and weight control for pilots and controllers
Many pilots are distressed when they notice that their own centre of
gravity is moving considerably further forward than it was when they were
just learning to fly. The consequences of pilots reaching a weight they
consider gross can be just as hazardous as trying to fly an aircraft that
exceeds its gross weight. When pilots can no longer see their own "landing
gear" because of the tire around their "fuselage," they look for medical
maintenance personnel or decide to perform their own annual inspection and
maintenance. This guide is a simplified manual on weight reduction and fat
loss. Following the manual may improve your airworthiness, add years to
your service life, and dramatically improve your performance.
Costs of Excess Weight
Excess weight is a common health problem in the United States. It may also
have adverse social and occupational implications in some individuals. In
several occupations, excess weight may be a safety concern. The social and
health consequences of excess weight lead to Americans spending over $30
billion each year in medical treatment and over the counter weight loss
efforts. Half of American women and a quarter of American men attempt to
lose weight each year with variable success over the long term.
Although "overweight", "obesity" and the politically correct
"gravitationally challenged" terms are often used interchangeably, medical
professionals have separate definitions for the first two terms. Obesity
is a more severe form of overweight and morbid obesity is the most severe
form. Nutritionists point out that someone can be near their ideal body
weight and have a "normal" figure, yet be "overfat". These individuals
weigh an average amount, but have low lean muscle mass and high percent
body fat. Similarly, a bodybuilder may be "overweight" by standard tables,
but have a very low body fat percentage, a high lean muscle mass and not
be "overfat". For this discussion, the terms overweight, overfat and obese
will refer to measures of ideal body weight and body mass index. Many
other methods of calculating body fat are available including skin
callipers, body circumferences, water immersion, bioelectric impedance and
nuclear imaging to name a few.
Obesity (overfat) is a chronic disease that is increasing in the United
States. Obesity is associated with many other diseases and makes their
consequences worse. Obesity has negative social implications in our
current society and sometimes connotes "fault" or lack of control. The
cause of a tendency toward obesity is not defined. Intentional weight loss
is often temporary and difficult to achieve. Medications to "treat"
obesity are fraught with complications. Surgery for the condition also is
associated with complications and introduces other medical problems.
Nutritional requirements for obese individuals attempting to lose weight
have not been well explained.
Ideal Body Weight
Approximately one third of Americans are overfat or obese. The definitions
of obesity and overweight are changing. In the past, ideal body weight (IBW)
was calculated by a formula based on gender. Some pilots and controllers
feel, perhaps correctly, that their Ideal Body Weight is that weight
listed on their medical certificate. A somewhat more scientific approach
uses a formula derived from insurance company research on longevity. For
men, the formula for IBW allows 106 pounds for the first 5 feet of height
and 6 pounds per inch above five feet. A 6’2" inch male would have an IBW
= 106 lb. (5’) + 84 lb. (14") = 190 lb.. Ten percent leeway on each side
of IBW is considered healthy. In the example, our 6’2" male could weigh
171-209 and still be considered healthy. The formula for women is 100 lb.
for the first 5 feet of height and 5 lb. per inch above that height.
Individuals are considered "overweight" if they are greater than 20% over
IBW (similar to exceeding the Utility category weight on an aircraft) and
"obese" if they were more than 30 percent over IBW (similar to exceeding
the Normal category weight). "Morbid obesity" is defined as >200% of IBW.
Obviously these formulae do not account for the bodybuilder with 4% body
fat or the anorectic young woman with 30% body fat.
Body Mass Index
Recently, the classification of obesity and overweight is moving toward
the use of Body Mass Index (BMI). For pilots, think of BMI as similar to
C.G. limits on an aircraft and IBW as Gross Weight limitations. A BMI of
25-29.9 is considered overweight and a BMI of 30 or greater is considered
obese by some experts. A National Institutes of Health Consensus
conference considers obesity to start at a BMI of 27. Morbid obesity is
defined as a BMI > 40 kg/m2. The BMI is calculated by using the body
weight in kilograms divided by the height in meters squared or BMI =
kg/(m2). For weight in kilograms, divide weight in pounds by 2.2. For
height in meters, multiply height in inches by 0.0254.
