The Huerta/Tilton Diet

November 19th, 2013 by Martin Rottler

Pilots and controllers: thinking of having that extra helping of gravy this Thanksgiving? You might want to think twice.

Earlier this week, the Federal Air Surgeon Dr. Fred Tilton notified the Aviation Medical Examiner community of a soon-t0-be calculation as part a standard medical examination moving forward. This calculation? A pilot’s Body Mass Index, which is a commonly used measure of obesity. For those pilots (and controllers, soon) whose BMI falls above 40 and a neck circumference of greater than 17 inches, the FAA will require evaluation by a sleep specialist for “Obstructive Sleep Apnea.” A medical certificate will not be issued until the “almost universal” diagnosis of OSA for those with these conditions is treated. It is intended that the minimum BMI for consideration of these extra steps toward medical certification will be reduced over time.

Maintaining a healthy body is of utmost importance to pilots and controllers. I am not a small guy by any definition of the term, and this new guidance from the FAA had me running to the National Institutes of Health calculator for BMI. Under the current guidelines, I fall outside of the 40BMI/17″ range of the calculation, but not by much. This doesn’t effect me…yet. By the FAA’s own admission, these requirements will effect 100,000+ pilots eventually. Are you ready to head to the gym with me yet?

For doctors and the FAA, a person’s BMI represents an easy calculation that can be done in seconds during an exam. Unfortunately, the concept and reasoning behind the BMI’s usage has been under increasing scrutiny in the past several years from the medical and academic communities.  Can one boil down a person’s level of activity, obesity, and potential suffering from OSA to a simple math formula?  Much as we all love and are attune to instant gratification and information that might come from this math, obesity and personal health are much more complicated. While short of a BMI of 40, I consider myself to be a fairly active individual who could still stand to shed weight. I’m not running marathons (bad knees), but do walk 30-60 minutes a day, make it a point to take the stairs, and practice yoga several times a week. I’ve also yet to display any of the symptoms of OSA. Does that mean I’m not at risk for it at some point in the future? Absolutely not. OSA can happen to anyone, but does occur more often in obese individuals. The above-linked articles also mention how the BMI can shield obesity in those that have lost a lot of muscle and show that more muscular people are obese when they might not necessarily be that way.

Having someone from the FAA paint with a broad regulatory brush when it comes to medical certification and aviation health issues is unhealthy for commercial and general aviation industry. Sleep and rest are significant issues in the aviation industry as a whole and, come January, we will see fundamental changes to the regulations pertaining to rest at airlines. The 2009 incident which sparked the change to BMI calculation rules came from an incident in Part 121 operations, and, as AOPA itself notes, has not been an issue in General Aviation accidents. Are we risking a significantly inconveniencing change that will lead to extra cost to aviation as a whole for something that could be fixed very soon in Part 117?

As it stands now, for most pilots, we are placing this calculation and assumption of OSA in the hands of a doctor that we may see every 6, 12, 24, 36 or 60 calendar months, depending on level of certification and age. Instead of a blanket requirement, the AME should serve the role of counselor, especially in light of the fact that any issues with OSA or obesity are already discussed with our personal care physicians. This change represents an overly restrictive cost and time burden that does not provide near the safety benefit it claims.

In the meantime, I’ll be at the top of my yoga mat prepping for an extra downward dog or two over the next few months.

 

Martin Rottler

Martin Rottler is a lecturer at the Ohio State University Center for Aviation Studies, in Columbus, Ohio and a Partner at First Segment. He is a commercial pilot and certificated flight instructor and has worked in general aviation, the airline industry, and international aviation. An avowed "avgeek" from a very early age, Martin maintains academic and personal interests in aviation education, outreach, flight training, and international aviation. He can be found via Twitter at @martinrottler. The views presented on this blog are Martin's and do not represent those of The Ohio State University, the OSU Center for Aviation Studies, or any other organization.

The opinions expressed by the bloggers do not reflect AOPA’s position on any topic.

  • A Richie

    If you read Dr Tilton’s words carefully, he says that the BMI threshold will be lowered such that ALL cases of pilot OSA will be identified and treated. He then goes on to say that 30% of individuals with BMI less than 30 likely have OSA.

    SO, the only conclusion here is that the sleep tests will eventually be required for all aviators, because even those that are “healthy” with BMI<30 have a huge risk of OSA.

    If this happens, the third-class medical just went from $120 to $3500; and this may be the recurring cost every year for special issuance if they still think you are too heavy.
    I predict that easily 40% of the pilot population will quit flying over this given the already tenuous existence of GA. That's one way to get safer skies; just ground the pilots!

  • Robert Latham

    This is just one more case of an overreaching government acting in the name of the greater good while slowly choking free markets and individual freedoms to death. Any industry or activity that affords individuals “too much” freedom is under assault. GA fits that description.

    This is also why ObamaCare is the camel getting it’s nose under the tent and a bad thing for individual choice. Once the government controls healthcare, then almost any activity can be said to impact an individual’s health, and therefore they must control it or ban it altogether in the name of saving money.

    The BMI measure is a complete joke. The only people, for the most part, that are “healthy” are vegans that have never engaged in any kind of muscle building activity – very skinny people. I’ve read a number of studies that conclude if you aren’t the “ideal” weight, it’s healthier to be a little over than a little under.

  • Woody Minar

    We may see a huge migration of pilots not renewing their medicals and flying as Sport pilots who can have every disease or problem known to mankind and still fly because of “self certification”. We are seeing it now.

