Feature Articles - Weekly Feature
BMI: What is Being Measured?
The Federal Motor Carrier Safety Administration (FMCSA) is now looking at making new regulations that will require any CDL holder whose body mass index (BMI) is 30 or above be tested for sleep apnea. This was brought up by the FMCSA medical review board last January 28 at their meeting in Utah. Some physicians have already started testing as I found out during my last DOT physical this past September when the corporate doctor measured my neck. He said that the DOT required that anyone with a neck measurement over 16 inches for women or 19 inches for men be given a restricted medical card and then would be required to have a mandatory sleep study done.
Where is all of this coming from? It is from people trying to figure out why truckers are fatigued and to find reasons for accidents involving trucks-so they say.
At the January meeting, Landline reported one testifying doctor's credentials and what she said and didn't say:
"Dr. Barbara Phillips, a former chairman of the drug company-funded National Sleep Foundation, ushered the FMCSA's Medical Review Board through the recommendation process in only a few minutes. Then she made a landmark claim.
‘The data do indicate the more you weigh, the more likely you are to crash,' she said, slowing to enunciate each word.
Phillips, who directs a sleep medicine program at the University of Kentucky Good Samaritan Hospital in Lexington, Kentucky, didn't go on to list the National Sleep Foundation's millions of dollars in annual contributions from pharmaceutical companies and at least one C-PAP manufacturer."
Interesting that someone with ties to sleep study clinics, pharmaceutical companies, and C-PAP manufacturers is pushing BMI and mandatory sleep studies. Sleep studies run from $2,000 to $3,000 or more. C-PAP machines can cost more than $2,000. Drugs to help sleep apnea are also expensive. Anyone else remember the old saw about "following the money" here?
The USA isn't the only country considering BMI as an indicator of sleep apnea as a cause for driver fatigue. Israel, where only 6 percent of the vehicles are trucks and where it is basically day work with little or no overnight runs, has a 20 percent incidence of fatality accidents involving trucks and cites driver fatigue as a possible cause of the wrecks. Brazil too, has done studies concerning driver fatigue and the involvement of sleep apnea in truck accidents. The UK has done extensive studies concerning BMI. RoadTransport.com reports that eight in ten of male truck drivers in the UK are overweight. In the article [http://www.roadtransport.com/Articles/2007/10/18/128741/eight-out-of-ten-male-truckers-is-overweight.html], a health education warns truckers must improve their lifestyle or face serious consequences.
"The results are a cause for concern because they indicate that there is a very high percentage of drivers on the road whose health makes them a potential hazard. A waist measurement of 40 inches or more and a Body Mass Index of 30 or more can spell danger because both are indicators of a high risk of Type 2 diabetes, which in turn can trigger sleep apnea."
The problem with BMI is that the calculation of height versus weight is not an accurate measure as it does not take into account individual bone structure or muscular development among other variables. From Wikepedia:
"...it (BMI) is not considered appropriate to use as a final indication for diagnosing individuals. It was invented between 1830 and 1850 by Adolphe Quetelet during the course of developing ‘social physics.' However, BMI categories do not take into account many factors such as frame size and muscularity. The categories also fail to account for varying proportions of fat, bone, cartilage, water weight, and more."
It is interesting to note here that when BMI was developed, they also were thinking that the lumps on one's head, phrenology, indicated character and mental capability, it has since been discredited.
All Americans and from the looks of it, people around the world, are weighing more today and yes, in some cases, this added weight gain can contribute to sleep apnea and other health issues. There are, however, other factors as reported in a recent study from Israel [http://injuryprevention.bmj.com/cgi/content/abstract/11/2/110] :
"...38.1percent of the drivers had worked more than the 12 hour legal limit. More than 30 percent reported falling asleep at the wheel recently and 13 percent had prior involvement in a sleep related crash. Sixty-seven (41.9 percent) drivers said that their employer forced them to work beyond the legal 12-hour daily limit. Involvement in a crash with casualties was associated with poor sleep quality and frequent difficulty finding parking when tired. Self-assessment of fatigue underestimated fatigue from the Pittsburgh Sleep Quality Questionnaire. However, fatigue occurred in many drivers without sleep problems and many crashes occurred without fatigue."
As the above study shows, though fatigue is a considerable factor in truck related wrecks, the fatigue can come from many other reasons than sleep apnea or BMI. Prolonged waits at shippers and receivers, parking availability, road construction, being pushed by disproportionate scheduling, and bad weather are all major contributors to fatigue.
Just what is the real purpose to measuring BMI? Could this just be one more "disease du jour" that will mean more money for someone outside of the trucking industry? Will it just weed out undesirable drivers based on weight? I don't know for sure, but there is sure something afoot in the FMCSA that is going to adversely affect a significant number of drivers again.