Health Consequences of
Obesity has recently been listed as a major independent risk factor for
heart disease and stroke. Previously, it was considered a minor risk
factor associated with many of its other attendant medical problems.
Overfat individuals are at significantly increased risk for diabetes, high
blood pressure and elevated cholesterol. Cancers including breast,
colorectal, prostate and endometrial occur in higher rates of obese
individuals. Obesity increases the risk of gall stones and gall bladder
disease. Obstructive sleep apnea with respiratory problems, daytime
sleepiness, heart disease and reduced mental function, is much higher in
obese individuals than those near their ideal body weight. The extra
weight that obese individuals carry leads to increased osteoarthritis and
back pain. Gout and varicose veins are also complications.
Causes of Obesity
Obesity is a product of genetic predisposition (heredity) and
environmental factors. Some individuals have a genetic make up that causes
them to store fats easier than others. Although the total number of fat
cells is relatively fixed, the size of the cells varies dramatically
depending on the amount of fat stored in each cell. Between 30% and 50% of
an individual's fat make up is genetically determined.
Environmental factors, such as disease and medications, can influence fat
distribution. Thyroid disease directly affects metabolism and weight.
Medications such as steroids can cause an increase in central body fat.
These are rare causes of obesity.
Calorie Burn Rate - Basal Metabolic Rate
The most significant environmental factor in determining weight is food
and calories taken in versus those expended. Even with a genetic tendency
toward being overfat, in the absence of more calories taken in than
expended, a person will not gain weight.
Calories are a unit of energy and are more correctly expressed as
kilocalories (kcal). Food energy is stored in the body as fat, muscle
proteins or carbohydrates. For the same amount of weight, fat (9 cal/gram)
has more than twice the calories of protein or carbohydrates (sugars and
starches, 4 cal/gram).
A key factor in determining how many calories an individual can take in
while maintaining weight is the resting metabolic rate (similar to the
throttle-idle fuel consumption rate). This determines how many calories a
person uses daily without any activity. These calories are expended just
by breathing, muscular activity of the heart and other essential functions
of living. Resting metabolic rates may vary as much as 400 calories per
day in different individuals. Since approximately 3500 calories are
equivalent to a pound of fat, 400 calories per day make a three and a half
pound difference per week.
The average adult male will burn about 1800-2500 calories with normal
activity each day. This includes a resting metabolic rate of about
1200-1500 calories per day and activity calories of 600-1000 per day.
Additional exercise may increase this by several hundred calories.
Different activities have different "caloric burn rates". Women have rates
about 10% less than men. Lean muscle burns calories over 20% more
efficiently than fat. Thus a muscular person will burn more calories
without any activity than an overweight (overfat) person who has the same
weight. Resting caloric rate decreases with age past approximately thirty
years in both men and women. Lean muscle mass also decreases with age.
Why Do We Gain Weight?
Why do many people tend to gain weight as they get older? The answer is
both simple and complex. The simple answer is that they begin to take in
more calories than they use or burn. Assuming the average adult burns
1800-2500 calories a day with minimal activity, an intake of the same
amount of calories each day would allow the person to maintain a stable
One pound of fat equals about 3500 calories. Therefore, if a person eats
500 calories per day more than they use up, they will gain one pound per
week (500 calories x 7 days = 3500 calories = one pound). As little as 100
calories per day excess intake will result in a ten pound weight gain in
The more complex answer to why we gain weight, particularly with getting
older, has to do with changes in the body's physiology. Several changes
occur with aging. First, our metabolism slows after age thirty. Our bodies
do not burn as many calories with the same amount of activity. Next, we
lose lean muscle mass which also burns calories faster than the fat it may
be replaced by. Perhaps most importantly, our activity level changes.