  • http://www.drsmokeairshows.com Ron Saglimbene

    This is a perfect example of what happens when the government is given too much authority. Sleep apnea is NOT a safety of flight issue. Never has been. It is just next in the long list of using governmental power to address non related behavior. The foot in the door was relating DWI history to obtaining or maintaining an aviation medical. As egregious as that behavior is, there was NEVER any data to support any connection, nor was drinking and flying proven to be a significant issue among pilots. Now it’s obesity. Can smoking or other socially “unacceptable” behavior be far behind?

  • http://www.biopatent.com Gary Baker

    Another example of government creep. What subpopulation is too small to attack with a rule that “fits all”?

  • Don

    The AOPA-EAA both note that seven years of data say that LS pilots flying with every ailment known to man don’t crash anymore than privates. So this comes just as the data shows the 3rd class medical to be comepletely pointless.

  • Mike

    In my “fitness for duty eval” the examiner pointed out that the powers to be very carefully navigated around coffee as addictive. The new dsm criteria is out and coffee is listed. Well guess what’s coming next boys and girls!! How do you stop these clowns??

  • cowboybob

    you are seriously telling me what to eat based on nothing more than some O-tron’s decree? get out. what a ridiculous opening line.

    Intense exercise is good for only one thing…training for a particular strenuous activity such as a sport or military duty. The vast majority of folks would be well served to eat a nutritious diet, but the occasional splurge is not outlawed by any means. You just have to adjust on a regular basis back to your normal diet and you’ll be fine if it worked for you before. Light exercise such as a brisk walk is all anyone really needs to maintain a healthy heart and physique. None of this extreme exercise being pushed by the medical establishment and gym-nation has any connection to longevity or being healthy in a medical sense. It does of course make a specific activity easier and more enjoyable if one has trained sufficiently for the activity by being in the proper physiological condition. But past that, there is no relationship to longer healthier life.

    All that said, sitting on your backside day in and day out while shoveling twice the number of calories per day into your body that you need to function is not a great idea. A person’s weight should be a comfortable balance between easy to maintain and what is right for their daily activity. But to parlay any or all of this into BMI = Sleep Apnea is utter horse manure.

    Now, if a person really wants to lose a few pounds for whatever reason, there are a lot great diets out there that work. You just need a little “intestinal” fortitude. Killing yourself at the gym is not a weight loss program. Pure Fiction.

    Each pilot should be evaluated individually. If it makes sense to have an individual do extra testing for a reported condition fine. But to say because you are this or that based on some premise and therefore you have to do this and that…ludicrous. They’ll soon have everybody with a “BMI” > X on some toxic medication…and call that better?

  • Sarah A

    Others have said but I will as well. The Sport Pilot option is the only way to get around this sort of BS. The Sprot Pilot experience has proven quite well that the 3rd class is not of any benifit as far as safety of flight and the limitation of day VFR with very light aircraft is purly arbitrary. I got a new drivers license yesterday and the medical conditions that had to be reported were more then enough to keep persons out of the skies (and off the road) that would not be safe.

  • Steve

    I agree with most that this is too much. Many like me in their 50′s and 60′s pack extra pounds, and most pilots are smart enough to realize they should lose it. As I get closer to retirement and consider a couple extra ratings to keep me involved (CFI, II), I wonder how much more of the FAA I want in my life. I like flying IFR in the system, but the burdens imposed on pilots / owners are truly opressive. To fly with advanced ratings and own / maintain a complex airplane these days takes an incredible committment. And we wonder why young people don’t flock to GA?

  • Martin Rottler

    Important aspect of the post: This is not a political issue in the sense of Democrat vs. Republican. Dr. Tilton has been the FAA’s Federal Air Surgeon since 2006. Blaming President Obama does not help further our case, and in fact hinders it greatly.

    • ABRUNS

      Thank You Sir. That needs to be said and understood

      • http://www.drsmokeairshows.com Ron Saglimbene

        To intimate that Tilton’s position on obesity isn’t politically motivated is naive. The man wants to keep his job. Obesity is the flavor of the week in Washington, what with Michlle Obama’s “focus” on nutrition and childhood obesity. The association between them is undeniable- and obvious.

  • Dave R

    Life, Liberty, and the pursuit of Happiness, guess it doesn’t mean anything anymore.

  • Jason

    I agree that the government’s actions and resulting decisions not longer seem in touch with reality. However, the sky belongs to us. And I for one will continue to fight the good fight throwing as much positive energy toward our future as I can.

  • Mike Mahoney

    Many responders are diving for cover under the LSA blanket. What is keeping the administrator who pops out rules like Keebler and cookies from expanding safety’s reach to LSA pilots?
    Camels and noses, you know.

  • MC

    What a difference six years makes: http://www.avweb.com/news/aeromed/191923-1.html?redirected=1

    After working with them for 25 years. The majority of doctors are arrogant, I’m so GD smart I hurt, a**h***s. NOT ALL!!! Also reminds me of, “What do you call a doctor who graduates last in his class?” … “Doctor.” The most arrogant ones couldn’t pour piss out of a boot with the instructions written on the heel!

    And last but not least! You cannot judge a person’s sanity by what they do for a living! Presidents, Doctors, Lawyers, Judges, Cops, Nurses can all be CRAZY!

  • http://www.yelp.com/biz/orlando-sushi-catering-orlando www.Yelp.com

    With the Hibachii chef creating fire, volcanoes out of onions
    aand sushi in the act of being made and also consumed. Agar agar,when added, offers a lunchtime buffet that costs $9.
    The reason I think they loolk better than they taste. 50, or their famous soft
    shell cravs catering tempura and the usual accompaniments with a delicious seafood buffet.
    Jappanese wholesalers, however, recently there are so many places to eat.