hopefully happier).”
Daniel Lark: “Tim I am not sure what statistics you have to support statements that the poor are more prone to be obese because they have less access to quality food. But in the U.S. , the CDC and other foundations paint a different picture:
• Among men, obesity prevalence is generally similar at all income levels, however, among non-Hispanic black and Mexican-American men those with higher income are more likely to be obese than those with low income.
• Higher income women are less likely to be obese than low income women, but most obese women are not low income.
• There is no significant trend between obesity and education among men. Among women, however, there is a trend, those with college degrees are less likely to be obese compared with less educated women.”
So there are people that can afford to eat healthier and with those options chose not to, whether it is poor diet or lack of exercise.”
Tom Keeley: “Daniel, I only made the statement about the poor to deal with Geoffrey’s point that it is difficult for them to eat in a healthy manner and get exercise – thus a rationalization for not taking responsibility. There really needs to be greater effort around the world to reduce overconsumption … it has a direct effect on the environment (particularly in the case of meat consumption).”
“Disability” and “responsibility” are orthogonal concepts. If a young man becomes quadriplegic because he was driving dangerously – or blind because he went bungee jumping and had a retinal detachment – or develops crippling long-term brain injury through repeated concussions while playing sport – I think most of us would still be willing to acknowledge those conditions as “disability” without feeling that we were encouraging risky behaviour, so why set a different standard for obesity?”
The idea that people get fat because they consume more than they expend seems straightforward at first glance… but both sides of the balance are heavily influenced by factors other than willpower and motivation. The brain works hard to maintain a “set point” weight by moderating things like appetite and resting metabolism, and without medical interventions like lap-banding it’s very hard to make a lasting change to that set point.
There is strong evidence that dieting for weight loss simply *does not work* in the long run; a UCLA study (2007ish, Mann et al) found that most people who try it end up heavier than when they started. Only a small minority managed to achieve lasting weight reduction. I agree with Tim on the dangers of overconsumption, but fat-shaming isn’t the answer. Indeed, it’s counter-productive if you want people to lose weight; a recent study by Tomiyama et al found that telling kids they’re too fat leads to *increased* weight later in life.
Further, although we tend to assume that weight loss is good for the health, the truth is much less straightforward. People with a BMI of 30 (“obese”) have no increase in mortality. Some interesting reading: http://www.redorbit.com/news/health/1113132254/obesity-linked-to-fat-shaming-042914/”
“Geoffrey, I appreciate all the new info in your comment. Nevertheless it is quite straightforward: if you do not consume more than you expend you will not be fat over the long run. I say the long run because it takes a while to create a new “set point.” Lap-banding is an escape from personal responsibility … the same as all the products offered by the pharmaceutical industry for weight loss.
My body type is such that I can gain weight very quickly … the positive side is that when I work out I get fast results … the challenging side is to not stray from balancing consumption of calories with expenditure. I found that periodic detox (fasting, colonics, yoga, and meditation) keeps me fit and healthy. I have been doing this for the last 15 years and if anything my body has gotten younger (I am 58).”
Angela Pankhurst, an executive and non-executive director in the resources industry in Perth, Australia:
“I used to believe that being overweight was lack of personal responsibility (except in the case of genetic disorders), including my own. But there is a lot of recent research that suggests otherwise, or at least that the deck is stacked against most people.
How our bodies process food is a combination of our genetics, the bacteria in our guts (which varies between people and over time) and the food and drink we consume. It is far more complicated than energy consumed v energy expended, and has a lot to do with the things different sugars do in our bodies (they can interfere with messages from the stomach to the brain) and the importance of fibre in processing fats and sugars.
Having lost 23kg, I now eat more than I ever used to and don’t add to my current 51kg, I have effectively increased by metabolism. But to do that I don’t eat processed food or refined sugars, which would be difficult for many people, due to (perceptions of) availability, cost and time.
The deck is stacked against most people not only because of the difficulty in eating in a genuinely balanced way, but also because of the lack of education about even the basics of healthy eating and a loss of cooking skills. You can prepare quick, inexpensive and nutritious meals, if you know how to. From a medical point of view obesity is a disease and governments should do the same, so that they expend more resources on tackling the problem through research, education and, if necessary, regulation of the food industry.
Wouldn’t it be wonderful if recognizing obesity as a disability prompted employers to become a part of the solution, through programs to educate employees and other measures to assist them in improving health choices?”
“Angela, your excellent comment shows that you took responsibility … I agree that more education is needed but I do not think calling obesity a disability is helpful. The reason is that people will then tend to have the mindset of a victim and not seek to find a solution the problem they have created.”
We look forward to a continued spirited debate, which we think these comments should encourage!