- Fat as Disability:The Case of the Jews
How slippery the concept of obesity truly is can be judged, perhaps, from the following thought experiment.1 Let us look at the question of what constitutes a "disability." Obesity is now considered a disability though for a long period of time it was not. 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, a suit brought by a Rhode Island woman, Bonnie Cook, who accused the state of illegally denying her a job on the basis of "perceived disability" because of her size.
The Americans with Disabilities Act (1990) states that impairment is a condition that substantially limits major life activities. (Analogous definitions are used in the Canadian Charter of Rights and Freedoms , the British Disability Discrimination Act , and the Swedish Act concerning Support and Services for Persons with Certain Functional Impairments .) Obesity certainly does limit such activities. The obese "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."2 Under the regulations promulgated to enforce this act, severe obesity is defined as body weight more than 100 percent over the norm and is deemed "clearly an impairment."3 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 but has to be morbidly obese. In one case the court held that the male "plaintiff cannot demonstrate that he was regarded as disabled [End Page 46] on the basis of a specific job of his choosing."4 Thus, the question of defining obesity as a disability remains fluid.
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 among 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 consequence 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 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 are sets of contemporary medical definitions of obesity, it is also clear that these definitions change from culture to culture as well as over time. Obesity is determined by more than the body-mass index (wt/ht2 ), because even this changes meaning over time.5 Today in the United States and the United Kingdom, people with a BMI between 25-30 kg/m2 are categorized as overweight, and those with a BMI above 30 kg/m2 are labeled as obese. Yet the BMI that categorizes people as obese was altered in 1995 and had previously been lower.6 What is considered fat and what obese shift 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 is impairment, what organ is "impaired"? Is...