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-   -   BMI & OSA: New Hurdles To Jump Thru For Medical Certification (https://vansairforce.net/community/showthread.php?t=106736)

Brantel 11-18-2013 02:49 PM

BMI & OSA: New Hurdles To Jump Thru For Medical Certification
 
Since I fit the profile of the profiling that is about to start by the FAA's aeromedical group, check out this news:

http://www.avweb.com/avwebflash/news...s220978-1.html

Notice that the new policy has no limiter. Might as well have said that all pilots will be required to be tested and treated for OSA!

"Once we have appropriately dealt with every airman examinee
who has a BMI of 40 or greater, we will gradually expand the
testing pool by going to lower BMI measurements until we
have identified and assured treatment for every airman with
OSA."


To identify and assure treatment for every airman with OSA means that all pilots will eventually have to be evaluated. There are millions of people out there with normal BMI's that have OSA. Ask most any sleep doctor and they will tell you that OSA is a risk factor for obesity not the other way around.

Where do they get these people?

Starting soon at a AME near you, have a BMI higher than 40 (soon to be lowered per the policy letter)? Well guess what, you just earned a trip to the sleep doctor for a bunch of time consuming and expensive test!

Here is a BMI calculator for those that may be interested:

http://www.nhlbi.nih.gov/guidelines/...MI/bmicalc.htm

rockwoodrv9 11-18-2013 03:24 PM

Unbelievable. I am amazed everyday with more regulations and ways they think they can "fix" anything. Cradle to grave protecting me from myself.

DaleB 11-18-2013 03:33 PM

I'm even more amazed that medical professionals give ANY credibility to BMI.

Buggsy2 11-18-2013 03:41 PM

FYI, OSA = Obstructive Sleep Apnea.

If you have OSA it can be serious, and I've heard stories of people who had it, got it treated, and experienced an astonishing new vitality from the better sleep they were enjoying.

However the treatment is an obnoxious breathing mask thing with attendant gizmotronic box which provides a slightly elevated pressure to your mouth and nose, preventing the apnea and thus the constant stop/start breathing which is so harmful. I went into a store that provides these gadgets and everyone was obese...seems a fundamentally better treatment would be a serious plan to lose weight.

N941WR 11-18-2013 03:54 PM

So it sounds like those that "all sleep apnea victims" will have to pay for their AME and a sleep specialist.

Then he wants to go after anyone with an extra 20 to 30 pounds on them. Hasn't he looked at the average age of pilots today? Almost everyone over 30 years old has an extra 20 to 30 pounds on them.

It sounds like they are not going to regulate us out of the air but do it via our medicals.

Once they find out all the pilots have dropped their 3rd class medicals and switched to LSA what are they going to do?

This it total BS!

Sounds to me like they aren't going to drop the 3rd class medical.

Brantel 11-18-2013 04:01 PM

Quote:

Originally Posted by Buggsy2 (Post 827248)
I went into a store that provides these gadgets and everyone was obese...seems a fundamentally better treatment would be a serious plan to lose weight.

Most sleep doctors will tell you that while this will help some, on average it won't cure OSA. Obviously everyone is different and there are always exceptions. Those with mild OSA this may help. Those with moderate to severe it will not on average.

Like most things there are tons of incorrect assumptions and just plain wrong information floating around.

My sleep Dr. that has almost 30 years treating sleep disorders and many other highly regarded professionals in the field claim that OSA is a major risk factor for developing obesity related issues and that most people that have it are born with it.

OSA is like heart disease, it does not care if you are obese or not. (OSA is also a huge risk factor for developing heart disease, seems like a trend here)

pmccoy 11-18-2013 04:04 PM

BMI Woes
 
My company requires blood work for our health insurance plan. You have to pass three out of four values to get the lowest rate (Blood Pressure, Blood Sugar, Cholesterol, BMI). I nailed them all, except BMI. I am way to high.

In the last year I have dropped 40 pounds and my BMI has dropped from 35 down to 30. That's still to high for my company insurance plan. If this FAA medical requirement goes through, it may be to high for them as well.

I am tired of other people telling me I am fat. I choose my lifestyle. It's my choice to loose the weight or not. Period.

Brantel 11-18-2013 04:08 PM

Quote:

Originally Posted by N941WR (Post 827260)
This it total BS!

You got that right!

I am not against people getting checked for OSA if they have a reason to believe they have it, I am against this type of rule making that profiles certain individuals without just cause and I am also against new rules that have no limits.

This is the first rule that targets pilots that are overweight. Where is this going to lead?