Physical activity is the
most significant variable in the weight control equation. If 1200-1500
calories are used each day simply by breathing and having a heart beat
(basal metabolic rate/BMR), only 500-1000 calories used each day are
accounted for by activity of living. People with desk jobs (or flying
jobs) and little physical activity may only use 600 calories each day
above their basal metabolic rate. Those with moderate activity that
requires some walking, such as a fuels handler at an FBO, may use 900 or
more additional calories per day. Finally, people with physically
demanding jobs, such as baggage handlers, may burn over a thousand
calories more than their BMR daily. Obviously, the last group may eat more
each day with less risk of gaining weight than the less active groups.
Who Should Lose Weight?
No consensus exists about who should lose weight and how much should be
lost. Most medical professionals feel that anyone with obesity (BMI > 30.0
or weight >140% of IBW) should lose weight regardless of their health
status to prevent health complications. Individuals with medical
complications of being overweight should lose weight if they have a BMI
>27.0 or weight > 120% of IBW to treat the complications. Complications
include high blood pressure, heart disease, diabetes, high cholesterol and
male sex. Some experts include arthritis, gall bladder disease and a
family history of some types of cancer.
Many health care providers feel that weight reduction to IBW or a BMI of
22.0-25.0 is the goal for anyone with medical complications of obesity.
Preventive medicine advocates are more aggressive in their
recommendations. Maintenance of IBW for all individuals is the goal,
though somewhat unrealistic for an entire population.
Remember that not all people who exceed their IBW are overfat and some
people who maintain an IBW are still overfat. An assessment of percent
body fat is more appropriate in determining weight control recommendations
for those with unusual body types.
Medical research has identified higher risk patterns of obesity. Those
people with fat distributed around their abdomens (called "apples") are at
higher risk for complications and death than those with the same amount of
fat distributed around their hips (known as "pears"). Men with abdominal
circumferences of greater than 34 inches or a waist to hip ratio of 1.0
and women with a waist circumference of more than 31" and a waist to hip
ratio of greater than 0.8 are at higher risk for complications due to fat
Can I Lose Weight in Just One Area?
No. Many people feel that only one or two parts of their bodies have too
much fat, such as thighs or the abdomen. Advertisers tout rubber wraps and
cellulite pills to improve the appearance of a particular area. These
don't work. A person losing fat does so equally across all parts of their
body as percent body fat decreases. The muscle tone in a particular area
may be toned through exercise targeted at that area to improve appearance.
An example would be sit ups for a flatter stomach. The muscles of the body
are generally covered by fat, so toned muscles with lots of fat over them
still appear fat.
Is Losing Weight and Regaining It Unhealthy?
Recent articles have raised concern about the health effects of repeated
weight loss and gain, also known as weight cycling. Scientific evidence
does not demonstrate any increased risk of weight cycling over maintenance
of a stable overweight status. In a large study of 28,000 women, weight
loss, even temporarily, reduced risks of disease. A 20 pound weight loss
lowered deaths from all causes, heart disease and cancer by 25%. In a
smaller study of 15,000 women, ANY weight loss reduced heart disease by
10%, deaths by 20%, deaths from diabetes by 30-40% and from breast cancer
How To Lose Weight
Sustained weight loss takes commitment, persistence and patience. Any
program to lose weight permanently will not happen fast. It involves a
multi-faceted approach of behaviour modification, healthy nutrition,
sensible dieting and physical activity. Medications are effective only
temporarily and do not change long term behaviour. Nearly all medications
used for weight loss are disqualifying for flying and controlling. Surgery
should be reserved for the morbidly obese, but may have significant
complications that may interfere with safety sensitive duties. For a
downloadable pamphlet from shape Up America!, see Healthy Weight, Healthy
Most overweight people feel guilty about what they eat, particularly if
they know what they are eating is high in calories. This triggers feeling
of self-criticism and a defeatist attitude about commitment to weight
loss. A more healthy attitude would include a recognition that weight loss
takes persistence and involves tradeoffs of food and exercise to burn off
calories. Eating an extra piece of pie containing 300 calories won't hurt
a weight loss program if 300 calories of extra exercise (walking or
running about 3 miles) is included. That is a lot of work, however, for
the several minutes it takes to eat one piece of pie.
Support of family members and friends in a weight loss program is very
helpful. Temptations are resisted more easily if someone helps remind you
of alternatives or will share a commitment to a joint exercise program.
