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EEOC now claims obesity is a disability under ADAAA. The U.S. Equal Employment Opportunity Commission (EEOC) now claims obesity is a disability under the Americans with Disabilities Act Amendments Act (ADAAA). Until now, the courts have routinely rejected general obesity as a "disability" under the ADA and Rehabilitation Act. Cases have required one to show some different underlying medical condition that is a disability and that causes obesity as a "symptom." Now the EEOC has filed suit, claiming that a company discriminatorily fired an employee because of obesity. The EEOC claims that ever since President George W. Bush authorized the ADA Amendments Act in 2008, the law has a much lower threshold for what constitutes a disability. The EEOC claims that basic obesity, without any other underlying condition, sufficiently impacts the life activities of bending, walking, digestion, cell growth, etc., to qualify as a disability or perceived disability. EEOC v. Resources for Human Development (E.D. LA.2010).
Animal trials of the electronic implant are about to begin and its makers say it could provide a more effective alternative to weight-loss surgery. The chip is attached to the vagus nerve which plays a role in appetite as well as a host of other functions within the body. Human trials of the implant could begin within three years, say its makers. The work is being led by Prof Chris Toumazou and Prof Sir Stephen Bloom of Imperial College London. It involves an 'intelligent implantable modulator', just a few millimetres across, which is attached using cuff electrodes to the vagus nerve within the peritoneal cavity found in the abdomen. The chip and cuffs are designed to read and process electrical and chemical signatures of appetite within the nerve. The chip can then act upon these readings and send electrical signals to the brain reducing or stopping the urge to eat.
The researchers say identifying chemicals rather than electrical impulses will make for a more selective, precise instrument. The project has just received over 7m euros (£5.9m; $9m) in funding from the European Research Council. A similar device designed by the Imperial team has already been developed to reduce epileptic seizures by targeting the same vagus nerve. "This is a really small microchip and on this chip we've got the intelligence which can actually model the neural signals responsible for appetite control," Prof Toumazou told the BBC. "And as a result of monitoring these signals we can stimulate the brain to counter whatever we monitor. "It will be control of appetite rather than saying don't eat completely. So maybe instead of eating fast you'll eat a lot slower." He said initial laboratory trials had already demonstrated proof of concept.
Prof Bloom, who heads Imperial's diabetes, endocrinology and metabolism division, said the chip could provide an alternative to "gross surgery". The chip is described as an 'intelligent implantable modulator of vagus nerve function for treatment of obesity' "There will be a little tiny insert and it will be so designed as to have no side effects, but restrict appetite in a natural way. "As far as the brain is concerned, it will get the same signals from the intestinal system as it normally gets after a meal, and these signals tell it don't eat any more - the gut's full of food and you don't need to eat any more." He claimed that unlike gastric banding, the chip would reduce both consumption and hunger pangs, and was therefore more likely to be effective.
Nerve blocks
Every two years, Antonio Beltran, like his classmates, steps on a scale. Trained district personnel also measure his height and then use the two figures to calculate his body mass index, an indicator of body fat. The calculation isn't reported to Beltran or her son, who cannot see the readout on the scale that has a remote display. Instead it's used by the district to collect local data on children's weight. Beltran supports her son's school in measuring students because the data has brought in help to address obesity, which can lead to diabetes and other illnesses tied to a lifetime of poor habits. But the practice hasn't been embraced everywhere.
Other school districts have angered parents and eating disorder groups by conducting screenings to identify overweight children and send home what critics call obesity report cards or "fat letters." Amid the nation's childhood obesity epidemic, schools in nearly a quarter of all states record body mass index scores, measuring hundreds of thousands of students. Some, like the Chula Vista Elementary School District, do what is known as surveillance, in which students are measured to identify how many are at risk for weight-related health problems but they remain anonymous. Other districts do screenings to track the weight of individual students and notify parents whose children are classified at an unhealthy weight.
Chula Vista is being touted for its methods that have resulted in motivating the community to take action. When nearly 25,000 students were measured in 2010, it discovered about 40 percent of its children were obese or overweight. Officials used the data to make a color-coded obesity map of the district and showed the community. Instead of creating a stir, the information acted as a distress call, bringing in help. Schools boosted partnerships with doctors. They planted gardens, banned cupcakes at school birthdays, and tracked kids' activity levels. "I've seen a dramatic change," Beltran said of her son, who now eats carrots and looks forward to running club.
Chula Vista's program which measures students in grades kindergarten through sixth grade differs from California's state-mandated program for fifth, seventh and ninth graders that screens students and notifies parents of the scores. Vicki Greenleaf said she received what she called a "fat letter" in the mail last summer from the Los Angeles Unified School District. Her daughter does Brazilian martial arts four times a week and is built like Olympic gold medalist Mary Lou Retton, but was classified as overweight by the state-mandated body mass index screening program, she said. Critics say body mass index can be misleading for muscular body types.
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The woman, who was morbidly obese, was part of the largest-ever audit of “accidental awareness during general anesthesia” published three years ago, a U.K.-based review that found a disproportionate number of people who report experiencing the terrifying phenomenon are obese. New Canadian research may help explain why. The study found a standard formula used to calculate the amount of propofol, a widely used anesthetic, needed to induce unconsciousness can result in serious under-dosing for people with morbid obesity, defined as a body mass index of 40 or more, and the fastest growing weight class in the country. Anesthesiologists usually base propofol induction doses in the obese on lean body weight — the person’s body weight, minus the fat.
The worry is that using total body weight can lead to serious overdoses in the extremely obese, resulting, among other serious complications, in a rapid drop in blood pressure and decreased blood flow to the heart and brain. However, the new study finds using lean body weight to calculate induction doses for morbidly obese people resulted in an “insufficient” depth of anesthesia in 60 per cent of cases, compared to using brain waves to guide dosing. A leading cause of accidental awareness is failure to deliver sufficient anesthetic to the body. For the new study, researchers randomly assigned 60 patients undergoing bariatric, or stomach-shrinking surgery, to one of two groups. In the first group, doctors dosed propofol based on lean body weight.
The rue dose of propofol required is certainly higher than the lean body weight but a littler lower than total body weight
In the second, they used a special device known as a BIS, or bispectral index monitor, which measures brain activity to determine how deeply a patient is anesthetized. The monitor translates the information into a single number, from 100 (meaning the person is wide awake) to zero (no brain electrical activity.) The propofol infusion was stopped once the number dropped to 50. In both groups, doctors used the trapezius-squeezing test — squeezing the trapezius muscle located between the neck and shoulder — to assess the depth of anesthesia. In the first group, 18 out of 30 people were still “responsive” after the initial dose of propofol and required additional doses before reaching a sufficient level of sedation.
In the brain-monitored group, all but one of the patients was “unresponsive” at the target of a BIS of 50. None of the patients in either group reported awareness. The phenomenon itself is exceedingly rare, occurring in an estimated one in 19,000 general anesthetics. However, propofol is highly fat soluble, meaning it gets stored in fat, making it harder to reach sufficient levels in specific target receptors in the brain to sedate people for surgery. “Using the lean body weight formula probably isn’t the best method to dose your propofol in the morbidly obese patient, because it results in under-dosing,” said Dr. Jean Wong, an anesthesiologist at Toronto Western Hospital and senior author of the new study, published in the Canadian Journal of Anesthesia.
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