# SSR 00-3p: SSR 00-3p: Superseded

> Federal · Rulings · In force

URL: https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_00_3p

## Section

- **Citation:** SSR 00-3p
- **Heading:** SSR 00-3p: Superseded
- **Jurisdiction:** Federal
- **Kind:** Rulings
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Social Security Rulings / DI / Disability Insurance — Medical / SSR 00-3p

## Text

SSR 00-3p (Superseded 9/12/2002 by SSR
02-1p )

EFFECTIVE/PUBLICATION DATE: 5/15/00

Policy Interpretation Ruling

PURPOSE:

To provide guidance on SSA policy concerning the evaluation of obesity in
disability claims filed under titles II and XVI of the Social Security Act
(the Act).

CITATIONS:

Sections 216(i), 223(d), 223(f), 1614(a), and 1614(c) of the Act, as
amended; Regulations No. 4, subpart P, sections 404.1502, 404.1508,
404.1509, 404.1512, 404.1520, 404.1521, 404.1523, 404.1525, 404.1526,
404.1528, 404.1529, 404.1530, 404.1545, 404.1546, 404.1561, 404.1594, and
appendix 1; and Regulations No. 16, subpart I, sections 416.902, 416.908,
416.909, 416.912, 416.920, 416.921, 416.923, 416.924, 416.925, 416.926,
416.926a, 416.928, 416.929, 416.930, 416.933, 416.945, 416.946, 416.961,
416.994, and 416.994a.

INTRODUCTION:

On August 24, 1999, we [1] published a final rule in the Federal Register deleting listing 9.09, Obesity , from the Listing of Impairments in 20 CFR, subpart P,
appendix 1 (the listings). The final rule was effective on October 25,
1999. 64 FR 46122 (1999).

We stated in the preamble to the final rule that we deleted listing 9.09
because our experience adjudicating cases under this listing indicated
that the criteria in the listing were not appropriate indicators of
listing-level severity. In our experience, the criteria in listing 9.09
did not represent a degree of functional limitation that would prevent an
individual from engaging in any gainful activity.
the preamble to the final rule that we deleted listing 9.09
because our experience adjudicating cases under this listing indicated
that the criteria in the listing were not appropriate indicators of
listing-level severity. In our experience, the criteria in listing 9.09
did not represent a degree of functional limitation that would prevent an
individual from engaging in any gainful activity.

However, even though we deleted listing 9.09, we made some changes to the
listings to ensure that obesity is still addressed in our listings. In the
final rule, we added paragraphs to the prefaces of the musculoskeletal,
respiratory, and cardiovascular body system listings that provide guidance
about the potential effects obesity has in causing or contributing to
impairments in those body systems. See listings sections 1.00F,
3.00I, and 4.00F. The paragraphs state that we consider obesity to be a
medically determinable impairment and remind adjudicators to consider its
effects when evaluating disability. The provisions also remind
adjudicators that the combined effects of obesity with other impairments
can be greater than the effects of each of the impairments considered
separately. They also instruct adjudicators to consider the effects of
obesity not only under the listings but also when assessing a claim at
other steps of the sequential evaluation process, including when assessing
an individual's residual functional capacity.

In response to public comments, we stated that we would provide additional
guidance in a Social Security Ruling (SSR). (64 FR at 46126) This SSR
provides that additional guidance by discussing how we evaluate obesity in
disability claims filed by adults and children under titles II and XVI of
the Act.

POLICY INTERPRETATION:

General

1. What is obesity?

Obesity is a complex, chronic disease characterized by excessive
accumulation of body fat. Obesity is generally the result of a combination
of factors (e.g., genetic, environmental, and behavioral).
dditional guidance by discussing how we evaluate obesity in
disability claims filed by adults and children under titles II and XVI of
the Act.

POLICY INTERPRETATION:

General

1. What is obesity?

Obesity is a complex, chronic disease characterized by excessive
accumulation of body fat. Obesity is generally the result of a combination
of factors (e.g., genetic, environmental, and behavioral).

In one sense, the cause of obesity is simply that the energy (food) taken
in exceeds the energy expended by the individual's body. However, the
influences on intake, the influences on expenditure, the metabolic
processes in between, and the overall genetic controls are complex and not
well understood.

The National Institutes of Health (NIH) established medical criteria for
the diagnosis of obesity in its Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obesity in
Adults (NIH Publication No. 98-4083, September 1998). These
guidelines classify overweight and obesity in adults according to Body
Mass Index (BMI). BMI is the ratio of an individual's weight in kilograms
to the square of his or her height in meters (kg/m²). For adults, both men
and women, the Clinical Guidelines describe a BMI of 25-29.9
as "overweight" and a BMI of 30.0 or above as "obesity."