Tracking calories in food and exercise through a diet and activity log
will help explain progress or lack of progress in a weight reduction
program. Habit patterns of eating in various situations are similar to
addictions of smoking or alcohol. Recognizing the triggers for food
snacking or bingeing is an important step in interrupting the behaviour.
Designing alternate activities or substituting nearly calorie-free food,
such as raw vegetables, for calorie dense snacks will lower daily caloric
intake. Avoiding buying food that is high in calories will eliminate some
choices. Shopping on the outside aisles of a supermarket where healthy
food (except ice cream and cheese) is located, as opposed to the inner
aisles where calorie-dense processed food is found, will help.
The major principle in sustained weight loss is a commitment to
establishing behaviour modifications that cause permanent lifestyle
changes, not temporary interruptions in unhealthy habits.
Thousands of weight reduction diets are touted as the answer to permanent
weight loss. If there was a single successful diet plan, its advantages
would spread rapidly through the public and would quickly outsell all
others. No such miracle diet exists. Instead, this article will offer some
sensible guidelines and comment on the potential hazards of some popular
Nutrition occurs on two levels, the macronutrient and the micronutrient
levels. Macronutrients for the body are oxygen, water, protein, fat and
carbohydrates. All are absolutely essential for the body to function, even
fat. The macronutrient requirements are fairly well defined and
quantifiable. Recent legislation mandates quantifying macronutrient
information on all food labels for consumer use.
Micronutrients include vitamins, minerals, trace elements and plant
products. These micronutrients are less well studied and requirements are
currently not well quantified for optimum health. Most of the vitamins and
a few of the minerals have Recommended Daily Allowances (RDA) established
by the Food and Drug Administration (FDA). RDA's are minimal amounts
required in the average person on an average diet to avoid overt disease.
For optimum health, people on a reduced diet or with increased needs, such
as illness, pregnancy, cancer or heavy exercise, may have significantly
higher requirements for optimum health than the RDA. See our article on
Nutrition and Heart Disease Prevention and our article on Vitamins &
General Rules for Dieting
Some general rules apply to all diets. First caloric intake for weight
maintenance should be approximately 30 calories per kilogram of IBW or 13
calories per pound. Calorie intake should be reduced by 500 calories per
day for each pound per week of weight loss desired. The minimum calorie
intake to obtain adequate nutrition from food sources varies with
individuals. Estimates range from 800 to 1500 calories. Dieters should
consider micronutrient supplementation to maintain optimum health during
periods of calorie restriction.
Next, healthy diets should contain elements form all of the macronutrient
groups. Approximately 20% of calories should come from fats, preferably
from mono- and poly-unsaturated fats to protect against heart disease.
Fats are essential in many functions of the body, such as hormone
production. Protein should make up 15-25% of the diet. Protein may come
from animal sources (preferably fish, fowl or lean meat to avoid saturated
fats), non-fat dairy products (egg whites, milk and cheese in moderation)
or plant sources, which are the healthier alternatives. These plant
sources include beans and soy products. Fibre and water are also important
components of a healthy weight reduction diet. Both increase satiety, or a
sense of fullness and decreased hunger. Water has no calories and many
high fibre foods and products are nutrient dense with few calories. Fibre
also helps bind fat in the intestines and slow absorption of the fat.
Many highly touted weight reduction diets are unhealthy or dangerous.
Single food diets are nutritionally bankrupt and may cause problems with
gall bladder disease. Very low calorie diets have some of the same
problems. Diets that avoid single macronutrients such as fats, protein or
carbohydrates tend to be nutritionally depleted also. Long term success
with weight control is best achieved with a healthy, nutritionally
balanced diet that is enjoyable and sustainable. See an article in the
Federal Air Surgeon's Medical Bulletin, Fall 2000 on the subject of fad
diets, In Dieting, You Can't Fool Mother Nature by Glenn Stoutt, MD.
A review of low-fat diets versus low-calorie (low-carbohydrate) diets
showed no significant difference in weight loss over 18 months. See the
Cochrane for Clinicians: Putting Evidence into Practice article from
American Family Physician for more details.
