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AINsight: Weight Loss Medications and Aviators
By: Robert Sancetta
Caption: FAA does allow pilots to use newer weight loss medications without special issuance approval
Word Count: 809
Pilots ask me near-daily whether weight loss medications are approved by the FAA. Several weight loss medications are indeed approved, with certain restrictions. In fact, there are now relatively simple protocols for the pilot and AME to follow to use them that usually permit the issuance of a medical certificate without requiring a formal application for a special issuance authorization.
Certain combinations of medications that are not as commonly used are also approvable but require a special issuance. Older generations of weight loss medications, including those with amphetamine-like properties, are not acceptable to the FAA.
Why are weight loss medications all the rage these days? Reasons range from appearance goals and self-image to, importantly, general health improvements.
This is also a sad truth: while many people are initially successful at losing weight, the problem remains with keeping that weight off. This elusive goal has never been an easy thing to achieve.
The medical issues that can result from being overweight are many. They include heart disease, diabetes, hypertension, obstructive sleep apnea (OSA), high cholesterol, arthritis, and—I think I have made my point. Suffice it to say that remaining significantly overweight brings with it many medical risks.
What does being “overweight” mean? Although there are many factors to ponder, there remains no perfect answer to this question.
One of the measurable criteria that doctors and insurance companies love so much is the body mass index (BMI). This is calculated by a mysterious mathematical formula that goes something like this: take height in millimeters, divide that by body weight in ounces, then add the number of functional GPS satellites at any given time (hence, the BMI may vary day to day). Kidding aside, the actual computation is quite complex. The easiest way to find a BMI is to use a simple online calculator.
Typical medical (and insurance company) BMI parameters are as follows:
	underweight: less than 18.5	normal weight: 18.5 to 24.9	overweight: 25 to 29.9	obese: 30 or higher	morbid obesity (when specified): 40 or higher
While a reasonable tool, BMI is not the only factor involved in determining how overweight someone might be. Other components such as muscle mass and bone structure must also be considered.
The FAA points out that a startlingly high percentage of people with BMIs in the morbid obesity range have symptomatic OSA. As all pilots know, the FAA requires AMEs to make a judgment of each pilot’s OSA risks.
Though the FAA is rather zealous with its OSA assessment criteria, it comes from solid medical reasoning. People with OSA have higher rates of arrhythmia (irregular heartbeats including atrial fibrillation), other forms of heart disease, progressive lung function problems, diabetes, weight gain, fatigue, and—for those who also snore—a spouse who requires separate bedrooms. Stable and treated OSA is approvable through the special issuance process.
For someone who is truly overweight, losing some of that weight is of significant long-term benefit. Countless weight loss programs have been advertised over the years—sometimes endorsed by celebrities.
There is no single weight loss program that works for everyone and no simple solution for keeping that weight off. Regardless of the modality chosen, the patient must maintain continued motivation with their weight loss goals.
The causes of weight gain and obesity are multifactorial. They include age, genetics, race, ethnicity, many different medical conditions, inherent hormonal balance, diet, activity and exercise level, age, and other factors.
No different than the medical community accepting alcoholism and other substance abuse issues as medical in nature, there is growing acceptance of the idea that obesity has a significant medical component. It is not as simple as saying, “Eat less and exercise more,” sage advice as that might be.
Being overweight or obese carries with it many medical and personal challenges. It is not simply a cosmetic issue, although people should be permitted to have healthy self-image goals. These goals should be respected by others.
People have been trying to effectively lose weight for decades, with only partial success. For pilots, eating well and exercising on the road are admirable but difficult tasks. As a result, pilots often struggle with their weight.
While healthcare providers will continue to recommend adherence to modifiable risk factors such as diet and exercise as part of an effective weight stabilization plan, the use of the newer weight loss medications is an exciting and highly effective addition to a comprehensive long-term lifestyle program.
In my next blog, I will discuss the FAA-approved weight loss medications themselves and the protocols for using them.
The opinions expressed in this column are those of the author and are not necessarily endorsed by AIN Media Group.