The Clinical Guidelines recognize three levels of obesity.
Level I includes BMIs of 30.0-34.9. Level II includes BMIs of 35.0-39.9.
Level III, termed "extreme" obesity and representing the greatest risk for
developing obesity-related impairments, includes BMIs greater than or
equal to 40. These levels describe the extent of obesity, but they do not
correlate with any specific degree of functional loss.
al Guidelines recognize three levels of obesity.
Level I includes BMIs of 30.0-34.9. Level II includes BMIs of 35.0-39.9.
Level III, termed "extreme" obesity and representing the greatest risk for
developing obesity-related impairments, includes BMIs greater than or
equal to 40. These levels describe the extent of obesity, but they do not
correlate with any specific degree of functional loss.

In addition, although there is often a significant correlation between BMI
and excess body fat, this is not always the case. The Clinical
Guidelines also provide for considering whether an individual of a
given height and weight has excess body fat when determining whether he or
she has obesity. Thus, it is possible for someone whose BMI is below 30 to
have obesity if too large a percentage of the weight is from fat.
Likewise, someone with a BMI above 30 may not have obesity if a large
percentage of the weight is from muscle. However, in most cases, the BMI
will show whether the individual has obesity. It also will usually be
evident from the information in the case record whether the individual
should not be found to have obesity, despite a BMI of 30.0 or above. See
question 4, below.

The Clinical Guidelines do not provide criteria for
diagnosing obesity in children. However, a BMI greater than or equal to
the 95 th percentile for a child's age is generally considered
sufficient to establish the diagnosis of obesity. (BMIs in the
95 th percentile vary by age and sex of the child.)
BMI-for-age-and-gender charts are published in medical textbooks or
professional journals and by the National Center for Health Statistics. As
with adults, the amount of body fat is considered in making the diagnosis
of obesity in children.

Treatment for obesity is often unsuccessful. Even if treatment results in
weight loss at first, weight lost is often regained, despite the efforts
of the individual to maintain the loss. See question 13, below, for
additional discussion of obesity treatment.
onal Center for Health Statistics. As
with adults, the amount of body fat is considered in making the diagnosis
of obesity in children.

Treatment for obesity is often unsuccessful. Even if treatment results in
weight loss at first, weight lost is often regained, despite the efforts
of the individual to maintain the loss. See question 13, below, for
additional discussion of obesity treatment.

2. How does obesity affect physical and mental health?

Obesity is a risk factor that increases an individual's chances of
developing impairments in most body systems. It commonly leads to, and
often complicates, chronic diseases of the cardiovascular, pulmonary, and
musculoskeletal body systems. Obesity increases the risk of developing
impairments such as type II (so-called adult onset) diabetes
mellitus—even in children; gall bladder disease; hypertension; heart
disease; peripheral vascular disease; dyslipidemia (abnormal levels of
fatty substances in the blood); stroke; osteoarthritis; and sleep apnea.
It is associated with endometrial, breast, prostate, and colon cancers,
and other physical impairments. Obesity may also cause or contribute to
mental impairments such as depression. The effects of obesity may be
subtle, such as the loss of mental clarity and slowed reactions that may
result from obesity-related sleep apnea.

The fact that obesity is a risk factor for other impairments does not mean
that individuals with obesity necessarily have any of these impairments.
It means that they are at greater than average risk for developing the
other impairments.

3. How do we consider obesity in the sequential evaluation
process? [2]

We will consider obesity in determining whether:

- The individual has a medically determinable impairment. See question
4.

- The individual's impairment(s) is severe. See question 6.
sity necessarily have any of these impairments.
It means that they are at greater than average risk for developing the
other impairments.

3. How do we consider obesity in the sequential evaluation
process? [2]

We will consider obesity in determining whether:

- The individual has a medically determinable impairment. See question
4.

- The individual's impairment(s) is severe. See question 6.

- The individual's impairment(s) meets or equals the requirements of a
listed impairment in the listings. See question 7. (We use special rules
for some continuing disability reviews. See question 11.)

- The individual's impairment(s) prevents him or her from doing past
relevant work and other work that exists in significant numbers in the
national economy. However, these steps apply only in title II and adult
title XVI cases. See questions 8 and 9.

4. How is obesity identified as a medically determinable
impairment?

When establishing the existence of obesity, we will generally rely on the
judgment of a physician who has examined the claimant and reported his or
her appearance and build, as well as weight and height. Thus, in the
absence of evidence to the contrary in the case record, we will accept a
diagnosis of obesity given by a treating source or by a consultative
examiner. However, if there is evidence that indicates that the diagnosis
is questionable and the evidence is inadequate to determine whether or not
the individual is disabled, we will contact the source for clarification,
using the guidelines in 20 CFR 404.1512(e) and 416.912(e).
ontrary in the case record, we will accept a
diagnosis of obesity given by a treating source or by a consultative
examiner. However, if there is evidence that indicates that the diagnosis
is questionable and the evidence is inadequate to determine whether or not
the individual is disabled, we will contact the source for clarification,
using the guidelines in 20 CFR 404.1512(e) and 416.912(e).