It is important to eat three or more small meals per day. One popular
misconception about dieting and calorie reduction is that skipping meals
will reduce calorie intake and make you lose weight fast. In the short
term, you may lose weight, but your body undergoes several changes that
make sustained weight loss difficult and unhealthy. First, the metabolism
changes to allow the body to convert muscle and sugars into fat making it
an efficient fat storage organism. This is to avoid the periods of
starvation induced by skipping meals. Second, the body breaks down muscle
for energy instead of using the muscle to burn fat. Third, the wide
fluctuations in blood sugar levels trigger hunger and eating. Finally, the
sustained nutritional needs of the body are not met.
By eating regularly in small amounts, the body has a constant supply of
energy. The sugars in the body are used and muscle is preserved. Blood
sugar levels are relatively even and hunger attacks are eliminated. If the
diet includes significant water and fibre, a person won't sense an empty
Dieting Strategies for Pilots
Many people have lifestyles that are not conducive to regular healthy, low
calorie meals. Airline and commercial pilots are prime examples. Food is
not available at regular intervals. When it is available on the road, it
may be high calorie/high fat/low nutrient density food. Snacking in
between meals is common. Several strategies exist to help manage weight
and obtain appropriate nutrition in this challenging environment.
First, attempt to eat a healthy breakfast that avoids high sugar foods or
excess amounts of sweet fruits. These will trigger a rise in blood sugar
for several hours followed by a precipitous drop. The dropping blood sugar
triggers hunger impulses and food cravings three to four hours after the
meal. Complex carbohydrates such as breads, grains, bagels (with jams
rather than butter or cream cheese), oatmeal and other starches will
provide a flatter, sustained level of blood sugar for longer periods.
Proteins and fats will also give similar results, but may be difficult to
find in low calorie forms for breakfast. Sausage and bacon is not a
healthy choice for protein, but eggs may be an alternate source if
cholesterol is not a problem. For those who can tolerate milk products,
yogurt with grains, such as grape nuts or wheat germ mixed in, offers an
excellent source of slowly delivered, nutrient-rich calories. Low sugar
fruits such as melons, provide vitamins, minerals and fibre in a healthy
Next, drink plenty of water during the flight. Water will keep the stomach
full, aid in elimination, prevent dehydration and not add any calories.
Three or more quarts of water daily will be helpful. Often, having a water
bottle available in the cockpit and refilling as necessary will make
obtaining that amount relatively easy. Coffee with cream and sugar
consumed regularly during flight adds tremendously to daily calorie
intake. Non-diet soft drinks and fruit juices made from concentrates also
add to the daily calorie load without significant nutrient value. Fruit
juices made from concentrates also add to the daily calorie load without
significant nutrient value, other than added vitamin C.
Snacking on dried fruit, which can be stored without refrigeration in
zip-lock bags, provides a nutrient and fibre rich substitute for high
calorie snacks. If sustained periods of flight without access to healthy
food is anticipated, a powdered nutritional dietary supplement that can be
mixed with water will eliminate hunger for several hours. When stored in
resalable plastic bags or individual serving containers, they require
minimal storage space. They also provide an acceptable substitute for
breakfast. Manufactured or processed food that frequently comes in plastic
wrapping often is high in fat, calories and salt. Snacking on fresh
vegetables is a very low calorie source of fibre and nutrition for those
who do not have to fly on multi-day trips away from a grocery store.
Several small snacks will maintain blood sugar levels and decrease calorie
absorption more efficiently than occasional large meals. In between these
large meals, the body goes into a relative state of starvation. This state
increases hunger and triggers physiologic changes in the body that
increase fat storage and calorie absorption. Probably the most tempting
source of unlimited high calories is a visit to a buffet for dinner. Try
to focus on ordering healthy, low fat food from a menu and drinking plenty
of water with a meal. For those who must have dessert, fruit or sorbet
offers low fat alternatives.
Avoid fast foods that are heavily laden with fats and calories. Although
convenient, most foods from fast food restaurants are nutritionally
deficient, high in salt and often supply a day's worth of calories in a
single meal. Tables exist to count fast food calories easily.
