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Maintaining a Healthy Weight as a Pilot: Why It Matters and How to Do It
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One of the key components of the FAA flight physical exam is height and weight, which are used to calculate Body Mass Index (BMI). While BMI is a simple measure, it doesn’t tell the whole story about a person’s health. However, it is something pilots can control, and it plays a crucial role in overall well-being and long-term medical certification. As both a board-certified internal medicine physician and a bariatrician (board certified in obesity medicine), I have a deep passion for this topic. In aviation, obesity might seem out of place, but the reality is that flying requires a lot of prolonged sitting. While pilots must maximize their mental acuity, the physical demands of the job are sometimes minimal. Add in irregular schedules, sleep disruptions, hormone fluctuations, fatigue, and stress, and weight gain becomes a real concern.
Weight management is at the core of preventative medicine. Maintaining a healthy weight can significantly lower the risk of several health issues, including certain cancers, cardiovascular problems, and diabetes. Keeping your weight in check can significantly impact your ability to maintain your medical certificate and avoid health issues that could ground your career. For example, obesity is the leading cause of obstructive sleep apnea (OSA), a condition that can directly affect your ability to fly. Obesity is also linked to several serious health conditions, including:
• Cancers: Such as esophageal adenocarcinoma, postmenopausal breast cancer, colon, rectal, uterine, gallbladder, kidney, liver, ovarian, pancreatic, thyroid, and brain cancers (including meningioma), as well as multiple myeloma.
• Cardiovascular Issues: Obesity increases the risk of high blood pressure, stroke, coronary artery disease, and cardiac arrhythmias like atrial fibrillation (Afib). • Diabetes: The leading cause of type 2 diabetes is insulin resistance, and excess body fat, especially around the abdomen, is a major risk factor for this disease.
This is just the beginning...
BMI is a quick and accessible screening tool which allows us to categorize as follows:
• 25-29: Overweight
• 30-35: Class 1 obesity
• 35-40: Class 2 obesity
• Over 40: Class 3 obesity
Other methods for measuring body composition include bioelectrical impedance analysis (BIA) and air displacement plethysmography (ADP). However, the gold standard is a DEXA scan, which provides detailed insights into fat distribution, including visceral fat (the fat surrounding internal organs). Why is this important? Visceral fat is linked to health issues. For example, fatty liver disease over time can lead to cirrhosis. Note, not a drop of alcohol is needed in that equation, we are only talking about visceral fat. Surprisingly, non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of liver disease in the U.S., affecting about 24% of adults, according to the National Institutes of Health (NIH).
Despite their crucial role in health, doctors often receive minimal formal training in nutrition. As a result, many pilots turn to the internet for health advice, where misinformation can abound. One widely accepted principle is increasing protein intake, and here’s why: digesting protein burns more calories than digesting carbohydrates or fats. This is due to the thermic effect of food (TEF), which means that:
• Protein burns 20-30% of its calories during digestion.
• Carbohydrates burn 5-10%.
• Fats burn 0-3%.
For pilots on the go, finding healthy food options in airports can be challenging. For this reason, I’m working on a Healthy Eats Map on my website to assist in locating the healthiest options in major U.S. airports. In many cases, planning and packing your own meals might be the best option.
The standard recommended amount of exercise is 150-300 minutes per week, but this doesn’t require expensive gym equipment or a membership. The key is setting SMART goals — specific, measurable, achievable, relevant, and time-bound — and creating a routine that works for you. Start at your fitness level to avoid burnout or injury. For those who like numbers, tracking your calories burned based on weight and activity can keep you motivated. Here’s a simple formula to calculate calories burned using METS, or metabolic equivalents, which is a unit of measurement used to quantify the energy expenditure during physical activity:
METS x 3.5 x Body Weight (kg) / 200 = KCAL/min
For example:
• A 225-pound person burns about 270 calories in 30 minutes of walking (METS = 5).
• A 150-pound person burns about 285 calories in 30 minutes of moderate cycling (METS = 8).
Even small adjustments, like taking the stairs, walking during layovers, or using fitness apps, can add up. If you have a gym membership, check if they offer nationwide access, or consider free apps like MINDBODY to find drop-in classes while traveling.
There are various medications that treat obesity depending on the patient. The FAA has given its approval for the use of a variety of them to include metformin, liraglutide, semaglutide, and tirzepatide. This approval requires you have never been diagnosed with diabetes. Diabetes has its own FAA pathway. The GLP-1 injectable medications (Zepbound and Wegovy) have been making headlines, both good and bad. When prescribed and monitored by a qualified medical provider, they can be a safe and effective tool for weight loss. However, they should never replace a foundation of healthy eating and exercise. All of the approved FAA medications are a CACI (Condition an AME Can Issue) so no special issuance is needed if you qualify.
• PLAN AHEAD: Just as you plan your flight, plan your nutrition. Look for healthy options at layovers or pack your meals. Some airlines offer healthier crew meal options, so consider these on your next flight.
• STAY ACTIVE: Use hotel gyms, check if your gym membership includes partner locations, or explore local fitness options with apps like MINDBODY. Outdoor exercise — weather and safety permitting — offers the added benefit of fresh air.
• PARTNER WITH A BARIATRIC CLINIC: Having a doctor guide you on your medical weight-loss journey can be a huge benefit. I work with Inclusa Health & Wellness, which offers completely virtual telehealth visits to accommodate your busy life.
• CONSIDER FITNESS/NUTRITION APPS: These can help you stay active no matter where you are or what equipment is available. They can also assist with calorie counting and hydration goals. I have personally used the Coeur Lifting Club App and 1st Phorm but find one that is right for you.
This is just an introduction to the vast topic of health and wellness for pilots. Staying in optimal health is one of the best ways to protect your medical certificate and extend your flying career. If you have questions, feel free to reach out — I’m happy to help! Send your questions or suggestions for upcoming articles to info@aviatemedical.com.
Our mission is to support pilots and aviation professionals in maintaining their health and well-being.
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