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The outrage over the FAA’s recently announced medical certification policy to require pilots with a body mass index (BMI) of 40 or more to be examined for obstructive sleep apnea has been consistent across all channels.
But not one of the chest-thumping screeds has provided an understandable mental image of what a 40 BMI looks like.
Listing the health conditions related to obesity, University of Rochester Medical Center starts with Type 2 Diabetes and high blood pressure before it gets to joint problems, sleep apnea, acid reflux, depression, infertility, and incontinence.
In his editorial discussing the new policy, Federal Air Surgeon Fred Tilton said the BMI trigger would, in time, be lowered, “once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater.” When that will be is anyone’s guess, but what I’d really like to know is how many applicants have reached this register?
Some have rightly said that BMI is an imperfect measure, that fits individuals, such as NFL players, have higher BMIs because muscle weighs more than fat. Lest you think I care naught for the obese, until a month ago, I was—by my BMI—one of them.
Ultimately, what bothers me most about the outrage against the FAA’s BMI trigger is that almost everything I’ve read about it strongly suggests that commenters jumped on their online soapboxes without thinking things through. But apparently they do, unless they just walk around the layover hotel lobby in a pilot uniform.
As for the outrage in the aviation community, you seem to be under the impression that pilots are upset because we feel there’s nothing wrong with obesity. I’d like to meet a few of these FAA dudes in my next tournament, but we only fight light contact. I don’t hate anyone, I just wish they would find something productive to do with their lives and quit screwing up the best country in the whole wide world (EVER!) with their good intentions and bad results. However, I would agree that many people in this nation, including pilots do not manage their health – not a focus on weight. Ron Rapp is right, and the FAA could have been much more reasoned and American in its approach.
It looks to me like someone in the FAA has a friend who is a sleep study doctor and needs more patients. If you’re looking for the data supporting this latest FAA effort, you might just be waiting awhile.
This is simply a stand the flight surgeon and some of his people took using BMI as their guide. Thanks for catching my error on the normal range of the BMI scale, I’ve corrected it and a few other typos that got by me. Your comments have been interesting, and I agree that BMI is not a very accurate sorting tool, so what would you recommend as a more accurate replacement?
As for pilot-specific apnea research, does the dearth of such studies mean that pilots are immune from the consequences proven in other medical studies of apnea?
Maybe its the devil’s advocate in me, but common to many of the comments are the words that diminish the overweight BMI category with reports of atypical habitus and excellent health.
Ultimately, he said, you determine what meets you in the mirror every morning, and the key is burning more calories than you consume. Other numbers determined by my physical were more concrete: a higher blood pressure, pre-diabetic blood sugar, and elevated cholesterol. Like many of the commenters here I offered the same rationalizations to my condition, which my doc, a very wise man for one so young, clearly understood and appreciated. I hear your comments on rationalization and maybe I’m rationalizing, too, but my doctor and I talked about my weight at my last physical (last week). I have a BMI of 42.9, and not only do I fit just fine in the cockpit, I just got back from a flight this afternoon. I don’t know what to make of all this, but I have a BMI of 30 and have been using a CPAP for 12 years. Ultimately, my point is that most pilots flying today are older, and as the comments here have shown, many of us are overweight.
The point of a medical is to assess the likelyhood of the pilot in question becoming physically or mentally incapicated to operate an aircraft, putting themselves and others in danger. The solution is to find and work to correct those with severe apnea, because their health and the safety of others is at marginally greater risk. The largest study with real numbers I could find is the one of truck drivers that I posted. Translating this data into actionable FAA medical rule making, only severe apnea where indications including high blood pressure and measureable cardiac extremes should cause mandatory sleep study. What bothers me about this is that the apnea studies point to what we already know and is encapsulated in that famous saying.. As I have posted elsewhere and find evident here, the focus is on primary care not flight safety.
Changing the subject into a factual monologue on the dangers of OSA and encouraging diagnosis and treatment is not, by itself, a valid reason to imperil the airmans’ medicals. The point here is I just want to go fly my plane on Sunday morning to an on-field eatery and have some EGGS, BACON, TOAST WITH BUTTER and some COFFEE!
I believe this is a flavor of the day, blue light special, money making disease of the decade that the medical industry is rapping us with.

In other words, for selfish reasons, we should take better care of ourselves for our own benefit, as well as the benefit of our passengers and those who live below our flight paths. Yes, I do fly…or at least I did until the sons started college, but I hope to return to the sky after my youngest son finally graduates in a year or so. As I read, no one is suggesting they not take care of themselves, take their doctors advice, have a sleep study done IF INDICATED, or even declare OSA during the AME exam. Most people who have OSA (which will be found in the sleep study) have no difficulty staying awake during the day. Apologizes for the rant, but I really would like some clarification about the DOT and now FAA’s assumptions. When I finally had enough and told them I wanted my medical back, I was told I then needed a wakefulness test.
BTW, when the stressors in my life disappeared that had sent me to the doctor in the first place … I got better.
I, along with my colleagues, recently introduced this legislation in response to the FAA’s proposal to significantly alter medical certification requirements regarding obstructive sleep apnea (OSA) for pilots and air traffic controllers. While I believe in the importance of properly treating those affected by sleep apnea, I do not think that the FAA should usurp Congress’ authority by forgoing the established rulemaking process. The more important number that I don’t see anyone talking about here, is the neck measurement, which must be less than 17 inches. I love how the medical community is always so quick to judge others… I am sure they would be a little more cautious if the same requirements were applied to the MD certifications. Don’t even get me started on mandatory drug and alcohol testing in those professions. I think we defiantly need mandatory drug testing on all elected officials and all of there staff, not to mention ANY PERSON that works for the federal or state govt.. Manning says he didn’t realize the effects of his weight gain would be more than physical. Manning suffered through soda deprivation headaches and food cravings on his way back to fit.
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Like many of my age, my BMI is in the “overweight” category, which starts at 25, and it is 1.5 points shy of obesity’s doorstep. So why is everyone giving the impression that the requirement imposes dire consequences on all overweight  aviators? But thanks to my new doc, who this last January presented the consequences of obesity in terms that resonated with me, diet and exercise have trimmed 25 pounds from my BMI, moving me into the overweight category. I think most pilots will agree that in flight, acting before thinking often leads to an undesirable outcome. When the financial costs imposed on those who suffer from the medical conditions associated with morbid obesity is more important than their quality—or continuance—of life, what does that say about our concern for the family of aviators? Tilton if it had been proposed the way it should have … through an NPRM designed to gather feedback BEFORE a rule is implemented. I used to do the same thing, but every morning when I got out of the shower, there was this old, fat, bald guy waiting for me in the mirror. BMI is just a number that society, from docs to insurance companies to the FAA, use to try and make some sense out of human diversity.
As many have pointed out here, everyone is atypical to the broad categories defined by BMI. In their effort to eliminate the 3rd class medical for some light plane categories, the EAA and AOPA data show there is no statistically significant basis for improved safety provided by the 3rd class medical.
This COULD be about the medical issues someday if they offer us a chance to comment before they simply institute the rule. Once the general public finds that travel will be be delayed for at least 1 week due to a shortage of pilots, the airlines will be lying so long and deep that the United States will have a PERFECT air travel system. Additionally I have witnessed and believe it’s also the excuse of the decade for individuals who get caught sleeping on the job or are involved in some type of disciplinary action related to awareness they don’t want to admit to so the “debilitating disease SLEEP APNEA” takes the fall and the individual is now a poor victim.
But for those affected, or who might be affected, one would think that, for the betterment of their own lives, that they might want to get and medical condition checked out regardless of whether the FAA requires it or not. The doctor I was working with at the time took one look at me during an exam and decided I had sleep apnea, completely ignoring the others stressors in my life that I told him about first.

All I did was lay there for a couple of hours with a dozen brightly colored wires stuck to my head. Then they sit you on a bed in a completely darkened, silent room and make you stay put for an hour. 3578 ensures that any new or revised requirement providing for the screening, testing, or treatment of an airman or air traffic controller for a sleep disorder is adopted pursuant to a rulemaking proceeding. By following regular order, all parties will have the opportunity to weigh in on the issue resulting in a more sound policy decision that effectively addresses the issue in an economical manner.
Both Manning and his wife, Lynn, can attest that a lot actually has changed in the past year. He’s that guy at the gym the rest of us love to hate, the one who likes to use his biceps for pumping iron instead of changing channels, and who prefers sucking down a spinach shake to indulging in a brownie sundae. When he failed yet again to push someone over to the light side, he knew something was wrong. In just six months, he went from 193 pounds with a 34-inch waist to 265 pounds with a 48-inch waist.
He became lethargic, stopped helping around the house and was less than eager to play with their 2-year-old daughter.
Before Fit2Fat2Fit, the self-described foodie wife would make treats, and Manning wouldn’t even look at them.
This herb is fine to use in small amounts during the day, though it is better to use it with a meal. Now I caution you that this is for the really skinny guy looking to really gain weight because they barely have any meat on their bones. While some parents worry even though their children eat well, there are others who have real cause for worry. Let’s be honest here, many other obesity-related conditions rank higher on the medical certificate denial list. It also immediately eliminated a case of acid reflux that had scared the hell out of me for years. Yet here the FAS is chasing a problem with no factual basis that it effects pilot performance relative to safe operation of the aircraft. While we recognize appropriate medical standards, they are supposed to be formulated in accordance with an appropriate, demonstrated medical threat. FAA should only have the jurisdiction to regulate the prevention of high frequency causes of accidents – not become the steward of pilot health. If their is a fault in pilots today it is a lack of basic airmenship, not one of medical deficiency. I fly in nice weather because I don’t want to shell out the money to fly in crappy conditions. Can anyone tell me if the sleep studies include observation of the patient in normal activities?
Of course, I bet almost anyone in a nice warm room that’s quiet and dark would take a nap during the day to be honest, but that had nothing to do with it apparently. There are no rest requirements for them to be in a certain health condition to preform their job. While Manning’s body may have returned to its six-pack heydays, his mind, in many ways, has not.
In order to better understand the struggles his clients were facing, he had to face them himself. How can someone possibly measure someone’s weight, or perform a sleep study and determine that individual is likely to become instantly and completely disabled while flying a plane? Are we truly better off now that the hearing test is done with a tone generator, than when it was “a whispered voice at five feet”?
Where is the cause and effect correlation that should be the basis of sound decision making? If so, you MIGHT be less alert than that (normal) guy, and you MIGHT fall asleep while at the controls of your truck or aircraft? This is a social experiment and ALL pilots are the rats in the cage for someone’s PhD dissertation (the ATC part is smoke, their union will never let this go into effect). Further, given there are so very few accidents in the database which might possibly be attributed to pilot incapacitation anyway, there is a strong argument to be made that the maximum possible impact of obesity or sleep apnea on flight safety is infinitesimal.
This is a bad idea not because the underlying medical conditions could be bad but because the process is severely flawed. And yet the FAA intends to force 100% of all pilots to succumb to sleep testing and possibly treatment, and also possibly cancel their fight certification? Do I believe SA is a threat to us all that must be identified by our government and eradicated like a plague?

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