Don't smoke to avoid eating. The risks of smoking outweigh (no pun
intended) the risks of being overfat in the over all health picture.
Finally, avoid alcohol. Alcohol in any form is a very high calorie source
with little or no nutrient value. Red wine and small amounts of alcohol
may add some degree of protection against heart disease, but any benefit
gained is less than the penalty paid for the individual trying to lose
weight. For those not concerned with excess weight, small amounts of
alcohol may be beneficial.
For more information on dieting and weight management strategies, contact
a preventive medicine specialist.
The third leg of a weight control program relies on regular exercise to
increase calorie expenditure. A nutritionally responsible method for
weight reduction includes eating adequate amounts of the proper foods and
exercising to burn the extra calories form these foods. A person who
exercises regularly can afford to eat several hundred calories a day more
than their non-exercising friends without incurring a weight gain. See the
Virtual Flight Surgeons article on Fitness Assessment and Exercise
Recommendations for more information on this subject
Exercise is categorized in two basic forms, aerobic and anaerobic. Aerobic
involves sustained activity of 20-30 minutes or more duration with an
increase in heart rate to 70% or more of the predicted maximum. This type
of activity has proven to be useful in reducing heart disease, stroke and
other cardiovascular diseases, lowering cholesterol and blood pressure,
improving blood sugar control in diabetics and improving mood. Examples
include, running, walking, cycling, swimming, cross country skiing, rowing
and many others. The disadvantage of aerobic activity is that the number
of calories consumed is relatively small for the time expended, unless the
intensity level is very high. However, aerobic activity uses fat as a fuel
and is an excellent way to lose body fat.
Anaerobic activity involves short bursts of intense activity, usually
involving some form of resistance. Weight training is the classic example.
Weight training and other resistance exercise increases lean muscle mass.
This will increase the baseline metabolic rate and resting caloric usage.
Calories consumed during anaerobic activity come primarily from stored
sugars in the body and is not as efficient in burning fat as aerobic
exercise. Because muscle weighs more than fat, people losing fat and
increasing muscle mass may not see a rapid reduction in weight. Muscle
tone will improve, however, and percent body fat will decrease. Resistance
training slows the progression of osteoporosis in both men and women and
increases strength. Astronauts engage in resistance exercise during long
duration space flight to minimize the rapid bone loss that occurs in a
weightless environment. Many team sports such as basketball and soccer
combine elements of both aerobic and anaerobic activity.
Both of these forms of activity consume calories and are useful in a
weight reduction program. The level of calorie consumption depends on the
intensity and duration of exercise. In general, walking and running one
mile uses about 100 calories. Runners just burn the 100 calories faster
than walkers who cover the same distance. Swimming 300 yards and bicycling
approximately three miles also burns about 100 calories.
Many pieces of modern exercise equipment found in health clubs will
quantify calories used. These numbers are not extremely accurate unless
your weight is used in the calculations or you weigh about 160 pounds
(average healthy weight for a 5'10" male used to program exercise
equipment). Weight lifting consumes a highly variable number of calories
depending on the amount of weight lifted and number of repetitions. Many
resources are available for calculating calories used for specific
activities. About 500 calories per day of added exercise are required to
lose one pound per week if weight was stable before starting an exercise
Other forms of activity, such as yoga or tai chi, increase flexibility and
improve mental function, but are not significant sources of calorie
It is important to find one or more activities that are enjoyable to
participate in. Exercise is a key element of a weight reduction program,
but if it is not enjoyable, it will not be sustained. Many people keep
their interest in exercise high by switching activities periodically.
Weather and availability of exercise facilities may force people to be
involved in several activities to maintain a regular exercise program.
Certainly a piece of home exercise equipment such as a treadmill, exercise
cycle or rowing machine is convenient. When on the road, many pilots find
it difficult to exercise. Walking in the terminal, while not a method to
increase strength, will consume some calories. This is particularly true
if walking is done instead of eating. For other hints on exercise during a
busy day without the benefit of a health club, see Fitting Fitness In from
Shape Up America!