When the evidence in a case does not include a diagnosis of obesity, but
does include clinical notes or other medical records showing consistently
high body weight or BMI, we may ask a medical source to clarify whether
the individual has obesity. However, in most such cases we will use our
judgment to establish the presence of obesity based on the medical
findings and other evidence in the case record, even if a treating or
examining source has not indicated a diagnosis of obesity. Generally, we
will not purchase a consultative examination just to establish the
diagnosis of obesity.

When deciding whether an individual has obesity, we will also consider the
individual's weight over
time. [3] We will not count
minor, short-term weight loss. We will consider the individual to have
obesity as long as his or her weight or BMI shows essentially a consistent
pattern of obesity. (See question 13 for a discussion of weight loss and
medical improvement.)

Finally, there are a number of methods for measuring body fat and, if such
information is in a case record, we will consider it. However, we will not
purchase such testing. In most cases, the medical and other evidence in
the case record will establish whether the individual has obesity.

5. Can we find an individual disabled based on obesity
alone?
n of weight loss and
medical improvement.)

Finally, there are a number of methods for measuring body fat and, if such
information is in a case record, we will consider it. However, we will not
purchase such testing. In most cases, the medical and other evidence in
the case record will establish whether the individual has obesity.

5. Can we find an individual disabled based on obesity
alone?

If an individual has the medically determinable impairment obesity that is
"severe" as described in question 6, we may find that the obesity
medically equals a listing. (In the case of a child seeking benefits under
title XVI, we may also find that it functionally equals a listing.) We may
also find in a title II claim, or an adult claim under title XVI, that the
obesity results in a finding that the individual is disabled based on his
or her residual functional capacity (RFC), age, education, and past work
experience. However, we will also consider the possibility of coexisting
or related conditions, especially as the level of obesity increases. We
provide an example of when we may find obesity to medically equal a
listing in question 7.

Sequential Evaluation: Step 2, Severe
Impairment

6. When is obesity a "severe" impairment?

As with any other medical condition, we will find that obesity is a
"severe" impairment when, alone or in combination with another medically
determinable physical or mental impairment(s), it significantly limits an
individual's physical or mental ability to do basic work activities. (For
children applying for disability under title XVI, we will find that
obesity is a "severe" impairment when it causes more than a minimal
functional limitation.) We will also consider the effects of any symptoms
(such as pain or fatigue) that could limit functioning
ical or mental impairment(s), it significantly limits an
individual's physical or mental ability to do basic work activities. (For
children applying for disability under title XVI, we will find that
obesity is a "severe" impairment when it causes more than a minimal
functional limitation.) We will also consider the effects of any symptoms
(such as pain or fatigue) that could limit functioning. (See SSR 85-28 , "Titles II and XVI: Medical
Impairments That Are Not Severe" and SSR
96-3p , "Titles II and XVI: Considering Allegations of Pain and Other
Symptoms In Determining Whether a Medically Determinable Impairment Is
Severe.") Therefore, we will find that an impairment(s) is "not severe"
only if it is a slight abnormality (or a combination of slight
abnormalities) that has no more than a minimal effect on the individual's
ability to do basic work activities (or, for a child applying under title
XVI, if it causes no more than minimal functional limitations).

There is no specific level of weight or BMI that equates with a "severe"
or a "not severe" impairment. Neither do descriptive terms for levels of
obesity (e.g., "severe," "extreme," or "morbid" obesity) establish whether
obesity is or is not a "severe" impairment for disability program
purposes. Rather, we will do an individualized assessment of the impact of
obesity on an individual's functioning when deciding whether the
impairment is severe.

Step 3, The Listings

7. How do we evaluate obesity at step 3 of sequential evaluation,
the listings?

Obesity may be a factor in both "meets" and "equals" determinations.
ity is or is not a "severe" impairment for disability program
purposes. Rather, we will do an individualized assessment of the impact of
obesity on an individual's functioning when deciding whether the
impairment is severe.

Step 3, The Listings

7. How do we evaluate obesity at step 3 of sequential evaluation,
the listings?

Obesity may be a factor in both "meets" and "equals" determinations.

Because there is no listing for obesity, we will find that an individual
with obesity "meets" the requirements of a listing if he or she has
another impairment that, by itself, meets the requirements of a listing.
We will also find that a listing is met if there is an impairment that, in
combination with obesity, meets the requirements of a listing. For
example, obesity may increase the severity of coexisting or related
impairments to the extent that the combination of impairments meets the
requirements of a listing. This is especially true of musculoskeletal,
respiratory, and cardiovascular impairments. It may also be true for other
coexisting or related impairments, including mental disorders.

