Obesity and Establishments

This is by no means comprehensive coverage of the law as it pertains to obesity. The object is to look at a few selected moments in history because they are typical, or atypical; and the other object is to grasp the big picture.

A publication from the Social Security Administration in 2019 explained “how we establish that a person has a medically determinable impairment (MDI) of obesity and how we evaluate obesity in disability claims”:

[W]e consider the person’s weight over time. We consider the person to have an MDI of obesity as long as his or her weight, measured waist size, or BMI shows a consistent pattern of obesity.

This seems rather vague, but apparently, variables are very important, and the question of who is legitimately disabled needs to be evaluated case by case. Which is only fair, because all applicants are individuals with their own histories and problems. Returning to the rights and obligations of the education system, in 2019, the Centers for Disease Control said,

Care coordination in schools involves school nurses organizing the care of students by sharing information and maintaining communication among those concerned with the needs and care of students with chronic health conditions (e.g., asthma, diabetes, epilepsy).

Since type 2 diabetes and obesity are very closely related, this would seem to make weight checks necessary, even if not specifically for the purpose of identifying obesity.

Information gathered in the early 1990s was included in a report called “A Closer Look,” which concentrated on the services that school districts nationwide were willing and able to provide. Almost every jurisdiction did First Aid, and administration of prescription meds to students. In the obesity area, “Other commonly provided services include such health screenings as height, weight, vision, and hearing…” Also related to obesity, just slightly more than half of the school districts concerned themselves about nutrition counseling.

Population-based approach versus selective high-risk approach

There are a couple of basic problems. Due to limited resources, school districts often feel they must face the choice between A) offering to everyone services that are so minimal they are almost insignificant; and B) providing more meaningful services to the neediest. As a real-life example…

[…] the National Cholesterol Education program recommends a population-based approach for implementing dietary guidelines for children, combined with a high-risk approach to blood lipid screening targeted only at children considered at risk based on family history.

Another factor is that, because mandatory attendance just makes corralling kids at their schools so easy, administrators sometimes object to being coerced into filling roles they don’t particularly feel it is their job to fill.

(To be continued…)

Your responses and feedback are welcome!

Source: “Policy Interpretation Ruling SSR 19-2p: Titles II and XVI: Evaluating Cases Involving Obesity,” SSA.gov, 05/20/19
Source: “Care Coordination,” CDC.gov, 05/29/19
Source: “Schools & Health: Our Nation’s Investment,” NIH.gov, 1997
Image by Maryland GovPics/CC BY 2.0

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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