Obesity: the condition of an adult having a body mass index (BMI; equal to weight in kilograms divided by the square of height in meters) of 30 or higher. Though BMI does not account for lean, muscular individuals such as competitive athletes, there is no doubt obesity is on the rise worldwide and especially in the United States. The crisis has grown beyond a public health issue, with obese individuals increasingly thrust into confrontations that extend beyond the realm of physical well-being. Do the rights of the obese and non-obese differ based on their respective physical conditions? To what extent does obesity give a person claim to benefits not shared by others? And who is responsible for determining the boundaries of these rights and distributing such benefits? In this article, I discuss four recent cases that highlight various health, economic and ethical issues associated with obesity and society.
Airline travel provides a marked example of the differential treatment of obese individuals within society. Obese passengers must often occupy two adjacent seats to avoid discomfort to themselves or other passengers. Should an obese person requiring an extra seat pay for the seat himself or should it be provided free of charge? May an airline force an obese passenger to wait for another flight if extra seating is not available? According to a recent article in The Economist magazine, Air Canada and a few other airlines offer obese passengers an adjacent seat for no additional fee.3 They claim obesity is a medical condition since obese people’s brains respond differently to food than do thin people’s, giving obese individuals an urge to eat more frequently and making it harder for them to lose weight. And just as the cost of an onboard defibrillator is included in every passenger’s ticket price, other flyers incur a portion of the cost of an obese passenger’s extra seat.
Rather than advocate one particular policy, The Economist article suggests each airline should be free to determine how to fill its seats. Likewise, customers should choose an airline that best suits their needs. In a free market economy, one should expect nothing less. Further difficulties arise when governments attempt to legislate on such matters. In those cases, it may be worth bearing in mind the following parallel example:
Luke is a competitive luger. During practices, he often scrapes against the sides of the course, tearing the skin off the sides of his arms and legs. As a result, sitting next to another passenger in a cramped airline seat can be very uncomfortable. Adjacent passengers are also discomfited by Luke’s cries of pain when they accidentally rub limbs and by the sight of blood leaking through his bandages when a wound tears open. Luke has a medical condition in two senses. His injuries are both painful and dangerous to his health, as the frequency and size of these abrasions make them particularly susceptible to infection. Luke also finds it harder to not luge than do other people. His father and uncle were lugers; the sport is in his blood. He knows the dangers of the sport (his father died in a catastrophic crash), but his brain responds differently to the adrenaline rush of luging than do most other people’s.
An unfortunate example of airline policies regarding obese passengers is found in the death of Vilma Soltesz. According to the New York Post, Soltesz suffered from diabetes and kidney disease, had only one leg and used a wheelchair. Her ailments led her to retain water and pushed her weight to 425 pounds. In September 2012, she traveled to Hungary with her husband Janos on Delta and KLM airlines. The couple informed Delta of Vilma’s condition prior to their trip and purchased two seats for her on their flight. However, when they attempted to return home the next month, KLM told them the airline lacked a seatbelt extension to accommodate Vilma and that the seat back could not support her weight.
The couple waited at the airport for five hours and then drove an additional five hours to Prague for a return flight on Delta. But when they arrived for their flight, Delta claimed the airline’s plastic wheelchair could not hold Vilma’s weight. The couple booked a Lufthansa flight for the next week, but this time Lufthansa crew and local firefighters could not lift Vilma from her wheelchair into her seat, and the plane’s captain ordered them off the flight. The couple returned to their vacation home in Hungary where Vilma died two days later.4
It seems obvious that the airlines involved in this tragedy must bear a portion of the blame for Vilma’s death. But how much? Vilma was the person most responsible for her own health, and given her size, it was also her responsibility to ensure the appropriate arrangements were made for her travel. While taking better care of herself would have kept Vilma from ever encountering this sad situation, she could not undo years of poor health in the few months surrounding her travel, and it seems she and Janos did everything in their power to prepare themselves and the carrier airlines for the trip. Like any other contractual agreement made for travel, it then fell to the airlines to fulfill the arrangement. If a passenger truthfully informs an airline of any potential complications beforehand and the airline agrees to fulfill the passenger’s travel arrangements nonetheless, then the airlines must uphold its end of the contract.
As Janos Soltesz files a multimillion-dollar lawsuit against Delta and KLM for violating disability protection laws, questions involving the line between obesity and disability and the notion of temporal responsibility are sure to surface. If obesity is a medical condition in the sense put forward by Air Canada, does it also qualify as a disability? Does Luke’s case qualify by the same criteria? If Vilma—56 years old at the time of her death—made lifestyle choices for 20 to 30 years or more that led to her obesity and illnesses, do those years of small decisions absolve the airline companies of any measure of blame for a few days of gross irresponsibility? Does an individual have any responsibility to society to live a life that would avoid such potentially unforeseen issues? Perhaps, but whatever might be said of Vilma’s or Luke’s past behavior, they still possess individual rights and their good-faith contracts deserve to be honored as much as anyone else’s.