For example, when evaluating impairments under mental disorder listings
12.05C, 112.05D, or 112.05F, obesity that is "severe," as explained in
question 6, satisfies the criteria in listing 12.05C for a physical
impairment imposing an additional and significant work-related limitation
of function and in listings 112.05D and 112.05F for a physical impairment
imposing an additional and significant limitation[s] of function. We will
find the requirements of those listings are met if an individual meets all
of the other requirements of the listings, including the capsule
definition of mental retardation contained in the listings. (See SSR 98-1p , "Title XVI:
Determining Medical Equivalency in Childhood Disability Claims When a
Child Has Marked Limitations in Cognition and Speech.")
icant limitation[s] of function. We will
find the requirements of those listings are met if an individual meets all
of the other requirements of the listings, including the capsule
definition of mental retardation contained in the listings. (See SSR 98-1p , "Title XVI:
Determining Medical Equivalency in Childhood Disability Claims When a
Child Has Marked Limitations in Cognition and Speech.")

We may also find that obesity, by itself, is medically equivalent to a
listed impairment (or, in the case of a child applying under title XVI,
also functionally equivalent to a listed impairment). For example, if the
obesity is of such a level that it markedly limits the individual's
ability to walk and stand, it may substitute for arthritis (and its
associated criteria) of a weight-bearing joint with "gross anatomical
deformity of a hip or knee" in listing 1.03A, and we will then make a
finding of equivalence. (See question 8 for further discussion of
evaluating the functional effects of obesity, including functional
equivalence determinations for children applying for benefits under title
XVI.)

We will also find equivalence if an individual has multiple impairments,
including obesity, no one of which meets or equals the requirements of a
listing, but the combination of impairments is equivalent in severity to a
listed impairment. For example, obesity affects the cardiovascular and
respiratory systems because of the increased workload the additional body
mass places on these systems. Obesity makes it harder for the chest and
lungs to expand. This means that the respiratory system must work harder
to provide needed oxygen. This in turn makes the heart work harder to pump
blood to carry oxygen to the body. Because the body is working harder at
rest, its ability to perform additional work is less than would otherwise
be expected
additional body
mass places on these systems. Obesity makes it harder for the chest and
lungs to expand. This means that the respiratory system must work harder
to provide needed oxygen. This in turn makes the heart work harder to pump
blood to carry oxygen to the body. Because the body is working harder at
rest, its ability to perform additional work is less than would otherwise
be expected. Thus, we may find that the combination of a pulmonary or
cardiovascular impairment and obesity has signs, symptoms, and laboratory
findings that are of equal medical significance to one of the respiratory
or cardiovascular
listings. [4]

However, we will not make assumptions about the severity or functional
effects of obesity combined with other impairments. Obesity in combination
with another impairment may or may not increase the severity or functional
limitations of the other impairment. We will evaluate each case based on
the information in the case record.

Sequential Evaluation: Steps 4 and 5, Assessing
Functioning in Adults Step 3, Assessing Functional Equivalence in
Children

8. How do we evaluate obesity in assessing residual functional
capacity in adults and functional equivalence in children?

Obesity can cause limitation of function. The functions likely to be
limited depend on many factors, including where the excess weight is
carried. An individual may have limitations in any of the exertional
functions such as sitting, standing, walking, lifting, carrying, pushing,
and pulling. It may also affect ability to do postural functions, such as
climbing, balance, stooping, and crouching. The ability to manipulate may
be affected by the presence of adipose (fatty) tissue in the hands and
fingers. The ability to tolerate extreme heat, humidity, or hazards may
also be affected.
exertional
functions such as sitting, standing, walking, lifting, carrying, pushing,
and pulling. It may also affect ability to do postural functions, such as
climbing, balance, stooping, and crouching. The ability to manipulate may
be affected by the presence of adipose (fatty) tissue in the hands and
fingers. The ability to tolerate extreme heat, humidity, or hazards may
also be affected.

The effects of obesity may not be obvious. For example, some people with
obesity also have sleep apnea. This can lead to drowsiness and lack of
mental clarity during the day. Obesity may also affect an individual's
social functioning.

An assessment should also be made of the effect obesity has upon the
individual's ability to perform routine movement and necessary physical
activity within the work environment. Individuals with obesity may have
problems with the ability to sustain a function over time. As explained in SSR 96-8p ("Titles II and XVI: Assessing
Residual Functional Capacity in Initial Claims"), our RFC assessments must
consider an individual's maximum remaining ability to do
sustained work activities in an ordinary work setting on a regular and
continuing basis. A "regular and continuing basis" means 8 hours a day,
for 5 days a week, or an equivalent work
schedule. [5] In cases involving
obesity, fatigue may affect the individual's physical and mental ability
to sustain work activity. This may be particularly true in cases involving
sleep apnea.

