Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Obesity


Medical Codes

ICD-9-CM:
278.00 - Obesity, Unspecified
278.01 - Obesity, Morbid
278.02 - Overweight

Related Terms

  • Adiposity
  • Corpulence
  • Fatness
  • Overweight

Overview

Obesity is a state of excessive accumulation of fat in the body. Obesity predisposes the individual to an increased risk of diseases (morbidity) and death (mortality).

One common standard to define overweight and obesity is the body mass index (BMI), which is derived by dividing an individual's weight in kilograms by his or her height in meters squared (BMI = kg/m2). Multiplying an individual's weight in pounds by 704 and then dividing it twice by the individual's height in inches can also compute BMI. Individuals with a BMI of 25.0 to 29.9 are considered overweight; those with BMI greater than or equal to 30.0 kg/m2 are classified as obese; and individuals with a BMI greater than 40.0 kg/m2 have severe (morbid) obesity ("Prevalence"). Other more sophisticated methods to measure body fat such as underwater weighing, dual energy X-ray absorptiometry (DXA), body average density measurement, and bioelectrical impedance analysis, are expensive, not readily available, require accurate calibration, and are primarily used for epidemiological studies.

Simple obesity differs from morbid obesity. Morbidly obese individuals have a body weight that is 2, 3, or more times the ideal weight and that begins to interfere with normal physiological functions, such as breathing.

Incidence and Prevalence: The prevalence of obesity has risen dramatically over the past several decades and continues to rise: in the US, obesity rates increased 1.7% between 2005 and 2007 (Galuska). Overall, 25.6% of the general population is obese (Galuska), and 67% of the population is either overweight or obese ("Prevalence").

Since 1980, the number of obese people worldwide has almost doubled. It is estimated that in 2008 more than 1.4 billion adults aged 20 or older were overweight and of these, more than 200 million men and nearly 300 million women were obese. In 2008, 35% of adults aged 20 and older were overweight, and 11% were obese. ("Obesity and Overweight").

Source: Medical Disability Advisor



Diagnosis

History: Obese individuals are often cognizant of being overweight. Complaints may include shortness of breath (dyspnea); fatigue; joint pains in the hips, knees, and ankles; poor mobility; and a general dissatisfaction with state of health. Family history may point to diabetes, hypertension or obesity.

Physical exam: The exam includes an assessment of body mass index (BMI) (see above). Other measurements include the waist-to-hip ratio. Skinfold measurements, which are taken by calipers and are measured at various locations on the individual's body, are unreliable.

To calculate an individual's waist-to-hip ratio, divide the waist measurement (measured at narrowest point) by the hip measurement (measured at fullest point). Women with waist-to-hip ratios of more than 0.8 or men with waist-to-hip ratios of more than 1.0 are called "apples" (because of their apple shape). "Apples" are at considerably greater risk for coronary heart disease, diabetes, high cholesterol, stroke, and sleep apnea because of their fat distribution than are "pears" ("Obesity").

Tests: Blood sugar (glucose) measurements taken at various times, including after fasting or after ingestion of glucose (glucose tolerance test), are used to evaluate diabetes. Blood tests may also reveal high cholesterol, high fats (hyperlipidemia), and elevated uric acid levels (hyperuricemia). Thyroid-stimulating hormone (TSH) should be measured to exclude thyroid deficiency.

Source: Medical Disability Advisor



Treatment

The five medically accepted treatment modalities are diet modification, exercise, behavior modification, drug therapy, and surgery. All these modalities, alone or in combination, are capable of inducing weight loss sufficient to produce significant health benefits in many obese individuals. Unfortunately, health benefits are not maintained if weight is regained. With the exception of surgery, it is difficult for most individuals to adhere to these modalities in a manner sufficient to maintain long-term weight loss.

Calorie restriction has remained the cornerstone of the treatment of obesity. The standard dietary recommendations for losing weight include reducing total calorie intake to 1,200 to 1,500 calories per day for women, and to 1,500 to 1,800 calories per day for men ("Obesity"). Saturated fats should be avoided in favor of unsaturated fats, but the low-calorie diet should remain balanced. Keeping a food journal of food and drink intake each day helps individuals to stay on track.