But to what extent must society adapt its practices to accommodate such individuals? In 1983 Ronald Post pled no contest to shooting and killing Helen Vantz, a desk clerk at a hotel in Ohio. Post was sentenced to death by lethal injection, to be carried out on January 16, 2013, after years of ongoing appeals. In the latest appeal, his attorneys claimed confessions Post made to other inmates were exaggerated at his trial and that lethal injection would subject the 480 pound Post to “a torturous and lingering death.” They referenced the 2007 execution of Christopher Newton, in which executioners struggled to find a vein for injection owing to the prisoner’s excess body fat. That procedure lasted for two hours and included a bathroom break for Newton.5 Post tried to lose weight while in prison but his request for gastric bypass surgery was denied and the exercise bike he used daily broke under his weight. In December 2012 Ohio Governor John Kasich upheld Post’s appeal and commuted his sentence to life in prison with no chance of parole. Kasich echoed the state parole board in naming Post’s poor legal representation as grounds for his decision.7
Ignoring the ethics of the death penalty alone, the issue at hand becomes whether or not a society should change its laws to accommodate individuals with certain conditions. Certainly, society does accommodate disabled individuals, which leads us back to the question of whether obesity is such a disability. Generally speaking, there are three types of disabilities: 1) inborn, as in cerebral palsy; 2) accidental, as with an unpreventable injury; 3) and self-inflicted/preventable, as in a drunk driver who injures herself in a collision.
Of these three categories, cases such as obesity and Luke’s luging injuries would fall under the third heading, if they may be considered disabilities at all. Conditions of this type are least likely to garner sympathy and subsequent accommodation from society, but the law itself is generally silent on the distinction. A drunk driver who breaks his leg has as much legal claim to priority seating on public transportation as does the victim of the crash, though other passengers might not look so favorably upon the former. So if obesity is to be granted any disability-type legal status in terms of alleviation of death penalty sentences or special treatment on airplane flights (or other forms of communal transportation) it should be addressed in the same way as other self-inflicted disabilities.
In fact, governments do seem to recognize obesity as a self-inflicted, preventable medical condition, given the myriad strategies deployed against it. New York City Mayor Michael Bloomberg attempted to eliminate a specific fat-inducing vice entirely by banning oversized sodas. In 2011, Denmark sought to encourage healthy behavior by imposing a 16 kroner ($2.70) tax on every kilogram of saturated fat in food products. The Danish government abandoned this plan the following year after citizens began to stock up on fatty foods in neighboring Germany and the Danish food industry complained of the extra administrative costs of complying with the tax.8
Another (perhaps satirical) suggestion comes from Jan Fidrmuc, Professor of Economics at Brunel University in London:
“A much better solution would be to tax outputs rather than inputs. Along with their income taxpayers should declare also their [BMI] … One’s income tax could be determined as a function of the deviation of BMI from some target value.”9
While basing such a tax on body fat percentage would be a better option, Fidrmuc’s proposal does allow for a greater degree of freedom in individual lifestyles. The government does not eliminate or punish specific behaviors, but merely rewards good health and penalizes obesity. The message here might be interpreted in the same sense as other laws regulating the limits of free action: eat and exercise as much or little as you want, so long as the end result does not negatively affect your fellow citizens. Could this approach serve as a viable compromise for governments between instructing airlines on how to seat obese passengers or limiting soda sizes and avoiding the obesity epidemic altogether?
In any case, governments do not seem to regard obesity in the same sense as does Air Canada. Obesity is a medical condition in that it poses a grave threat to the individual’s health. However, laws like the ones above indicate that governments believe obesity remains a personally controllable problem. Individuals can be encouraged to make healthier lifestyle choices and are not completely at the mercy of their own brain chemistry.
With these cases in mind, let us now return to the example of Luke the luger. To some extent, Luke, like an obese individual, is in control of his behavior. Presumably, there are ways one could influence Luke to give up luging. So should Luke be provided with a free adjacent seat on airplane flights? If he is sentenced to death, should his sentence be commuted to life in prison because a lethal injection through his scarred arms would cause him excessive pain? Should he pay the same for medical insurance as healthy individuals who do not engage in such dangerous behavior? The intuitive answer to each question appears to be no. And if we accept that Luke’s analogy accurately reflects cases of obesity, our answers should be the same in this regard as well.
- “usp-ray-4_3_r536_c534.jpg.” Image. USA Today. Online. 31 Jan. 2013. http://www.gannett-cdn.com/media/ USATODAY/USATODAY/2013/01/02/usp-ray-4_3_r536_c534.jpg?1b79b3da202957124496e3768cfb7b67cdb 10c81.
- “Ray Lewis.” ESPN.com. 2013. Online. 31 Jan. 2013. http://espn.go.com/nfl/player/_/id/964/ray-lewis.
- “Obese Flyers – How should airlines treat larger passengers?” The Economist. 12 Nov. 2012. Online. 6 Jan. 2013. http://www.economist.com/node/21566305.
- Bennett, Chuck. “Sickly, obese Bronx woman dies in Hungary after airlines say she’s too fat to fly.” New York Post. 26 Nov. 2012. Online. 6 Jan. 2013. http://www.nypost.com/p/news/local/airlines_left_my_wife_to_die_nF3WDbQiw0EZLnvYr9XQmM.
- Susman, Tina. “Inmate says he’s too obese for execution; victim’s son not swayed.” Los Angeles Times. 18 Sept. 2012. Online. 6 Jan. 2013. http://articles.latimes.com/2012/sep/18/nation/la-na-nn-obese-inmate-20120918.
- Crimesider Staff. “Ronald Post, condemned obese Ohio killer, granted clemency.” CBS News. 17 Dec. 2012. Online. 21 Jan. 2013. http://www.cbsnews.com/8301-504083_162-57559657-504083/ronald-post-condemned-obese-ohio-killer-granted-clemency.
- “Taxing the Fattest: First check your BMI…” The Economist. 1 Dec. 2012. Online. 6 Jan. 2013. http://www.economist.com/node/21567525.