BJohnson 11-18-2013 04:28 PM

BMI of 40
 
According to the calculator, for someone 6ft 2in, that equates to a weight of 315lbs. Ideal weight for the same height is around 180 - 210. So this is more about 100 pounds overweight not 20 to 30 lbs. There are many other issues to be worried about at that weight. Something other than OSA will make the medical tough to keep. There already was a requirement to test for OSA if your neck size was greater than 18 inches.

I do not say this lightly. In 6 months I dopped 100 lbs this year through just controlling my consumption and working out . Talk about improved vitality! And the aircraft has gained 100 lbs of useful load without any mods. The human body is amazing on how it can correct itself if treated properly.

Neal@F14 11-18-2013 04:30 PM

Quote:

Originally Posted by Brantel (Post 827271)
This is the first rule that targets pilots that are overweight. Where is this going to lead?

Only skeletons will be allowed to fly?

Brantel 11-18-2013 04:42 PM

Quote:

Originally Posted by BJohnson (Post 827279)
According to the calculator, for someone 6ft 2in, that equates to a weight of 315lbs. Ideal weight for the same height is around 180 - 210. So this is more about 100 pounds overweight not 20 to 30 lbs. There are many other issues to be worried about at that weight. Something other than OSA will make the medical tough to keep. There already was a requirement to test for OSA if your neck size was greater than 18 inches.

I do not say this lightly. In 6 months I dopped 100 lbs this year through just controlling my consumption and working out . Talk about improved vitality! And the aircraft has gained 100 lbs of useful load without any mods. The human body is amazing on how it can correct itself if treated properly.

Yes, initially that is exactly right. What happens when they do what they say they are going to do in that memo and reduce the BMI to 35 or 30 or even less to meet their goal of finding all pilots with undiagnosed OSA?

While you should be very proud of your accomplishment at losing weight, the real challenge is keeping it off long term. I hope you can beat the statistical data that shows that on average those that are of a starting BMI of 30 or more typically fail to keep lost weight off long term. I sure hope you are the exception. I do not wish obesity on anyone. Great job!

Quote:

Originally Posted by BJohnson (Post 827279)
There already was a requirement to test for OSA if your neck size was greater than 18 inches.

I just searched the entire "2013 Guide For Aviation Medical Examiners" and found nothing that indicates this is true. Where did you learn this information?

There is a suggestion to be tested in the AIM for BMI's greater than 30 or neck sizes over 17" in men. This is not a requirement however to get issues a medical, only a suggestion.

Neal@F14 11-18-2013 04:54 PM

Quote:

Originally Posted by Brantel (Post 827285)
Yes, initially that is exactly right. What happens when they do what they say they are going to do in that memo and reduce the BMI to 35 or 30 or even less to meet their goal of finding all pilots with undiagnosed OSA?

An AME over on the PoA forums said he believes the next target after BMI 40 is BMI 32.

tadsargent 11-18-2013 05:00 PM

Crazy point, using the simple method of height and weight LAbron James is overweight, who's going to tell him that. A calculator that does not measure your waist at the belly button is useless. The military and the YMCA use a more complex formula that has a greater accuracy. I hope the latter is used.

Brantel 11-18-2013 05:01 PM

Quote:

Originally Posted by Neal@F14 (Post 827286)
An AME over on the PoA forums said he believes the next target after BMI 40 is BMI 32.

If that becomes the new limit, that means anything over 236 lbs for a 6' person will require a sleep study.

Brantel 11-18-2013 05:05 PM

Quote:

Originally Posted by tadsargent (Post 827287)
Crazy point, using the simple method of height and weight LAbron James is overweight, who's going to tell him that. A calculator that does not measure your waist at the belly button is useless. The military and the YMCA use a more complex formula that has a greater accuracy. I hope tha latter is used.

No such luck...

Straight from the FAA's 2013 Guide for Aviation Medical Examiners:

Formula: weight (lb) / [height (in)]2 x 703
Calculate BMI by dividing weight in pounds (lbs) by height in
inches (in) squared and multiplying by a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5'5" (65")
Calculation: [150 ? (65)2] x 703 = 24.96

rhill 11-18-2013 05:19 PM

I read it on a T shirt. "Were the FAA were not happy till your Unhappy!":eek:

Low Pass 11-18-2013 05:22 PM

Where are the incidents that would have been prevented by this measure?

I thought so.

WhiskeyMike 11-18-2013 05:25 PM

Beware...
 