The combined effects of obesity with other impairments may be greater than
might be expected without obesity. For example, someone with obesity and
arthritis affecting a weight-bearing joint may have more pain and
limitation than might be expected from the arthritis alone.
al's physical and mental ability
to sustain work activity. This may be particularly true in cases involving
sleep apnea.

The combined effects of obesity with other impairments may be greater than
might be expected without obesity. For example, someone with obesity and
arthritis affecting a weight-bearing joint may have more pain and
limitation than might be expected from the arthritis alone.

For a child applying for benefits under title XVI, we will evaluate the
functional consequences of obesity (either alone or in combination with
other impairments) to decide if the child's impairment(s) functionally
equals the severity of a listed impairment that includes disabling
functional limitations among its criteria. For example, the functional
limitations imposed by obesity, by itself or in combination with another
impairment(s), may establish an extreme limitation in one broad area of
functioning (e.g., motor) or marked limitations in two broad areas of
functioning (e.g., motor and social). We may also find that the functional
limitations imposed by obesity establish functional equivalence based on
one of the other methods set out in 20 CFR 416.926a.

As with any other impairment, we will explain how we reached our
conclusions on whether obesity caused any physical or mental
limitations.

9. How can we consider obesity in the assessment of RFC when SSR 96-8p "Age and body habitus are not
factors in assessing RFC"?
limitations imposed by obesity establish functional equivalence based on
one of the other methods set out in 20 CFR 416.926a.

As with any other impairment, we will explain how we reached our
conclusions on whether obesity caused any physical or mental
limitations.

9. How can we consider obesity in the assessment of RFC when SSR 96-8p "Age and body habitus are not
factors in assessing RFC"?

The SSR goes on to say that "[i]t is incorrect to find that an individual
has limitations beyond those caused by his or her medically
determinable impairment(s) and any related symptoms , due to such
factors as age and natural body build, and the activities the individual
was accustomed to doing in his or her previous work." (Emphasis added.) We
included the italicized statement in the SSR to distinguish between
individuals who have a medically determinable impairment of obesity and
individuals who do not. When we identify obesity as a medically
determinable impairment (see question 4, above), we will consider any
functional limitations resulting from the obesity in the RFC assessment,
in addition to any limitations resulting from any other physical or mental
impairments that we identify.

Effect of the Rules Change: Claims in Which
Prior Listings Apply and Do Not Apply

10. How does the deletion of listing 9.09 affect claims pending on
October 25, 1999?

The final rules that deleted the listing became effective on October 25,
1999. The final rules deleting listing 9.09 apply to claims that were
filed before October 25, 1999, and that were awaiting an initial
determination or that were pending appeal at any level of the
administrative review process or that had been appealed to court. The
change affected the entire claim, including the period before October 25,
1999. This is our usual policy with respect to any change in our
listings.
deleting listing 9.09 apply to claims that were
filed before October 25, 1999, and that were awaiting an initial
determination or that were pending appeal at any level of the
administrative review process or that had been appealed to court. The
change affected the entire claim, including the period before October 25,
1999. This is our usual policy with respect to any change in our
listings.

However, different rules apply to individuals who were already found
eligible to receive benefits prior to October 25, 1999. For an explanation
of how we apply listing 9.09 in continuing disability reviews, see
question 11.

11. How does deletion of listing 9.09 affect claims already
allowed?

Deletion of listing 9.09 does not affect the entitlement or eligibility of
individuals receiving benefits because their impairment(s) met or equaled
that listing. We will not find that their disabilities have ended just
because we deleted listing 9.09.

We must periodically review all claims to determine whether the
individual's disability continues. When we conduct a periodic continuing
disability review (CDR), we will not find that an individual's disability
has ended based on a change in a listing. For individuals receiving
disability benefits under title II and adults receiving payments under
title XVI, we apply the medical improvement review standard described in
20 CFR 404.1594 and 416.994.

We will first evaluate whether the individual's impairment(s) has
medically improved and, if so, whether any medical improvement is related
to the ability to work. If the individual's impairment(s) has not
medically improved, we will find that he or she is still disabled, unless
we find that an exception to the medical improvement standard applies.
Even if the impairment(s) has medically improved, we will find that the
improvement is not related to the ability to work if the impairment(s)
continues to meet or equal the same listing section used to make our most
recent favorable decision
as not
medically improved, we will find that he or she is still disabled, unless
we find that an exception to the medical improvement standard applies.
Even if the impairment(s) has medically improved, we will find that the
improvement is not related to the ability to work if the impairment(s)
continues to meet or equal the same listing section used to make our most
recent favorable decision. This is true even if we have since deleted the
listing section that we used to make the most recent favorable decision.
See 20 CFR 404.1594(c)(3)(i) and 416.994(b)(2)(iv)(A). We apply a similar
provision when we do CDRs for individuals who have not attained age 18 and
who are eligible for title XVI benefits based on disability (20 CFR
416.994a(b)(2)).

