June 18, 2009 -- Fat can be disabling. A person 180 pounds over a healthy weight is susceptible to arthritis, has increased blood pressure, a weakened heart and could soon need a walker just to get around.
Under the Americans with Disabilities Act, such a person could legally be labeled as disabled.
But should obesity be considered a disability? On Tuesday the American Medical Association voted a resounding no at its annual meeting.
But in a country where nearly one in three people is obese but where laws do not always cover size discrimination, and many health insurance policies do not cover obesity treatments until a patient develops a more serious health condition -- not all who deal with obesity agree on the matter.
"We believe that we passed this for the patient's benefit," said Dr. Domenic Federico, an AMA delegate from Michigan. "We do not want to have this limit the ability to have doctors talk about a very serious condition."
Federico explained that doctors are worried they could be legally reprimanded for discussing obesity with a patient who doesn't want to hear it.
"If obesity is designated as a disability, physicians could be sued or reprimanded for discrimination under the Americans with Disability Act if a patient takes offense at the physician discussing obesity," the resolution states. "Therefore be it resolved that our American Medical Association not support the effort to make obesity a disability."
Federico said he hasn't heard of any similar lawsuits between doctors and patients with any disability or of an activist group specifically lobbying for obesity to be designated a disability. But he pointed out that bringing up weight in a doctor's office can be a difficult conversation.
"I have people who told me that they choose to go to an obese physician because they know they will never talk to them about their weight," said Pam Davis a registered nurse in Nashville, Tenn., and a bariatric surgery patient.
Doctors Struggle to Address Weight in Office Visits
Davis, 44, said she has struggled with weight issues her entire life, even after she lost 160 pounds following bariatric surgery eight years ago. At her largest -- 330 pounds -- Davis said she knew she had a problem. But it was the talk at the doctor's office when she really felt a burning stigma.
"I know the first time I left my physician's office carrying that chart that said 'morbidly obese' and seeing it in black and white like that -- it almost feels like it had been tattooed on my forehead, a scarlet letter," Davis said.
"It's definitely difficult talking to people about obesity," said Dr. Keith Ayoob, a nutrition and obesity specialist at Albert Einstein College of Medicine in New York. "It takes somebody with decent beside manner to approach the topic without placing blame ... but it can cause immobility. It's also a gateway condition to so many other problems."
Davis said that for all practical purposes, her weight was disabling. She could not go up stairs easily and she couldn't run and catch her dog in her yard. She was tired all the time and couldn't get down on the floor to play with her young children.
"But I think that for some it would take it as a step forward in that scarlet letter, if it said, 'Now at that weight we consider you disabled,'" she said.
As a nurse, Davis said she's well aware that many insurance companies do not offer general obesity counseling unless there's a co-morbid condition or a patient is approved for surgery. But she said she'd rather see that issue handled with anti-discrimination laws than under the Americans with Disabilities Act.
"I think it makes more sense where we don't discriminate against someone for their sex, for their ethnic basis, and for their size," Davis said. "If we were to say, 'Well, if somebody's of a certain size then we are considering that as part of the disability act,' you set up a resentful atmosphere."
Yet while doctors and obese patients are concerned about the label "disabled," lawyers who specialize in obesity suits said many people are missing the point.
The Term 'Disabled' Used Broadly Under the Law
"There isn't one paramount definition of disability from a legal standpoint," said Walter Lindstrom of the Obesity Law and Advocacy Center -- a private firm in the San Diego area that specializes in "fighting for the rights of people of size to receive equal access to health care and be free of discrimination in life."
Lindstrom explained that a disability label from a social security benefits point of view would require different criteria than a disability label from an insurance point of view, or disability as classified under the Americans With Disabilities Act.
Each "disability" label also wins a person different rights. According to Lindstrom, the Americans With Disabilities Act covers civil rights protections such as employer discrimination more than compensation benefits.
"You're talking about disability with a small 'd' and disability with a capital 'D,'" Lindstrom said.
"The problem that the AMA resolution has in all honesty is that they fundamentally don't understand disability law: Very few medical conditions are a disability by definition," he said.
Getting a disabled label under the Americans With Disabilities Act requires a person to prove their condition has a physical impairment that also puts substantial limitations on major life activities, Lindstrom said.
However Lindstrom said no two obese people are alike: One obese person might have health issues serious enough to be labeled disabled, while another obese person might not qualify.
"You could have that same scenario with people who suffer from certain joint conditions, brain conditions or diabetes," Lindstrom explained. "It's not like there's a laundry list of diseases to fill in the disability boxes -- the AMA knows that and in my mind this is a little bit of grandstanding."
Lindstrom also thought the move might be "self-protective."
But the Obesity Action Coalition had a less intense reaction.
"As a coalition of those affected, the OAC encourages discussion around this topic of obesity and disability, as it is not clearly defined and is not simple. The determination of obesity should be based on scientific and medical factual data and not fear of litigation," OAC executive director Joseph Nadglowski wrote in statement responding to the AMA vote.
"Every individual who is affected by obesity is not disabled, but this does not mean that obesity does not and cannot contribute to disability," the statement said.