BMI does not account for the age, gender or muscle mass of the individual. It is a simpleton’s “one size fits all” metric that has zero medical diagnostic value. To use BMI as a single criterion for mandated OSA screening is completely disconnected from fact-based medical science, which tells us that it is politically motivated. Others can opine on the FAA’s true agenda in this case, but we’re seeing an alarming increase in “non-science-based science” trotted out by government agencies as the basis for new rules and regulations that limit citizen’s freedoms and liberties. BS indeed!!

Brantel 11-18-2013 05:29 PM

Quote:

Originally Posted by WhiskeyMike (Post 827302)
BMI does not account for the age, gender or muscle mass of the individual. It is a simpleton?s ?one size fits all? metric that has zero medical diagnostic value. To use BMI as a single criterion for mandated OSA screening is completely disconnected from fact-based medical science, which tells us that it is politically motivated. Others can opine on the FAA?s true agenda in this case, but we?re seeing an alarming increase in ?non-science-based science? trotted out by government agencies as the basis for rules and regulations that limit citizen?s freedoms and liberties. BS indeed!!

Exactly!!!!!!!

BillL 11-18-2013 06:15 PM

I thought it said . .
 
"Once we have appropriately dealt with every airman examinee
who has a BMI of 40 or greater, we will gradually expand the
testing pool by going to lower BMI measurements until we
have identified and assured treatment for every airman."


Well, too bad all medical records are at the IRS now, it makes it harder to cheat. My former employer had a program to "gently influence" us to be more healthy to lower health care costs. When it began, I reported way overweight and high blood pressure. Over the next 10 years, each 6 months I reported improvements in weight, BP, and diet until it finally reached my real numbers. I always got glowing (form) letters saying how proud they were for my improvements.

az_gila 11-18-2013 06:36 PM

"Once we have appropriately dealt with every airman examinee
who has a BMI of 40 or greater, we will gradually expand the
testing pool by going to lower BMI measurements until we
have identified and assured treatment for every airman with
OSA."


The use of the words "testing pool" almost sounds like they want a large group of folks who get regular, standard medical exams to prove out a theory.

I sort of wonder who the "they" is that would want this experiment....

Mike S 11-18-2013 07:34 PM

Dont know if it will do any good or not, but I did send EAA and AOPA a note about this.

"The newly released FAA **** about checking BMI--------------this needs to be stopped immediately or sooner. This is a condemnation based solely on conjecture not fact. Profiling at its ugliest."

N941WR 11-18-2013 07:38 PM

AOPA is already on it.

Sam Buchanan 11-18-2013 08:41 PM

thread note
 
Doug, this thread was deleted by one of the mods as "not RV related".

I hate to undelete a thread but I believe this is a subject that effects hundreds of RV pilots and who knows how many non-RV pilots. This is a huge development in our medical certification.

Please override my override if you see fit. :)

Mike S 11-18-2013 10:48 PM

Interesting reading below. I wonder if a case could be made that the FAA is violating some federal law/regulation such as ADA, or EEOC or HIPAA etc??

http://www.diversityinc.com/diversit...ity-says-eeoc/

http://www.psmag.com/health/obesity-...th-care-60619/

http://www.hhs.gov/ocr/privacy/index.html

plehrke 11-19-2013 04:52 AM

Quote:

Originally Posted by Low Pass (Post 827301)
Where are the incidents that would have been prevented by this measure?

I thought so.

I have not heard or seen any accident reports indicating sleeping as a cause.

Quote:

Originally Posted by WhiskeyMike (Post 827302)
Others can opine on the FAA?s true agenda in this case, but we?re seeing an alarming increase in ?non-science-based science? trotted out by government agencies as the basis for new rules and regulations that limit citizen?s freedoms and liberties. BS indeed!!

Scary part is the precidence it could make. This is more then just a worry for people with high BMI. Eventually the FAA will target Anybody within ANY risk group and require you to prove you are not affected before the FAA allows issueance of a medical. Example: Family history of cardiac condictions my require you to prove, with a stress test, your heart is OK.

Brantel 11-19-2013 05:54 AM

Quote:

Originally Posted by Sam Buchanan (Post 827363)
Doug, this thread was deleted by one of the mods as "not RV related".

I hate to undelete a thread but I believe this is a subject that effects hundreds of RV pilots and who knows how many non-RV pilots. This is a huge development in our medical certification.

Please override my override if you see fit. :)

Thank you Sam. This thread most definitely is RV related. I was very sad to see it deleted last night. Glad to see in brought back to life.

While the initial BMI limit set for this discrimination/profiling may not effect that many, the other statements made in that memo should be scaring the majority of RV pilots. This is just the beginning and who knows where this will end.

