Obesity

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Body Mass Index (BMI is calculated by dividing a person’s weight in kilograms by the square of their height in metres)

Limited cockpit space may constrain range of movement increasing risk of venous thrombo-embolic disease

Increased risk of sudden incapacitation secondary to cardiovascular disease (myocardial infarction and cerebrovascular accident)
Increased risk of sudden and subtle incapacitation secondary to sleep apnoea
Increased risk of complications of type 2 diabetes
Increased risk of incapacitating pulmonary embolus
Distraction due to pain from lower back pain, gall bladder disease, osteoarthritis
Limited cockpit space may impact on ability to fully and safely operate controls in normal and emergency situations
Ability to egress aircraft in emergency may be restricted
Weight may exceed design limitations of seat and harnesses
Body weight may have significant impact on weight and balance of aircraft

Appetite suppressants are disqualifying for medical certification
Medications which reduce absorption of dietary fat may cause significant GI side effects, headaches and anxiety. A two week ground trial will be required with DAME review
Bariatric surgery will require grounding for a period of up to 3 months with a DAME and CASA AVMED review before decision on fitness to return to flying or controlling

The result of a fasting glucose test (with follow up Glucose Tolerance Test if > or = 5.5mmol/L). Clinical status
A sleep study should be performed if
- Symptoms of OSA
- History of congestive heart failure, atrial fibrillation, treatment refractory hypertension, type 2 diabetes, nocturnal dysrhythmias, stroke, pulmonary hypertension
- Epworth sleep score >8
- Neck circumference >42cm for men and > 40cm in women
- History of aircraft or motor vehicle accident

The result of a fasting glucose test (with follow up Glucose Tolerance Test if > or = 5.5mmol/L)
A sleep study should be performed if
- Symptoms of OSA
- History of congestive heart failure, atrial fibrillation, treatment refractory hypertension, type 2 diabetes, nocturnal dysrhythmias, stroke, pulmonary hypertension
- Epworth sleep score >8
- Neck circumference >42cm for men and > 40cm in women
- History of aircraft or motor vehicle accident

An assessment by the DAME using the CASA cardiovascular risk profile, and if necessary, a cardiovascular assessment by a cardiologist or consultant physician, including results of resting ECG and interval Stress ECG. The report should detail:
- Clinical status.
- Presence and control of risk factors e.g. hypertension, smoking, hyperlipidaemia (Total Cholesterol, LDL and HDL fractions should be recorded), and the result of a fasting glucose test (with follow up Glucose Tolerance Test if >5.5mmol/L).
- Risk of any acutely disabling cardiovascular event.
A sleep study should be performed.
An operational check.
- The operational check is to be conducted by either a Civil Aviation Safety Authority Flight Operations Inspector or a Civil Aviation Safety Authority Approved Test Officer or your local Chief Flying Instructor. To arrange this test please telephone the Manager of Flying Operations on 131 757 or your flying school
- an operational check of the applicant with special attention being given to ability to fully utilize all controls to full extent of travel and ability to exit aircraft expediently in the event of emergency, and also pay attention to the accurate assessment of weight and balance calculations in the aircraft (please provide an example of the applicant’s calculations for his weight)

Uncomplicated obesity responding to diet and exercise
Uncomplicated bariatric surgery following period of grounding and satisfactory review

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer