Discussion of: “The Growing

Disability Rolls:

Obesity Prevalence Among

Disability Applicants, 2005 – 2013”

by Schimmel, Mastrianni, Song, and Choi

Max Schmeiser

Federal Reserve Board

The opinions and conclusions expressed herein are solely my own and should not be construed as representing the opinions or policy of the Federal Reserve Board, Federal Reserve System, or any agency of the Federal government.

1

Overview

• Numerous studies linking obesity to increased risk of disability and receipt of SSDI (Burkhauser and Cawley, 2005; Lakdawalla, Bhattacharya, and Goldman, 2004; Ferraro et al., 2002; Narbro et al., 1996)

• Currently, we have a limited understanding of how being obese interacts with the disability application process – Not a listed impairment since October 1999

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Contribution

• Research purpose is to examine rates of obesity amongst SSDI and SSI applicants, as well as the role of obesity in disability determinations

• Use SSA administrative (EDCS) data to examine:

– Trends in applicant obesity relative to population

– Level of SSA review required by BMI category

– Initial determinations and allowances by BMI category

• Data include self-reported weight and height at time of application

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Summary of Findings

• Obesity prevalence amongst applicants has increased along with prevalence in general working-age population

• Obesity more prevalent amongst disability applicants – Partially driven by demographic (age, gender, education)

differences

– Not race?

• Musculoskeletal determination increases with BMI

• Greater prevalence of obesity among applicants at higher levels of review

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Initial Determinations and Allowances Made in 2013, by Body System and BMI Category*

19% 10%

28% 20%

35% 29%

38% 36%

27%

21%

29%

25%

26%

22%

22% 18%

4%

3%

5%

6%

7%

8%

8% 10%

10%

12%

9%

12%

8%

11%

7% 9% 8%

11%

4%

5%

3%

4%

4%

5% 12%

25%

7%

18%

5%

13%

4% 8%

15% 17% 11% 13% 9% 11% 8% 10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Determ. Allow Determ. Allow Determ. Allow Determ. Allow

Pe

rce

nt

of

tota

l ap

pli

cati

on

s

All other

MalignantNeoplastic

Endocrine

Respiratory

Special/Other

Neurological

Cardiovascular

Mental Disorders

Musculoskeletal

Underweight Normal weight Overweight Obese

Source: Schimmel et al (2014) calculations using the EDCS for initial applicants. 5

Trends in Obesity Prevalence and SSDI Receipt

0

5

10

15

20

25

30

35

40

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

10,000,000

Pe

rce

nt

of A

du

lts

Ob

ese

(Re

d)

Nu

mb

er

of S

SDI R

eci

pie

nts

(Blu

e)

6

Obesity and Disability Application

• Fundamentally, we are interested in causal relationships for shaping public policy responses

• Relationship between obesity and disability complex (potentially endogenous)

• Also complexity (ambiguity) in how obesity interacts with disability application, determination, and application review

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Obesity and Disability Application

• Factors driving relationship between obesity and disability:

• At the individual level:

– Disability (illness) can result in weight gain or loss – Certain demographic groups more prone to obesity and

over-represented in disability applications – May face discrimination or a wage penalty for obesity

• At the macro level:

– Obesity more prevalent in south and mid-west – Areas of high unemployment

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15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013

*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

CA

MT

ID

NV

UT

AZ NM

WY

WA

OR

CO

NE

ND

SD

TX

OK

KS

IA

MN

AR

MO

LA

MI

IN

KY

IL OH

TN

MS AL

WI

PA

WV

SC

VA

NC

GA

FL

NY

VT

ME

HI

AK

NH

MA

RI

CT NJ

DE

MD

DC

PR GUAM

9

Unemployment Rates by State, 2013

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Further Analysis

• NHANES data are particularly well-suited to analyzing the effect of obesity on disability application – Contain detailed health information (potentially prior to

disability onset or at least application) – Have multiple measures of adiposity including percent body fat

(BIA) and measured weight and height – Contain a reasonable set of demographic characteristics – Multiple waves linked to SSA MBR, SSR, PHUS, and 831 files

• Burkhauser, Cawley, and Schmeiser (2008) – Alternative measures of adiposity better predict SSDI application

(although self-reported BMI performs reasonably well) – Adiposity mainly predictive of application for whites

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Policy Implications

• Obesity leveling off, but at a high prevalence

– Child obesity also leveling off

• If obesity increases probability of SSDI or SSI application, or makes SSA’s determination process more difficult then the ongoing high prevalence will continue to be a burden on SSA

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Policy Implications

• From a policy perspective, I’m most interested in the implications for how SSA handles obese disability applicants – Whether or not obesity increases disability or

disability applications, beyond SSA’s control – Plenty of public health and economic reasons to

reduce obesity in general population

• Does SSA require clearer guidelines for assessing whether obese applicants are disabled? Implications for obese recipient employment? Something else? 13

Conclusion

• Area of inquiry is important given the prevalence of obesity amongst disability applicants

• Curious to see the implications of subsequent research for informing SSA’s response to increased prevalence of obesity

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Contact Information: Maximilian Schmeiser Senior Economist Federal Reserve Board Email: max.Schmeiser@frb.gov

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