The FAA will soon roll out a new medical certification policy that makes life miserable for fat pilots. Federal Air Surgeon Fred Tilton says the target isn’t fat, but obstructive sleep apnea (OSA).
The new FAA pilot medical certification procedures will require your AME to calculate and report your BMI—body mass index. The BMI is a single number that is the ratio of your height and your weight. If your BMI is 40 or greater, your AME will pack you off to a board certified sleep specialist who must test you for OSA. If you have OSA you can’t fly again until Dr. Tilton and his gang are certain you have been successfully treated.
OSA is caused by physical obstruction of your airways while you sleep. Tissue in our throats and mouth relax when we sleep and can sag down and block the breathing passage. After a brief period the brain detects the low oxygen level in the blood and causes us to wake up and restore breathing. Often the OSA sufferer is not aware of the repeated awakening during the night, but sleep quality suffers by the sleep-waking cycles.
Obviously, people with significant OSA will not be fully rested and may be drowsy during the day. All sorts of other health and behavioral issues have been blamed on OSA including high blood pressure, heart attacks and personality disorders. OSA is and has been a disqualifying medical condition for pilots. What’s new is that fat pilots will be forced to prove that they don’t have OSA rather than the AME looking for the symptoms of OSA and then treating the condition. Overweight equals OSA until proven otherwise to the FAA.
A BMI of 40 is pretty large. At 6-2 and 205 pounds my BMI—according to the Federal government’s website calculations—is 26.3. If I put on 100 pounds I’m still just under the new FAA BMI target of 40. I’m lucky to have height on my side. A pilot who is 5-8 would hit the 40 BMI threshold weighing around 270, or a little less.
Dr. Tilton’s position is that a big majority of people with a BMI of 40 or greater do have OSA. The medical literature certainly lists being overweight as a significant contributor to OSA but I haven’t seen a BMI threshold where the assumption becomes that OSA is essentially universal. But the new FAA policy will make large pilots prove they don’t have OSA whether or not they have symptoms.
In his announcement of the new OSA policy Dr. Tilton says that as time goes by the BMI threshold will be lowered from 40 because people with BMI of 30 or less also may have OSA. He doesn’t predict at what lower BMI level the FAA could force pilots to go into a sleep lab for a full OSA evaluation, but does say the FAA will keep dropping the threshold. In the future if you put on the pounds, get ready for a trip to a certified medical sleep lab.
Probably the most intrusive aspect of the new requirement that there isn’t really a one-step cure for OSA. Most often the treatment requires people to wear a pressure breathing mask while they sleep to force air into their lungs. Can you imagine sleeping with a military style pressure breathing oxygen mask on every night? Doctors and companies that make the pressure breathing apparatus say it’s not as annoying as an MBU-XX mask strapped to your face all night, but all of us who have worn oxygen masks in the cockpit can imagine what it’s like. And the “cure” for OSA would be wearing this contraption every night for the rest of your flying career.
In some cases of OSA surgeons may cut out some of the flesh that is blocking the airway. I did see one procedure recommended that implanted struts in your throat to prop open the airway. It all sounds pretty grim.
OSA is a very real physical condition that affects many. And it should be treated seriously by anyone , pilot or not, who suffers from OSA. But medical certification should work in the normal way where symptoms are noted, studied, investigated, a cause found, and a treatment recommended. This new FAA medical certification procedure goes the other direction. Dr. Tilton assumes because you cross an arbitrary fat threshold you have OSA, whether you have symptoms or not, and it’s up to you, through costly and invasive testing, to prove you don’t have it.
Over the years I have read hundreds and hundreds of NTSB investigation reports on fatal aviation accidents and have never seen OSA listed as the probable cause of the crash, or even a contributing cause. Dr. Tilton doesn’t point to a single statistic of how many accidents have been caused by OSA, or how many accidents may be prevented with his new requirements. This is a solution in search of a problem.
I, of course, see this as part of the medical profession’s continuing crusade against weight. Many, even most AMEs, would love to be able to order us to lose weight, and nearly all insist that their pilot applicants eat less, drink less, don’t smoke and drop a bunch of pounds. But the FAA medical office could never withstand issuing an arbitrary height-weight standard for pilots. Imagine the reaction if Dr. Tilton said “you’re too fat to fly.” The docs would be guilty of weight discrimination. What they need is a “medical” justification for singling out the fat among us. And in OSA they have found their medical defense.
Dr. Tilton said he also plans to enforce the same 40 BMI threshold on air traffic controllers who are also required to undergo FAA medical exams. But Dr. Tilton says the FAA must “finalize some logistical details” before forcing the new standards onto controllers. Could those “details” be the fact that the controllers have a union? I wonder.