Many people try to exercise with rubber suits or heavy clothing to
increase water loss from the body. A false sense of rapid weight loss is
gained if a person weighs themselves immediately after exercising and
before rehydrating. Weight loss due to water is very transient and is
reversed as soon as the person consumes fluids again. The risk of heat
exhaustion or heat stroke with loss of consciousness makes exercising with
these suits very dangerous medically. This is also very dangerous
administratively for pilots/controllers who may have to undergo extensive
and expensive testing to maintain their medical certificate if they lose
consciousness while exercising. Exercise in clothing that allows you to
remain as cool as possible and stay well hydrated when exercising.
Exercise increases physical fitness and mental well-being. Measures of
fitness should not be limited to single categories. Aerobically fit
individuals may not be able to lift relatively light loads. Muscular
individuals with very low body fat percentage may not be able to reach
their toes or jog more than a few minutes. Useful fitness assessments
should include evaluations of cardiovascular conditioning, strength,
flexibility and body fat percentage. Comprehensive personal fitness
assessments are available at some health clubs or through commercially
available self-assessment products. We recommend the educational,
scientifically based and easy to understand Fitness Age assessment tool.
See the VFS Fitness and Exercise article for expanded discussions and
Medications for Weight
Many overweight people experience intense cravings for food and feel the
need for medications to suppress their appetite. Several prescription
medications are available as well as several over-the counter medications.
The medications are effective in suppressing appetites as long as a person
remains on the medication. Once discontinuing the medications, appetite
returns and so does the weight. Medications are rarely effective in
establishing permanent lifestyle modifications required to sustain weight
loss in a healthy manner.
The National Institutes of Health recommends considering weight reduction
medications only if a person has a BMI > 30 or greater than 27 with
obesity related co-morbidities or other diseases. In the book Clinical
Evidence: A Publication of BMJ Publishing Group, a chapter on Obesity
contains a listing of the effects of drug treatments for obesity in
For pilots and controllers, most prescription weight loss medications are
not allowed. Many are related to the amphetamine category of drugs. See
the article "Weight and Balance, Diet Pills and Flying," by Drs. Donato
Borillo and David Lozano in the Federal Air Surgeon's Medical bulletin on
prescription weight loss medications and aeromedical certification. Most
medications are not recommended for periods longer than 12 weeks.
Recent research has shown that the weight loss combination known as Fen-Phen
can cause serious heart valve abnormalities, even when used as prescribed.
The risk of severe lung problems also exists with these medications. As a
consequence, they have been removed form the market. Other similar weight
reduction medications not approved by the FAA include Bontril (phendimetrazine),
Tenuate (diethylproprion), Mazanor (mazindol), Fastin and Ionamin (both
A new weight reduction medication of the same category has been approved
by the FDA. It is called Meridia (sibutramine). Meridia is also a
controlled drug that is prohibited for use when flying or controlling. The
maximum duration of therapy for this medication is 12 weeks. Sustained
weight loss past this period is rare. It is currently not approved by the
FAA. See FDA Meridia Press Release.
Xenical (orlistat): A "fat blocking" lipase inhibitor reduces weight by
blocking the absorption of fat from the intestine by 1/3, thus reducing
calories absorbed from the intestines is approved by the FAA for use.
Prior to flying/controlling on the medication, individuals must
demonstrate two weeks of use without significant side effects. The major
side effects are flatulence, greasy smelly stools and urgent bowel
movements. These side effects may compromise flying safety or worsen with
increasing altitudes. The medication may also interfere with the
absorption of fat soluble vitamins and supplementation with vitamins A, E
and K may be recommended. View FDA Xenical Consumer Information Page
(Adobe Acrobat required). See manufacturer info.
Because of significant complications and deaths in older people using
"herbal fen-phen" or ephedra, acompound very closely related to the
pseudoephedrine found in over the counter cold preparations such as
Sudafed, these medications have been withdrawn from the market.
Medications containing ephedra are not approved by the FAA.
