By Dr. Chuck Crinnian, MD
While boarding an airline flight, the gentleman in the seat in front of me required a seat belt extension. The flight attendant retrieved one from the galley and gave it to the gentleman. His face turned red, he yelled out to the flight attendant, "I'm not a fatso, this belt says fatso". Perplexed, the attendant looked at the label on the belt and saw "FAA-TSO". She explained to the passenger that wording stands for Federal Aviation Administration-Technical Service Order. OH, says the passenger, he sat down embarrassed for his display.
This leads me to discuss the not so new issue on body mass index (BMI) and the recently suspended directive from the FAA's Aeromedical Branch to monitor pilots for obesity. This attempt for the FAA to become involved in preventative medicine is unique. Generally, disqualifying medical conditions are diseases and disorders that have occurred. Obesity is a risk for future disorders. Without debating the pros and cons of a medical "risk" being disqualifying, let's look at the facts-you decide.
Obesity is defined as a weight greater than 30% of the ideal body weight. A simple calculation for this is a Body Mass Index (BMI). Rather than give you a formula, just go to https://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm and calculate yours. A shocking statistic is that 32.9% of the adult male population is obese, another 25% are overweight. Next time you are at the airport restaurant, look around. I bet your observations will confirm this finding.
So why do I write about this issue on a pilots publications? For starters, obesity is directly linked to the following: heart disease, stroke, hypertension, diabetes, depression, cancers, and liver disease. You should note, all these disorders make up the mandatory disqualifying medical conditions that your local AME cannot issue a medical certificate. All these conditions will require a special issuance from the FAA. There are no guarantees that you will get the special issuance. Do I have your attention now?
Obesity has its roots in your genetic makeup. But, it can be modified. The average adult male has a basal metabolic rate of 1200-1500 calories a day. Normal activity will burn an additional 600-1000 cal/day. Thus, consuming more than 2500 cal/day will result in storage of the excess potential energy (calories are a measurement of potential energy) as fat. One pound of fat is equivalent to 3500 cal. One reason we put the pounds on as we get older is the resting metabolic rate decreases with age, as does activity. Also we lose muscle. Lean muscle burns more energy. As we age, we lose lean muscle. The cards are stacked against us. Additionally, hormonal changes with age alter our metabolic rate, think 'Low T".
For those of you who use exercise machines such as treadmills, exercise bikes, etc., you will note that 30 min of moderate work, will burn a few hundred calories. So, to eliminate that supersized burger and fries will take a good chunk of time mindlessly sweating on that machine. An 800 cal. Big Mack will propel you for about 100 min on a stationary bicycle. Are you starting to see the issue?
Pilots: you need to change your behaviors. Back during CFI training, we were told that "learning is a change in behavior". So, learn about that extra baggage you are carrying. Reduce your total calorie intake and don't eat the fat stuff. Exercise more. This is a long term commitment. Don't give up. Practice your weight management skills just like you practice your flight skills. If you continue to fly (and live) over gross weight, you will crash.