In the past, obesity was included in the Listings of Impairments (Listing No. 9.09), which meant that if it was severe enough it could result in an automatic finding of disability. However, SSA later found that the criteria in the Listing were not appropriate indicators of listing-level severity. In SSA’s experience, the criteria in Listing No. 9.09 did not represent a degree of functional limitation that would prevent an individual from engaging in any gainful activity. In other words, SSA found that being even severely morbidly obese did not necessarily equate with disability. Thus, on August 24, 1999, SSA deleted Listing No. 9.09.
SSA’s current policy regarding the evaluation of obesity is stated in SSR 02-1p. SSR 02-p1 states that SSA defines disability as “a complex, chronic disease characterized by excessive accumulation of body fat.” It acknowledges that obesity is generally the result of a combination of factors (e.g., genetic, environmental and behavioral). SSA relies on the National Institute of Health (NIH) guidelines which classify obesity according to Body Mass Index (BMI). BMI is the ratio of an individual’s weight in kilograms to the square of his or her height in meters (kg/m2). For adults, both men and women, the clinical guidelines describe a BMI of 25-29.9 as “overweight” and a BMI of 30.0 or above as “obesity.” The guidelines recognize three levels of obesity. Level I indicates BMIs of 30.0-34.9, Level II includes BMIs of 35.0-39.9, and Level III (“extreme” obesity, representing the greatest risk for developing obesity-related impairments), include BMIs of 40.0 and higher. These levels describe the extent of obesity, but they do not correlate with any specific degree of functional loss.
Even though there is no longer a specific Listing for obesity, SSA still considers obesity as an important factor in determining disability. Obesity is considered at four of the five steps of the Sequential Evaluation Process for determining disability, namely, whether the claimant has a medically determinable impairment, whether the claimant’s impairments are severe, whether the claimant’s impairments meet or equal the criteria of a Listing (not Listing 9.09, which does not exist), and whether claimant is able to perform his or her past work or any other work which exists in the national economy.
When determining if an individual’s obesity constitutes a severe, medically determinable impairment, SSA will look at the evidence in the record. If the evidence includes a diagnosis of obesity, then SSA will accept this diagnosis unless there is other evidence in the record to the contrary. When the evidence does not include a diagnosis, but does include notes about high body weight or BMI, SSA will use its own judgment to determine whether obesity exists. Obesity is considered “severe” when it alone, or combined with other conditions, causes “more than minimal” functional limitations.
Obesity is important in determining whether a claimant “meets” or “equals” a Listing. SSA will find that a Listing is met if there is an impairment that, in combination with obesity, meets the requirements of a Listing. For example, obesity may increase the severity of coexisting or related impairments to the extent that the combination of impairments meets the requirement of a Listing. This is especially true of musculoskeletal, respiratory, and cardiovascular impairments, and may also be true for other coexisting or related impairments, including mental disorders.
SSA may also find that obesity, by itself, is medically equivalent to a listed impairment. For example, if the obesity is of such a level that it results in an inability to ambulate effectively, as defined elsewhere in the Listings, which substitutes for the major dysfunction of a joint, SSA may then make a finding of medical equivalence to Listing No. 1.02 (major joint dysfunction)
Obesity is also important in determining whether someone retains the residual functional capacity (RFC) to perform his or her past relevant work or any other work which exists in the national economy. SSA will look at the effects obesity has on the individual’s ability to perform physical and mental activities which are demanded in competitive work environments.
SSA acknowledges that obesity can limit function. Obesity can make it harder for an individual to do things such as sitting, standing, walking, lifting, carrying, pushing and pulling. It may also make it harder for someone to do postural functions, such as climbing, balance, stooping and crouching. Moreover, an individual’s ability to manipulate objects may be affected by the presence of adipose (fatty) tissue in the hands and fingers. Additionally, the ability to tolerate extreme heat, humidity or hazards may also be adversely affected.
The effects of obesity may not be obvious. For example, some people with obesity may also have sleep apnea. This can lead to drowsiness and lack of mental clarity during the day. Obesity may also affect an individual’s social functioning, as many obese people are self-conscious and lack confidence, or may even be treated differently by co-workers.
In conclusion, although obesity is no longer the subject of a specific Listing, it is still a very important factor in determining disability. The presence of obesity can make the difference between winning and losing. Thus, if a claimant is obese, it is important to mention that in the application.
Moreover, SSA knowledges that the combined effects of obesity with other impairments may be greater than might be expected without obesity. For example, someone with obesity and arthritis affecting a weight-bearing joint may have more pain and limitation than might be expected from the arthritis alone.
When determining whether obesity, either by itself or in combination with other conditions, prevents an individual from returning to their previous work or other work, the Social Security Administration will determine an individual’s residual functioning capacity. To do this, an assessment will be made of the effect obesity has upon the individual’s ability to perform routine movement and necessary activity within the work environment. SSA will then use this information to determine whether an individual can return to their previous work or do any other work.