Even if the individual's impairment(s) has medically improved and no
longer meets or equals prior listing 9.09, we must still determine whether
he or she is currently disabled, considering all of the impairments.

12. What amount of weight loss would represent "medical
improvement"?

Because an individual's weight may fluctuate over time and minor weight
changes are of little significance to an individual's ability to function,
it is not appropriate to conclude that an individual with obesity has
medically improved because of a minor weight loss. A loss of less than 10
percent of initial body weight is too minor to result in a finding that
there has been medical improvement in the obesity. However, we will
consider that obesity has medically improved if an individual maintains a
consistent loss of at least 10 percent of body weight for at least 12
months. We will not count minor, short-term changes in weight when we
decide whether an individual has maintained the loss consistently.

If there is a coexisting or related condition(s) and the obesity has not
improved, we will still consider whether the coexisting or related
condition(s) has medically improved.
aintains a
consistent loss of at least 10 percent of body weight for at least 12
months. We will not count minor, short-term changes in weight when we
decide whether an individual has maintained the loss consistently.

If there is a coexisting or related condition(s) and the obesity has not
improved, we will still consider whether the coexisting or related
condition(s) has medically improved.

If we find that there has been medical improvement in obesity or in any
coexisting or related condition(s), we must also decide whether the
medical improvement is related to the ability to work. If necessary, we
will also decide whether any exceptions to the medical improvement review
standard apply and, if appropriate, whether the individual is currently
disabled.

13. What are the goals and methods of treatment for
obesity?

Obesity is a disease that requires treatment, although in most people the
effect of treatment is limited. However, if untreated, it tends to
progress.

A common misconception is that the goal of treatment is to reduce weight
to a "normal" level. Actually, the goal of realistic medical treatment for
obesity is only to reduce weight by a reasonable amount that will improve
health and quality of life. People with extreme obesity, even with
treatment, will generally continue to have obesity. Despite short-term
progress, most treatments for obesity do not have a high success rate.

Recommended treatment for obesity depends upon the level of obesity. At
levels I and II (BMI 30.0-39.9), treatment usually consists of behavior
modification (diet and exercise) with the option of medication, usually
either in the form of a fat-blocking drug or an appetite suppressant. Some
people do not respond to medication, while others experience negative side
effects
a high success rate.

Recommended treatment for obesity depends upon the level of obesity. At
levels I and II (BMI 30.0-39.9), treatment usually consists of behavior
modification (diet and exercise) with the option of medication, usually
either in the form of a fat-blocking drug or an appetite suppressant. Some
people do not respond to medication, while others experience negative side
effects. (In making our decision, we will also consider any side effects
of medication the individual experiences.) Individuals with coexisting or
related conditions may not be able to take medication because of its
effects on their other conditions.

Generally, physicians recommend surgery when obesity has reached level III
(BMI 40 or greater). However, surgery may also be an option at level II
(BMI 35-39.9) if there is a serious coexisting or related condition.
Obesity surgery modifies the stomach, the intestines, or both in order to
reduce the amount of food that the individual can eat at one meal or the
time food is available for digestion and absorption. Surgery is generally
a last resort with individuals for whom other forms of treatment have
failed. Some individuals also experience significant negative side effects
from surgery (e.g., "dumping syndrome" — that is, rapid emptying of
the stomach's contents marked by various signs and symptoms).

Obesity is a life-long disease. Even when treatment has been successful,
individuals with obesity generally need to stay in treatment or they will
gain weight again, just as individuals with other impairments may need to
stay in treatment. Individuals who have had surgery should receive
continuing follow-up care because of health risks related to the surgery.
As with other chronic disorders, effective treatment of obesity requires
regular medical follow-up.

14. How do we evaluate failure to follow prescribed treatment in
obesity cases?
gain weight again, just as individuals with other impairments may need to
stay in treatment. Individuals who have had surgery should receive
continuing follow-up care because of health risks related to the surgery.
As with other chronic disorders, effective treatment of obesity requires
regular medical follow-up.

14. How do we evaluate failure to follow prescribed treatment in
obesity cases?

Before failure to follow prescribed treatment for obesity can become an
issue in a case, we must first find that the individual is disabled
because of obesity or a combination of obesity and another impairment(s).
Our regulations at 20 CFR 404.1530 and 416.930 provide that, in order to
get benefits, an individual must follow treatment prescribed by his or her
physician if the treatment can restore the ability to work, unless the
individual has an acceptable reason for failing to follow the prescribed
treatment. We will rarely use "failure to follow prescribed treatment" for
obesity to deny or cease benefits.

