On Tuesday, Bill Santamour stole my blog idea. As you may recall, he wrote about hospitals and health systems that are taking a hard line on hiring employees who engage in unhealthy habits. Since Bill is my boss, I couldn't really tell him to back off and find something else to write about. Besides, his birthday was this week, so I had to be extra nice.


Still, I just can't resist revisiting the topic, largely because I just finished editing an interesting article for the May issue of H&HN. It profiles how employees at an eight-hospital system have over the past few years trimmed more than 30,000 pounds from their waistlines. Close to 90 percent of employees now participate in the system's wellness program, which offers some pretty substantial financial incentives, including sizeable discounts on their insurance premiums. It should be noted that the health system is in a state that consistently ranks in the top five for having the most overweight population.

That's the warm and fuzzy way to approach employee wellness. As Bill noted, some hospitals are using more stick than carrot. Citizens Medical Center in Victoria, Texas, now requires any potential employee to have a body mass index below 35. The Texas Tribune reported that the hospital's policy stipulates that an employee's physique "should fit with a representational image or specific mental projection of the job of a healthcare professional."

Citizens isn't the first hospital to take a bold stand on a sensitive wellness issue. In 2007, officials at the Cleveland Clinic announced that they would no longer hire smokers. Job candidates are subject to urine tests that check for traces of nicotine. "If a candidate tests positive for nicotine, the offer is rescinded, and he or she is offered a free tobacco-cessation program and may reapply in 90 days," Paul Terpeluk, M.D., the clinic's medical director of employee health services, wrote in a USA Today op-ed last January.

These three hospitals may be taking different approaches, but all of them are attacking the same underlying problem: if a hospital is a place of health and healing, shouldn't the institution promote those things with its own staff? When I took my daughter to the hospital recently for an appointment, we had to walk past a throng of people in blue scrubs lined up on the sidewalk puffing away on their Marlboros (that's far better than when I was a kid and my doc would light up his pipe during the middle of the exam). And the only option for a snack in the joint? You guessed it, McDonalds (avid readers of this blog may recall that my daughter loathes the fast food chain).

Now, I'm not about to open up a large can of worms and suggest that every hospital follow the lead of Citizens or the Cleveland Clinic. I'll let the labor experts and civil rights advocates haggle over whether the policies are too extreme. But as Terpeluk wrote, hospitals have a certain obligation to their patients, employees and community at large: "We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices. It is only right to practice what we preach."

Matthew Weinstock is senior editor of H&HN. You can reach him at mweinstock@healthforum.com.