Obesity – Its Killing Us

I keep a copy of the 1999 Social Security statute in my library because it is the last year that the Social Security Administration listed disability as a disabling condition in and of itself. Over the years, the Social Security Administration has done away with the Listings for obesity because of the number of Americans battling this condition.

Sixty-seven percent of American adults are overweight (BMI of 25 or higher). Thirty percent are obese. Five percent of American adults are morbidly obese—a 400 percent increase since 1986.[1]  The obesity epidemic in America is unquestionably tied to hidden sugars, saturated and hydrogenated fats in processed foods, high caloric intake and genetics.

Prior to 1999 a man or woman who was morbidly obese could rely on obesity tables set forth by the government to prove that they were disabled based on their height and weight. For example, a man who was six feet tall and weighed 336 pounds or a woman who was five foot five inches tall and weighed 266 pounds would be automatically deemed disabled provided they also had issues with one of the following:  musculoskeletal pain and limitation; diastolic blood pressure over 100 mm; history of congestive heart failure; venous insufficiency or respiratory distress.

As the obesity epidemic became greater and greater, the government realized it had a problem with the cost of obesity-related disability claims, and decided to make the criteria for disability benefits somewhat more stringent. However, the reality is that obesity remains the determinative factor in many claims. Accordingly, in 2002 the Social Security Administration indicated that administrative law judges must take the additional and cumulative effects of obesity into account when assessing orthopedic claims.[2] The interaction between obesity and the inability to walk effectively is also taken into account. Obviously, there is also a link between obesity and sleep apnea, high blood pressure, diabetes, kidney and heart disease. Often, the obese individual is also suffering from what is known as metabolic syndrome, i.e., a combination of these symptoms that adversely impact one another and lead to even greater disability.

“Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.

The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.

In this article, “heart disease” refers to coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque builds up inside the coronary (heart) arteries.

Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead to chest pain, a heart attack, heart damage, or even death.

Metabolic Risk Factors

The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

• A large waistline. This also is called abdominal obesity or “having an apple shape.” Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
• A high triglyceride level (or you’re on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
• A low HDL cholesterol level (or you’re on medicine to treat low HDL cholesterol). HDL sometimes is called “good” cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.
• High blood pressure (or you’re on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
• High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.Your risk for heart disease, diabetes, and stroke increases with the number of metabolic risk factors you have. The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical activity.OutlookDoctors, judges and members of the public at large are not immune from harboring widespread prejudice toward the morbidly obese. However, based on the increasing numbers of obese people throughout the developed world, it is quite clear that obesity is not a moral failing. Americans must individually and collectively tackle the problem of obesity in our society. The health and human costs are staggering. However, we must also have compassion for individuals whose obesity has led to the development of other disabling health conditions. Thankfully, the Social Security Administration still acknowledges the causal connection between morbid obesity and disability.
• Metabolic syndrome is becoming more common due to a rise in obesity rates among adults. In the future, metabolic syndrome may overtake smoking as the leading risk factor for heart disease.”[3]
• Insulin resistance also may increase your risk for metabolic syndrome. Insulin resistance is a condition in which the body can’t use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it’s used for energy. Insulin resistance can lead to high blood sugar levels, and it’s closely linked to overweight and obesity. Genetics (ethnicity and family history) and older age are other factors that may play a role in causing metabolic syndrome.
• Overview

[1] www.lahey.org/WorkArea/linkit.aspx?LinkIdentifier=ID&ItemID=3841

[2] 20 C.F.R. 404.1500s, Appendix 1, Listing 1.00Q

[3] https://www.nhlbi.nih.gov/health/health-topics/topics/ms