SSR 82-59 , "Titles II and XVI:
Failure To Follow Prescribed Treatment," explains that we will find
failure to follow prescribed treatment only when all of the following
conditions exist:

- The individual has an impairment(s) that meets the definition of
disability, including the duration requirement, and

- A treating source has prescribed treatment that is clearly expected to
restore the ability to engage in substantial gainful activity, and

- The evidence shows that the individual has failed to follow prescribed
treatment without a good reason.

If an individual who is disabled because of obesity (alone or in
combination with another impairment(s)) does not have a treating source
who has prescribed treatment for the obesity, there is no issue of failure
to follow prescribed treatment.
engage in substantial gainful activity, and

- The evidence shows that the individual has failed to follow prescribed
treatment without a good reason.

If an individual who is disabled because of obesity (alone or in
combination with another impairment(s)) does not have a treating source
who has prescribed treatment for the obesity, there is no issue of failure
to follow prescribed treatment.

The treatment must be prescribed by a treating source, as defined in our
regulations at 20 CFR 404.1502 and 416.902, not simply recommended. A
treating source's statement that an individual "should" lose weight or has
"been advised" to get more exercise is not prescribed treatment.

When a treating source has prescribed treatment for obesity, the treatment
must clearly be expected to improve the impairment to the extent that the
person will not be disabled. As noted in question 13, the goals of
treatment for obesity are generally modest, and treatment is often
ineffective. Therefore, we will not find failure to follow prescribed
treatment unless there is clear evidence that treatment would be
successful. The obesity must be expected to improve to the point at which
the individual would not meet our definition of disability, considering
not only the obesity, but any other impairment(s).

Finally, even if we find that a treating source has prescribed treatment
for obesity, that the treatment is clearly expected to restore the ability
to engage in SGA, and that the individual is not following the prescribed
treatment, we must still consider whether the individual has a good reason
for doing so. In making this finding, we will follow the guidance in our
regulations and SSR 82-59 , which
provide that acceptable justifications for failing to follow prescribed
treatment include, but are not limited to, the following:

- The specific medical treatment is contrary to the teaching and tenets
of the individual's religion.
still consider whether the individual has a good reason
for doing so. In making this finding, we will follow the guidance in our
regulations and SSR 82-59 , which
provide that acceptable justifications for failing to follow prescribed
treatment include, but are not limited to, the following:

- The specific medical treatment is contrary to the teaching and tenets
of the individual's religion.

- The individual is unable to afford prescribed treatment that he or she
is willing to accept, but for which free community resources are
unavailable.

- The treatment carries a high degree of risk because of the enormity or
unusual nature of the procedure.

In this regard, most health insurance plans and Medicare do not defray the
expense of treatment for obesity. Thus, an individual who might benefit
from behavioral or drug therapy might not be able to afford it. Also,
because not enough is known about the long-term effects of medications
used to treat obesity, some people may be reluctant to use them due to the
potential risk.

Because of the risks and potential side effects of surgery for obesity, we
will not find that an individual has failed to follow prescribed treatment
for obesity when the prescribed treatment is surgery.

EFFECTIVE DATE:

CROSS-REFERENCES:

SSR 82-52 , "Titles II and XVI: Duration
of the Impairment;" SSR 82-59 ,
"Titles II and XVI: Failure To Follow Prescribed Treatment;" SSR 85-28 , "Titles II and XVI: Medical
Impairments That Are Not Severe;" SSR
96-3p , "Titles II and XVI: Considering Allegations of Pain and Other
Symptoms In Determining Whether a Medically Determinable Impairment Is
Severe;" SSR 96-6p , "Titles II and XVI:
Consideration of Administrative Findings of Fact by State Agency Medical
and Psychological Consultants and Other Program Physicians and
Psychologists at the Administrative Law Judge and Appeals Council Levels
of Administrative Review; Medical Equivalence;" SSR 96-8p , "Titles II and XVI: Assessing
Residual Functional Capacity in Initial Claims;" SSR
s
Severe;" SSR 96-6p , "Titles II and XVI:
Consideration of Administrative Findings of Fact by State Agency Medical
and Psychological Consultants and Other Program Physicians and
Psychologists at the Administrative Law Judge and Appeals Council Levels
of Administrative Review; Medical Equivalence;" SSR 96-8p , "Titles II and XVI: Assessing
Residual Functional Capacity in Initial Claims;" SSR 98-1p , "Title XVI:
Determining Medical Equivalency in Childhood Disability Claims When a
Child Has Marked Limitations in Cognition and Speech;" and Program
Operations Manual System sections DI 23010.005 ff., DI 24510.006, DI
24570.001, DI 34001.010, DI 34001.014, and DI 34001.016.