Many folks may be shocked to find that their BMI falls within the proposed lower limits that are being discussed.

The memo states that they plan to find all pilots that have undiagnosed OSA. It goes on to say that 30% of people with a BMI > than 30 have OSA. This tells me that to meet their goal they will eventually have to lower the BMI requiring an evaluation to the sub 30 BMI range. I would bet that the % of the pilot population with a BMI of 25-30 is a huge number.

AOPA said this "In 2011, the FAA identified 124,973 airmen who are considered obese" My gut feeling is that only a small percentage of those are part 121/135 pilots. My guess is that the majority of em are folks just like us....

rmartingt 11-19-2013 06:19 AM

Quote:

Originally Posted by Brantel (Post 827410)
This tells me that to meet their goal they will eventually have to lower the BMI requiring an evaluation to the sub 30 BMI range. I would bet that the % of the pilot population with a BMI of 25-30 is a huge number.

I fall in that 25-30 category. I'd like to see whatever desk-driving bureaucrat came up with this idea come do a half-ironman with me next year.

(rant about FAA and medical certification typed then deleted to avoid straying into politics...)

brad walton 11-19-2013 06:34 AM

Cost
 
It is my understanding these sleep studies cost many thousands of dollars and one or more sleep overs at the doctors office wiired up like Frankenstein. Can you imagine going through this annually on your special issuance medical?

Moondog 11-19-2013 06:36 AM

AOPA asks FAA to suspend implementation
 
Quote:

Originally Posted by Low Pass (Post 827301)
Where are the incidents that would have been prevented by this measure?

I thought so.

Exactly. Planes are not falling out of the sky because of sleep apnea.

The FAA is casting a wide net. You may have to spend a couple thousand dollars to determine your sleep apnea score. Should you fail that test, you?ll place an expensive mask on your face every night for a couple of weeks before you become so frustrated with the device that you sell it for a loss on ebay.

Furthermore, while body fat is a contributing factor to sleep apnea, Body Mass Index is not a true indicator of body fat.

So the FAA is using criteria that doesn?t does not directly correlate to a health problem, to solve an aviation problem that apparently doesn?t exist. Besides the cost, it may take a lot of RVs and their pilots out of the sky.

http://www.aopa.org/News-and-Video/A...aspx?CMP=ADV:1

plehrke 11-19-2013 06:37 AM

Quote:

Originally Posted by Brantel (Post 827410)
Thank you Sam. This thread most definitely is RV related. I was very sad to see it deleted last night. Glad to see in brought back to life.

Just to make RV related a bit more, I wonder how this may effect RV-14 sales and drive people back to RV-12. (not saying RV-14 is for any particular type of people but just more comfy for Higher BMI people)

rhill 11-19-2013 08:06 AM

Insurance company's
 
Insurance company's are the driving force behind the data.I've been to the doctors office a few times this year and BMI is a new block up in the corner of pre exam form filled out by the assistant along with LDL/HDL ratio,Blood pressure,presenting complaint. Four points

1. Everything is paperless but still compartmentalized within a health care system.Be careful about what you present to your doctor,ask to talk to him off the record before your visit about your FAA concerns.have a list of medications that are and are not approved before they enter something in the record that will red flag your file. Arrive 15 minuets early,check in,sit in a chair and meditate,I use this time to communicate with my maker.Get your blood pressure as low as can,relax for a least 10 minuets before they take your pressure.

2. Now you know what the standards are,start working towards them.There is no point in "Dieing to keep your medical!" Big Corporations have already determined if your over the age of 56 your of no use to them anymore and you can expire of natural causes without affecting the statistics.It's hard to lose weight as the same big corporations supply processed food that is slowly killing us all. Eat better & Eat less. stay active...you know the drill.

3. Adapt a new mind set. I have the Bee Gees "Stayin' Alive" downloaded to my mp3,comes on when I'm out walking.

4. Support VAF/EAA/AOPA. Write letters when requested for less then $125 a year they are our only voices in Washington. Oh yea get a subscription to Kit Planes.... It's never been better.IMHO:)

aerovin 11-19-2013 08:21 AM

I think the Federal Air Surgeon, Mr. Fred Tilton, is way overstepping his authority by unilaterally imposing a "policy" change with such far reaching impact. If this is something that he feels so strongly about, it should be a regulatory change proposal to FAR Part 67 (Medical Standards) that requires a NPRM process so it can be properly vetted, justified by some basis of facts, discussed, amended and/or probably rejected. I would imagine all the alphabet groups like EAA and AOPA will at the least pursue this avenue.

