Disability

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O besity is now considered a disability, though for a long period of time it was not. In 1973, Carolyn Soughers brought the first (but unsuccessful) size-discrimination lawsuit. She had been denied employment with a county civil-service agency on account of her size. It was only in 1993 that the federal Equal Employment Opportunity Commission ruled that "severely obese" people could claim protection under federal statutes barring discrimination against the disabled. A "friend of the court" brief based on this ruling was filed in the case of Cook v. Rhode Island (0 F.3d 17 [ 1st Cir 1993]), a suit brought by a Rhode Island woman, Bonnie Cook, who accused her state of illegally denying her a job on the basis of "perceived disability" because of her size. In this case, the Equal Opportunity Commission filed an amicus brief stating that "voluntary morbid obesity" is covered under the Americans with Disabilities Act. As obesity became a disability, by 2000, San Francisco, Calif., Washington, DC, Santa Cruz, Calif., and the state of Michigan had passed ordinances that added height and weight to the same antidiscrimination codes in addition to race, religion, sex, gender, sexual orientation, disability, and place of birth.

The Americans with Disability Act (1990) stated that impairment was a state that substantially limited major life activities. (Analogous definitions are used in the Canadian Charter of Rights and Freedoms [1994], the British Disability Discrimination Act [1995] and the Swedish Act Concerning Support and Services for Persons with Certain Functional Impairments [1993].) And obesity certainly does limit such activities. The obese, as we shall see, continually encounter various forms of discrimination, including outright intentional exclusion, the discriminatory effects of architectural, transportation, and communication barriers, overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities.

(Americans with Disability Act 1990)

Under the regulations promulgated to enforce this act "morbid obesity," defined as body weight more than 100 percent over the norm, is "clearly an impairment" (Equal Employment Opportunity Commission Compliance Manual § 902.2 [c] [5]). This rather arbitrary line means that to be covered by the "Americans with Disabilities Act," the individual cannot just be too overweight for a specific occupation. In one case, the court held that the male "plaintiff cannot demonstrate that he was regarded as disabled on the basis of a specific job of his choosing" (Clemons v. Big Ten Conference, [1997] WL 89227 [N.D. Ill. 1997]). What that means is that the question of defining obesity as a disability still remains fluid.

One can add that not only is "fat" debated under the question of disability, but also that "too thin" is drawn into question. In 2000, a student, Keri Krissik, sued Stonehill College, a private Catholic college in Easton, Massachusetts "for refusing to let her register on the grounds of her anorexia," in violation of the Americans with Disabilities Act. At the time she was 5 feet and 6 inches and weighed 97 pounds, and had suffered a heart attack the preceding spring. The judge of the U.S. District Court, Rya Zobel, dismissed her suit saying that Krissik failed to show she would be irreparably harmed by not being allowed to attend the college. The judge did not, however, rule on whether Krissik could properly be classified as disabled (Roeber 2000).

The definition of a disability seems to be rather specific, even if the Supreme Court has been recently altering and limiting it. The World Health Organization (WHO), in its 1980 International Classification of Impairments, Disabilities, and Handicaps, makes a seemingly clear distinction between impairment, disability, and handicap.

Impairment is an abnormality of structure or function at the organ level, while disability is the functional consequence of such impairment. A handicap is the social consequences of impairment and its resultant disability. Thus cognitive or hearing impairments may lead to communication problems, which in turn result in isolation or dependency. Such a functional approach (and this approach was long the norm in American common and legal usage) seems to be beyond any ideological bias. This changes very little in the most recent shift to the idea that disability is to be redefined on a scale of "human variation" that postulates the difficulties of the disabled as the result of the inflexibility of social institutions rather than their own impairment.

When, however, we substitute "obesity" for "cognitive impairment" in the functional model, there is suddenly an evident and real set of implied ethical differences in thinking about what a disability can be. What is obesity? While there is a set of contemporary medical definitions of obesity, it is also clear that the definition of those who are obese changes from culture to culture over time. Obesity is more than the body-mass index (wt/ht2), because even this changes meaning over time. Today in the U.S.A. and the U.K., people with a body-mass index between 25 and 30 kg/m2 are categorized as overweight, and those with a body-mass index above 30 kg/m2 are labeled as obese. Yet, when the National Health and Nutrition Survey in 1999 recorded a 55 percent increase in obesity over three decades in the U.S.A., they retrospectively used the body mass index of 30 to compute this figure. What is fat and what is obese (their two categories) shifts over time.

Let us apply the rather straightforward WHO standards of disability to the world of the obese. Is obesity the end product of impairment or is it impairment itself? If it must begin with impairment, what "organ" is "impaired"? Is it the body itself? Is it the digestive system? Is it the circulatory system? Or is it the mind, meaning, therefore, the obese suffer from that most stigmatizing of illnesses, mental illness? Is obesity a mental illness which is the result of an addictive personality (where food is the addiction)? Is addiction a sign of the lack of will? Is it physical dependency, as in heroin addiction? Is "addiction" a genetically preprogrammed "error" in the human body, which expresses itself in psychological desire for food or the mere inability to not know when one is no longer hungry?

Is the impairment of obesity like lung cancer in that it is the result of the voluntary consumption of a dangerous substance such as fat or carbohydrates? Certainly, WHO believes this. Having struggled against tobacco consumption, it is intent on launching a campaign against the rising levels of obesity by persuading manufacturers of processed foods to limit the amounts of added sugar. Is such food "addictive" like nicotine, or is it merely an interchangeable sign in society for those things we all desire but most of us can limit? Surely it is not possible to go without food as one could go without cigarettes. Is the obese person mentally or physically disabled? On the other hand, can you be obese and mentally stable? Is obesity a disease of "civilization" caused by too fat or too rich or too well-processed food? Is its "cure" a return to "real" food or the rejection of food in general? Has it become the new "epidemic" to be chartered by epidemiologists and combated by public health organizations? If it is an epidemic, is it contagious or ubiquitous? Are diet and exercise the sole cures for the myriad definitions of obesity? Is the social consequence of obesity isolation or a central place in the society? Where on the scale of "human variation" are you placed in a world completely shaped by and for those who are not fat? Is obesity exogenous or is it endogenous? Are you in the end treated like a social pariah or Santa Claus?

See also Celebrities; Fast Food; Obesity Epidemic; Smoking

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