A Weighty Topic – Obesity-Related Disabilities in a Health Care Setting

A number of anti-discrimination laws, including the Americans with Disabilities Act (the “ADA”) and Section 504 of the Rehabilitation Act of 1973 (“Section 504”), prohibit health care facilities from discriminating against patients who belong to a protected class, such as patients who have disabilities.  Obesity is not explicitly listed as a protected class in these laws.  Moreover, the vast majority of federal courts have held that obesity is not a physical impairment under the ADA unless it is caused by an underlying health condition. 

Despite this, the U.S. Department of Health and Human Services (the “Department”) has more broadly suggested obesity might be a physical impairment that substantially limits one or more of the patient’s major life activities, potentially rendering an obese patient a person with a disability.

While many providers are aware of the obligation to utilize medical diagnostic equipment (“MDE”) that meets the relevant federal accessibility standards—thus providing improved access for individuals with disabilities—what is thought of as accessible MDE might not necessarily accommodate patients who have an obesity-related disability.  Even when using MDE that meets traditional accessibility standards, a health care entity providing services to a patient with an obesity-related disability might encounter issues involving transferring the patient to an exam table or performing diagnostic imaging, for example.

Notably, in May 2024, the Department issued a final rule (the “Rule”) enhancing the patient protections provided by Section 504.  Among other things, the Rule addressed discrimination in medical treatment and the need for accessible MDE.  While the Rule does not explicitly reference technical requirements for MDE for patients with obesity-related disabilities, the Rule does not relieve a covered entity of its obligation to provide access to a patient with an obesity-related disability.  Thus, under Section 504, regardless of whether a facility purchases or otherwise acquires the required accessible MDE, the facility must still operate its programs and activities that use MDE so that the program or activity, in its entirety, is accessible to patients with disabilities, including those who have obesity-related disabilities.  To allow for overall program or activity accessibility, a health care entity might consider, the reassignment of services to alternate accessible locations, the acquisition of other accessible MDE, or even home visits.  Ultimately, ensuring that a patient with an obesity-related disability receives equal access will require a fact-intensive analysis to ensure compliance with the Rule and other applicable laws.