Areas like this is where AOPA and EAA can do their most good.

Mike S 11-19-2013 08:36 AM

Quote:

Originally Posted by Mike S (Post 827340)
Dont know if it will do any good or not, but I did send EAA and AOPA a note about this.

"The newly released FAA **** about checking BMI--------------this needs to be stopped immediately or sooner. This is a condemnation based solely on conjecture not fact. Profiling at its ugliest."

And, I got this reply from AOPA in my email this morning.

Dear Mr. Starkey,

Thank you for your email. We agree with you 150% and will aggressively fight any implementation of the proposal. Please see the lead article on the AOPA website for more information.

http://www.aopa.org/News-and-Video/A...aspx?CMP=ADV:1

The FAA continues to evaluate our petition for an exemption to the 3rd class medical requirement for what we term ?recreational flying.? Mark met recently with FAA Administrator Huerta to keep the pressure on them to make a decision soon. We are also exploring legislative avenues that would accomplish the same end goal.

All the best,


Patrick Timmerman
AOPA

rv7boy 11-19-2013 09:53 AM

Quote:

Originally Posted by plehrke (Post 827401)
I have not heard or seen any accident reports indicating sleeping as a cause.....

There is one, but I also fail to see how one (or more) accident due to the pilot falling asleep could result in such a major change in medical certification.

The above linked fatality is the subject of Peter Garrison's excellent analysis in his monthly column in FLYING magazine this month (December issue).

SMRacer 11-19-2013 10:08 AM

Why worry?
 
Anyone with a BMI over 40 wouldn't fit in a RV.

Seriously though, a BMI over 40 is grossly unhealthy. It isn't "fat", it's morbidly obese. Maybe OSA isn't a significant problem in aviation, but it is a serious problem. Perhaps instead of claiming another FAA conspiracy theory, we should view this as a wake-up call for improving our lifestyle and health.

Jim
BMI 24.7
Weight peaked at 211 and I'm now down to 195. 185 is my goal.

Jerry Fischer 11-19-2013 10:43 AM

I know a pilot...
 
Who has OSA who when asking his AME back in the 90's about it received this sage advice. He asked the pilot: "have you ever fallen asleep while flying?" The pilot responded: "no". So the AME, now deceased, said to the pilot: "keep your OSA to yourself". This pilot held a commercial, MEI rating with over 2100 hours of safe PIC time. BTW the AME was also a pilot with an instrument rating.
My personal situation is such with CAD (coronary artery disease) that I am subject to an annual physical, stress test like Brantel, and cardiac evaluation.
So I sold my partner my RV7, bought the RV1 MockingBird, and will go light sport. :rolleyes:

plehrke 11-19-2013 11:12 AM

Quote:

Originally Posted by SMRacer (Post 827511)
Maybe OSA isn't a significant problem in aviation, but it is a serious problem. Perhaps instead of claiming another FAA conspiracy theory, we should view this as a wake-up call for improving our lifestyle and health.

Jim
BMI 24.7
Weight peaked at 211 and I'm now down to 195. 185 is my goal.

I still think the major issue here is the precedence this would set. Not only for the FAA to dictate a pilot's life style but also to target risk groups and not those that actual have a particular medical condition. It leads the healthy to have to spend time and money to prove they are healthy.

cmrvkid 11-19-2013 11:23 AM

BMI
 
As someone who has been in the health and fitness field for many years (and competes in fitness and figure competitions), I have to chime in with the rest that BMI is one of the least accurate measurements of someone's health and fitness available. With a body fat percentage of close to 20% in my off season, my BMI score still lists me as OVERWEIGHT.

Unnecessary, uncalled for, and unbelievably inaccurate.

N15JB 11-19-2013 11:31 AM

The flip side
 
Many of the previous posts make valid points about what appears to be a precipitous and perhaps overreaching policy. On the other hand, a male of average height with a BMI of 40 is approximately 100 lbs. overweight; morbidly obese. Most will have obstructive sleep apnea, and many will also be hypertensive and diabetic. If that describes you, I understand that you want to continue to fly, whether or not it is prudent. Would you want to be a passenger of such a pilot?

Several posters have commented on the shortcomings of the BMI. It is actually a reasonably good screening tool, even though it does not distinguish between an increase in fat versus muscle. The occasional power lifter or body builder packing an extra 50-100 lbs. of muscle is at nearly as much health risk as an individual carrying an equivalent amount of fat. The extra pounds put added stress on heart and lungs, either way. Very few people in this country with a BMI of 40 are not obese.

Flame suit on!

Jim Berry
RV-10


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