Obesity is an impairment that can contribute to disability in a variety of ways depending on the individual and the specific impairments. While obesity alone may be a severe impairment, it also often makes other conditions worse. Examples of this include increased pain and mobility issues with degenerative joint disease or degenerative disc disease. Obesity may make it more difficult to control blood sugar in those with Type II diabetes. Obesity can impact mental impairments. The increased body size with obesity can also make breathing difficulties worse. The Social Security Administration (“SSA”) must consider a claimant’s obesity if it causes or contributes to an inability to work. In 2019, SSA issued Social Security Ruling 19-2p (“Ruling) to clarify how obesity should be evaluated.
How does SSA define obesity?
Obesity is a complex disorder that results from a number of factors including environment, genetics, and behavior. Health care providers will generally diagnose obesity based on your medical history, physical exams, and your body mass index (“BMI”). BMI is a calculation based on your weight and height. In the medical community, a BMI of 30.0 or higher is considered obese. However, as discussed further below, SSA does not just look at a specific weight or BMI to determine if your obesity contributes to your disability.
What kinds of impairments are associated with obesity?
Impairments that are associated with obesity include, but are not limited to:
- Endocrine disorders, such as Type II diabetes mellitus
- Disease of the heart and blood vessels, such as high blood pressure or heart attacks
- Respiratory impairments, such as sleep apnea or asthma
- Osteoarthritis
- Mental impairments, such as depression or anxiety
- Cancers of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast, or liver.
How do I show obesity is a medically determinable impairment?
SSA must determine if obesity is a medically determinable impairment. This means the record must contain objective evidence from an acceptable medical source about your height and weight. It is not enough to have a diagnosis of obesity, the record must contain findings from an acceptable medical source such as height and weight, measured waist size, and BMI measurements over time. It is important that your medical provider consistently tracks these kinds of findings as SSA will look at these measurements over time to determine if obesity is a medically determinable impairment. SSA does not rely on a specific BMI, but looks at the entire case record to determine if obesity is a medically determinable impairment.
How do I show obesity is a severe?
If SSA determines that obesity is a medically determinable impairment, then they evaluate the severity of this impairment. It will be important that your medical records reflect any symptoms associated with your obesity such as fatigue or pain that can affect your ability to function. It is important that the record demonstrate that your obesity, either by itself or in combination with other impairments, significantly limits your ability to perform basic work activities. Examples of ways obesity may impact functioning include limitations in sitting, standing, walking, and lifting, climbing, balancing, stooping, kneeling, or crouching. It increases stress on weight bearing joints. It can also affect a person’s ability to use their hands and fingers in manipulating objects or decrease tolerance to heat and humidity.
Again, no specific weight or BMI establishes that obesity is “severe”. SSA will do an individualized evaluation of the effect of obesity on a person’s functioning. Therefore, consistent and supportable evidence of your weight, BMI, and any related symptoms over time will be key in SSA’s evaluation of your claim.
What can I do right now?
- Make sure your provider is consistently taking note of your weight, BMI, and/or waist size. While you will be asked some of this information in the documents you fill out for SSA, they will evaluate obesity based on the findings of a medical provider, not from self-reported measurements.
- Communicate with your provider as to any functional limitations you feel your obesity causes or any impairments it exacerbates. As noted above, this includes issues such as pain and fatigue. It is important that any impairment due to obesity is noted in your medical records.
- Please be compliant with medication and treatment. If you are not willing to take medications or otherwise comply with your provider’s recommended treatment for your obesity, please let us know why. Medications and surgeries that are sometimes recommended for weight loss may not work for you. We want to make sure SSA understands your specific situation.
Remember, obesity does not impact everyone in the same way. It is important for us to help SSA understand the specific way your obesity contributes to your impairments or your work-related limitations.