[1] The terms we and us in this Social Security Ruling have the same meaning as in 20
CFR 404.1502 and 416.902. We or us refers to either the
Social Security Administration or the State agency making the disability
or blindness determination; i.e., our adjudicators at all levels of the
administrative review process and our quality reviewers.

[2] For ease of reading, we
refer in this Ruling only to the steps of the sequential evaluation
processes for initial adult and childhood claims. 20 CFR 404.1520,
416.920, and 416.924. We use separate sequential evaluation processes when
we do continuing disability reviews; i.e., reviews to determine whether
individuals who are receiving disability benefits are still disabled or
when we determine whether an individual has a "closed period of
disability." These rules are set out in 20 CFR 404.1594, 416.994, and
416.994a, and the guidance in this Ruling applies to all of the
appropriate steps in those regulations as well. However, in some
continuing disability review cases, we will still consider the provisions
of former listings 9.09 and 10.10. See question 11.
ed or
when we determine whether an individual has a "closed period of
disability." These rules are set out in 20 CFR 404.1594, 416.994, and
416.994a, and the guidance in this Ruling applies to all of the
appropriate steps in those regulations as well. However, in some
continuing disability review cases, we will still consider the provisions
of former listings 9.09 and 10.10. See question 11.

[3] As with all impairments, to
establish a finding of disability based on obesity, in whole or in part,
the statutory duration requirement must be satisfied. See 20 CFR 404.1509
or 416.909, and SSR 82-52, "Titles II and XVI: Duration of the Impairment"
(superseded in part by SSR 91-7c).

[4] For our regulations and
rulings on the consideration of medical or psychological consultant
opinions in determining medical equivalence, see 20 CFR 404.1526(c) and
416.926(c), and SSR 96-6p, "Titles II and XVI: Consideration of
Administrative Findings of Fact by State Agency Medical and Psychological
Consultants and Other Program Physicians and Psychologists at the
Administrative Law Judge and Appeals Council Levels of Administrative
Review; Medical Equivalence."

[5] However, see footnote 2 of
SSR 96-8p. That footnote explains that the ability to work 8 hours a day
for 5 days a weeks is not always required for a finding at step 4 of the
sequential evaluation process for adults when an individual can do past
relevant work that was part-time work, if that work was substantial
gainful activity, performed within the applicable period, and lasted long
enough for the person to learn to do it.

## Nearby sections

- [SSR 00-1c SSR 00-1c: Sections 222(c) and 223(a), (d)(2)(a), and (e)(1) of the Social Security Act (42 U.S.C. 422(c) and 423(a), (d)(2)(A), and (e)(1)) Disability Insurance Benefits—Claims Filed Under Both the Social Security Act and the Americans with Disabilities Act](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_00_1c.md)
- [SSR 00-3p SSR 00-3p: Superseded](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_00_3p.md)
- [SSR 02-1p SSR 02-1p: Rescinded](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_02_1p.md)
- [SSR 02-2p SSR 02-2p: Rescinded](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_02_2p.md)
- [SSR 03-01p SSR 03-01p: SSR 03-1p: Titles II and XVI: Development and Evaluation of Disability Claims Involving Postpolio Sequelae](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_03_01p.md)
- [SSR 03-02p SSR 03-02p: SSR 03-2p: Titles II and XVI: Evaluating Cases Involving Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_03_02p.md)
- [SSR 03-03p SSR 03-03p: SSR 03-3p: Policy Interpretation Ruling - Titles II and XVI: Evaluation of Disability and Blindness in Initial Claims for Individuals Aged 65 or Older](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_03_03p.md)
- [SSR 06-01p SSR 06-01p: Titles II and XVI: Evaluating Cases Involving Tremolite Asbestos-Related Impairments](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_06_01p.md)
- [SSR 06-03p SSR 06-03p: Rescinded](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_06_03p.md)
- [SSR 07-01p SSR 07-01p: Titles II and XVI: Evaluating Visual Field Loss Using Automated Static Threshold Perimetry](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_07_01p.md)
- [SSR 11-1p SSR 11-1p: Titles II and XVI: Procedures for Handling Requests to File Subsequent Applications for Disability Benefits](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_11_1p.md)
- [SSR 11-2p SSR 11-2p: Titles II and XVI: Documenting and Evaluating Disability in Young Adults](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_11_2p.md)
- [SSR 12-2p SSR 12-2p: Titles II and XVI: Evaluation of Fibromyalgia](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_12_2p.md)
- [SSR 13-2p SSR 13-2p: TITLES II AND XVI: EVALUATING CASES INVOLVING DRUG ADDICTION AND ALCOHOLISM (DAA)](https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_13_2p.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/SSA_SSR_DI_SSR_00_3p. Check the current official text before relying on it. Not legal advice.