The addition of an exercise program to diet modification results in more weight loss than dieting alone and seems especially helpful in maintaining weight loss and preserving lean body mass. The exercise program should be preceded by a thorough medical examination, and both the intensity and duration of exercise sessions should increase gradually and be supervised by a health care professional. Moderate activity (walking, cycling up to 12 miles per hour) should be performed 30 minutes per day or more, 5 days a week or more. Vigorous activity that increases the heart rate (jogging, cycling faster than 12 miles per hour, and playing sports) should be performed 20 minutes or more, 3 days a week or more. Although vigorous workouts do not immediately burn great numbers of calories, the metabolism remains elevated after exercise. The more strenuous the exercise, the longer the metabolism continues to burn calories before returning to its resting level. Although the calories lost during the postexercise period are not high, over time they may count significantly for maintaining a healthy weight. Included in any regimen should be resistance or strength training 3 or 4 times a week. Even moderate regular exercise helps improve insulin sensitivity and in turn helps prevent heart disease and diabetes. Exercising regularly is critical because it improves psychological well-being, replaces sedentary habits that usually lead to snacking, and may act as a mild appetite suppressant.

Behavior modification for obesity refers to a set of principles and techniques designed to modify eating habits and physical activity. It is most helpful for mildly to moderately obese individuals. One frequently used form of behavior modification called cognitive therapy is very useful in preventing relapse after initial weight loss.

Drug options include anorexiants, which help individuals feel full after eating less food and which lower the appetite, and a drug that blocks the absorption of fat from the diet. These drugs are adjunctive rather than solo therapy; anorexiants should be prescribed only for short periods of time as an initial support while the individual gets used to the diet modification.

Surgery for weight loss (bariatric surgery), which carries significant morbidity and mortality, is reserved for well-informed and motivated severely obese adults (more than 180% overweight or whose BMI is greater than 40) whose condition has failed to respond to medical weight control. Surgery may also be considered for individuals with less severe obesity (BMI between 35 and 40) who have disabling joint disease, pulmonary insufficiency, heart disease, hypertension, or diabetes. The most common surgical procedures used to achieve weight loss are gastric bypass and gastric banding. Other procedures include gastroplasty, partial biliopancreatic bypass, and jejunoileal bypass.

After losing a great amount of weight due to bariatric surgery or a weight reduction program, some individuals choose a cosmetic procedure called body contouring, which involves the removal of excessive saggy fat and skin from the abdomen, arms, and/or thighs. Liposuction, which involves the suctioning of fat, is not a substitute for weight loss, but rather a procedure to treat isolated areas of fat that persist in spite of exercise and diet. It should be noted that if the individual gains weight after a liposuction procedure, fat is deposited in new sites that did not undergo liposuction.

Source: Medical Disability Advisor



Prognosis

Weight gain of just 11 to 18 pounds doubles an individual's risk of developing diabetes, and gaining 44 pounds or more quadruples the risk ("The Surgeon General"). Weight gain of 10 to 20 pounds increases the risk of coronary heart disease by 1.25 times in women and 1.6 times in men ("The Surgeon General"). Obesity (BMI greater than 30) has an increased risk of premature death from all causes, with an estimated 300,000 obesity-attributed deaths occurring annually ("The Surgeon General").

If an individual strictly follows a sensible diet and exercise program and loses the needed number of pounds, the prognosis is excellent provided the individual continues with the program or with a maintenance program based on the original. The benefits of weight loss are dependent on the amount of weight lost: moderate weight loss of 4.4 pounds to 9.7 pounds can reduce blood pressure, losing 10% of body weight results in improved sleep patterns for those with obstructive sleep apnea, and weight loss in general results in lower blood sugar levels ("Obesity").

For untreated obesity, the prognosis is poor, and the risk of serious comorbidities tends to worsen.

Source: Medical Disability Advisor



Differential Diagnosis

  • Cushing's syndrome
  • Deficiency in thyroid activity (hypothyroidism)
  • Genetic disorders (e.g., Down syndrome)
  • Severe familial high cholesterol (hyperlipidemia)
  • Severe familial obesity
  • Tumors of the adrenal or pituitary gland

Source: Medical Disability Advisor



Specialists

  • Clinical Psychologist
  • Endocrinologist
  • General Surgeon
  • Internal Medicine Physician
  • Neurologist
  • Psychiatrist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Obesity is associated with a number of complications detrimental to health and quality of life. Included are the individual's continued inability to lose weight, the metabolic syndrome (also called the insulin resistance syndrome or syndrome X), cardiovascular disease, stroke, diabetes, high blood pressure (hypertension), osteoarthritis, cataracts, cancer (the type varies for men and women), gum disease, gallstones, reproductive and hormonal problems, lung diseases, stoppage of breathing during sleep (obstructive sleep apnea) and other sleep disorders, binge eating and other eating disorders, and emotional and social problems.

Diseases formerly associated only with adults are increasingly seen in children as the prevalence of overweight and obesity grows. These diseases include type 2 diabetes, hypertension, gallbladder disease, hyperlipidemia, obstructive sleep apnea, and orthopedic conditions.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence length of disability include type of job and compliance with treatment protocol.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Some obese individuals, especially those who are severely obese, may no longer be able to perform their duties efficiently due to fatigue and poor mobility. Weight-related conditions and diseases may also occur. Accommodations may include the possibility of a more sedentary position or one that incorporates limited exertion. The work station may need to be modified to accommodate obese individuals with a larger body size. A position that involves walking and moving around may also be beneficial because it engages the individual in exercise while working.

Individuals may need additional time away from work for appointments with the physician, dietitian, or personal trainer. A flextime arrangement may be a consideration for the individual whose weight reduction plan includes regular visits to a fitness club.

Risk: Limits in return to work will most likely reflect any underlying condition caused or associated with the obesity (e.g. hypertension, cardiomyopathy, diabetes, peripheral vascular disease).

Capacity: Stress echocardiography will help to identify any significant evidence of limitation due to deconditioning from the obesity. This would have to be combined with any information from associated diseases.

Tolerance: Patient concerns over symptoms resulting from surgical intervention should be addressed to clarify that the symptoms do not reflect a limitation in work.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a genetic predisposition to obesity?
  • Does individual have history of hypothyroidism, Cushing's syndrome, or depression?
  • Is individual taking drugs that may cause weight gain, such as steroids or certain antidepressants?
  • What does individual eat? Is individual active?
  • Does individual eat in response to negative emotions, such as boredom, sadness, or anger?
  • Is individual a binge eater?
  • Is individual very conscious of being overweight?
  • Does individual complain of shortness of breath (dyspnea); fatigue; joint pain in the hips, knees, and ankles; or a general dissatisfaction with state of health?
  • Was individual's body mass index (BMI) measured? Was it 30 or greater? 40 or greater?
  • Was individual’s waist-hip ratio measured?
  • Was blood sugar (glucose) measured at various times, including after a fast or ingestion of glucose (glucose tolerance test)?
  • Were blood tests done to measure fats (lipids) and uric acid levels?
  • Was a diagnosis of obesity confirmed?

Regarding treatment:

  • Was caloric intake reduced to 1,200 to 1,500 calories per day (women), or 1,500 to 1,800 calories per day (men)?
  • Does individual avoid saturated fats? Is dietary content balanced?
  • Is individual involved in an exercise program that promotes recommended amount of physical activity?
  • Would individual benefit from enrollment in a community exercise or weight-loss program?
  • Did individual maintain weight loss? Was individual compliant with treatment regimen? What could be done to increase compliance?
  • Would a behavior modification program be beneficial?
  • Did individual with more than 180% overweight or with a BMI greater than 40 have surgery?
  • What surgical procedure was performed? Gastric bypass or lap band? How effective was the procedure?

Regarding prognosis:

  • Has individual depended on diet alone to lose weight?
  • Does individual understand the importance of following an exercise regimen?
  • How successful was individual in keeping weight off?
  • How much is obesity affecting individual's health?
  • Is individual a candidate for more stringent, multidisciplinary weight-loss program or for surgical intervention?
  • Do the benefits of surgery outweigh the risks?
  • If weight does not decrease, can individual still perform daily activities?

Source: Medical Disability Advisor



References

Cited

"Obesity and Overweight (Fact Sheet No. 311)." World Health Organization. Sep. 2006. 4 Jun. 2013 <http://www.who.int/mediacentre/factsheets/fs311/en/index.html>.

"Obesity." WebMD. 13 Apr. 2011. 4 Jun. 2013 <http://www.webmd.com/diet/tc/obesity-treatment-overview>.

"Overweight and Obesity." National Center for Chronic Disease Prevention and Health Promotion. 19 Aug. 2009. Centers for Disease Control and Prevention. 4 Jun. 2013 <http://www.cdc.gov/obesity/index.html>.

"Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960-1962 through 2005-2006." National Center for Health Statistics. 11 Sep. 2009. Centers for Disease Control and Prevention. 4 Jun. 2013 <http://www.cdc.gov/nchs/data/hestat/overweight/overweight_adult.htm>.

"The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity 2001." Office of the Surgeon General. 2001. U.S. Department of Health and Human Services. 4 Jun. 2013 <http://www.surgeongeneral.gov/topics/obesity/calltoaction/CalltoAction.pdf>.

Galuska, D. A., et al. "State-Specific Prevalence of Obesity Among Adults—United States, 2007." MMWR 57 28 (2008): 765-768.

Source: Medical Disability Advisor