Another non-prescription medication found in cold medications,
phenylpropanolamine or PPA, is used in some of the common diet pills. It
has the same potential complications as ephedra. The FDA has issued a
recall of all products containing PPA due to documented cardiac deaths.
Newer anti-depressant medications, the Selective Serotonin Reuptake
Inhibitors (SSRI's) including Prozac, have a side effect of weight loss.
The presumed mechanism is boosting brain levels of serotonin to suppress
appetite and cravings. currently, no anti-depressant medications are
authorized by the FAA for pilots or controllers holding medical
certificates. Some research indicates that several over-the-counter
nutritional supplements that boost serotonin levels in the brain, may have
similar effects. These are not currently regulated by the FDA or
restricted by the FAA. Pilots/controllers should use these products with
caution to determine there are no side effects.
The bottom line for all weight loss medications is that the effects are
not permanent because, if used independently of a comprehensive weight
management program, they do not modify behavior long-term and that they
are potentially dangerous from both health and medical certification
The journal American Family Physician published an excellent article, on
Drug Therapy for Obesity, for people wanting more information on the
subject. A second article addresses the ineffectiveness of Common Dietary
Supplements for Weight Loss.
Surgery for Weight Loss
Two broad categories of surgery exist to help overfat people. One,
liposuction, is simply a cosmetic procedure designed to remove some
accumulated fat from a particular portion of the body. The second
category, called bariatric surgery, involves by-passing a part of the
stomach or intestines to limit the amount of food a person can eat and
Both surgeries have the potential for very serious complications.
Liposuction does nothing to modify behavior and does not result in long
term weight or fat reduction. Some gastric bypass operations are
associated with nutritional deficiencies and "dumping syndromes" or
chronic diarrhea. These operations are more successful in long term weight
reduction. The surgery is usually reserved for people with a BMI > 35 with
medical complications of obesity or for the morbidly obese individual with
a BMI > 40. See an article from the Winter 2002 Federal Air Surgeon's
Medical Bulletin, Medical Certification After Bariatric Surgery by Donato
J. Borrillo, MD, JD.
Liposuction has also been used to reduce fat in selected areas of the
body. In this technique, a hollow catheter is inserted under the skin to
remove fatty tissue by suction. Significant amounts of blood and fluid can
be lost if the liposuction is not performed correctly. See The New England
Journal of Medicine article on deaths due to liposuction in New York City.
Liposuction is not disqualifying for FAA medical certification after the
individual has been released to return to full activity.
Obesity and being overfat are serious risks to health. Effective
strategies for achieving healthy and desired weight and body fat depend on
a long-term commitment to changing behaviour. Three major elements in a
weight reduction program include behaviour modification and support,
calorie reduction through regular intake of limited amounts of nutrition
rich foods and regular exercise. Nutritional supplementation may be useful
for those who can not eat healthy foods at every meal. Water and fibre
intake are important adjuncts to avoid hunger. Medications have
potentially harmful side effects, generally only work while taking them
and are not allowed by the FAA for pilots/controllers. Surgery is
appropriate only in extreme cases that have failed other methods to
control fat and weight. Success takes time and persistence. The rewards of
achieving and maintaining a healthy body fat percentage extend beyond
physical and emotional health. Pilots, like aircraft, will perform best
with a desirable centre of gravity, takeoff weight far below the maximum
gross weight, high quality fuel without contaminants, avoidance of
prolonged periods on the tarmac without flight and regular maintenance and
inspections. May your flight through life be a healthy and safe one.
Healthy Weight Loss Checklist - A 12 Step Program
1 Commit to a weight loss program and stay with it
2 Analyze your body fat, BMI, weight and IBW
3 Learn how count calories and read food labels
4 Define daily calorie intake goals for weight loss
5 Eat lots of high fibre foods (25-30 grams/day)
6 Drink lots of water (1 oz/kg of body weight/day)
7 Eat grains, starches, fruits, vegetables, lean meats
8 Avoid dairy products, except non-fat types
9 Avoid Consider nutritional supplements for aggressive diets
10 Avoid sweats, simple sugars, alcohol, soft drinks
11 EXERCISE DAILY in moderation
12 Stay with the program, check weight only monthly