Obesity Epidemic in Commercial Drivers

Obesity is epidemic in commercial drivers.  As a group, they are also getting older, are sedentary, smoke, have poor eating habits, have multiple medical problems including cardiovascular disease and obstructive sleep apnea, and are unhealthier than the general population.
We had a patient that weighs 594 pounds.  I’m trying to finding documentation about specific requirements before this pt. can be cleared to drive.
Of course he is in a Union that thinks we’re picking on him.  I know he needs a sleep apnea workup.  also since he weighed 460 pounds last year and now weighs 594 our MD wants an ECHO for cardiac function.  But is there anything else??

You are responsible for ensuring that only the driver who meets the Federal physical qualification requirements is issued a Medical Examiner’s Certificate. When you issue a Medical Examiner’s Certificate, you are certifying that the driver is medically fit for duty and can perform the driver role that is described in the Medical Examination Form.

Operating a commercial vehicle is considered a heavy duty job.  Although there is no specific “cutoff” for weight or BMI, the medical examiner does need to evaluate the driver for conditions that would affect fitness for duty and safe operation of the vehicle.

Consider whether the individual is able to climb into and exit from the cab, involving climbing steps much as one would climb a ladder, maintaining 3 points of contact gripping the handrails and stepping up/down several times a day.  Hip angle and knee flexion may both have to exceed 90 degrees.
Other strenuous tasks include coupling and uncoupling the trailers, raising and lowering trailer supports, connecting cables with physically demanding grip strength, upper body strength, range of motion and balance.
Physical demands of commercial driving are equivalent to 6 METS upon stress testing.  We know that extreme obesity carries risks for many other diseases, including cardiovascular disease, diabetes and sleep apnea.
OSA algoritm graphic
The medical examiner is responsible for evaluating drivers at risk for certain conditions, and requiring the driver to obtain further evaluation to the examiner’s satisfaction.
I would think it near impossible to safely operate a commercial vehicle at 590 pounds.  At the very least I would want to see a full cardiac evaluation, sleep apnea work up, and physical agilities testing to ascertain fitness for performing the tasks outlined above.