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.