In April, I mentioned here in H&HN Daily that a hospital in Texas had decided to stop hiring obese workers. And I asked, "Are you OK with that?"
Then the floodgates opened. So far, more than 300 responses have been sent to my email or posted on various health care LinkedIn conversation boards, and they're still coming in every day.
The back-and-forth among readers has been lively to say the least, ranging from a thundering "no, it's discrimination, plain and simple" to "yes, hospitals have an obligation to model healthy behaviors, especially when obesity has become a national epidemic."
Some readers objected to the use of BMI to measure obesity, and, by default, an individual's fitness for doing a job. Some have said it's common sense that patients would be less apt to take advice from somebody who obviously doesn't practice what he preaches. Some took issue with comparing body weight with smoking or drug use as a basis for hiring.
Here is a small sample of readers' reactions, edited for space and clarity, and with names omitted:
"This is an employer who is attempting to walk the talk of a healthy lifestyle and workforce."
"If I were looking for a personal trainer, I'd want one who is in shape. If I were looking for a financial adviser, I'd want one who dresses professionally. If I were in a hospital being treated for hypertension or diabetes, I would feel more comfortable being treated by an individual who seems to be in control of their health."
"I have worked with excellent nurses who were obese or smokers and conversely with slim, nonsmoking individuals who were not productive by any means of measurement."
"This will soon be the new normal. I see nothing wrong with the policy as long as it extends into the executive suite."
"I worry that if we allow a section of the population to be hired or fired based on personal choices, that it will only grow to include one of my own choices."
"Since smoking and being obese are not illegal, these are not equivalent in any way to using illegal drugs."
"What is the driving factor to bring employers to enact or review such a decision? Money! This comes down to controlling health care expenses for employers and insurers."
"It is discrimination and should not be allowed. The hospital should be offering health education classes and encouraging healthy lifestyles."
"At my hospital, we are proactive rather than reactive. There are a multitude of wellness classes offered to staff at discount prices. The cafeteria offers 'better bite' selections. There are incentives in the form of financial rewards, gift cards and days off. A wellness coach is available. There are rewards for walking from the parking lot rather than taking the shuttle. We have a gym and exercise rooms. Yoga, zumba and other classes are offered. It's all part of what we call 'moving upstream' — managing health care rather than sick care."
"My company ties our insurance premiums to the wellness program. If you follow the wellness criteria, you maintain a lower premium."
"I fail to see why my employer is obligated to provide a wellness program. Research shows that the ROI is not there no matter how many incentives you throw at the employees. What happened to being self-reliant? Why are my actions anyone else's responsibility?"
"I am typically a morning pastry away from an obese BMI. That's due to 15 years of weightlifting. Typically, I bike to work 3-4 days/week, rock climb once per week, practice yoga, jog 3.5 miles once per weekend. What would the hospital do about me? When BMI was developed, it was not intended to determine obesity but as a unit to express height/weight ratio."
"If the hospital truly wants to enforce what is probably already an informal process (research shows someone's attractiveness is a large factor in the hiring process), I hope they have a way to measure it."
"BMI with all its perceived flaws is the only objective measure of obesity."
"I was hired and worked for a health organization that required a fitness or duty test. I was not excluded for BMI."
"As someone who has gone from 250 to 130 pounds, I can speak for both sides. If any health/weight issues prevent you from doing the job as well as another candidate, the hospital has the right to hire the best person for the job. At my heaviest I could not perform the job duties as well as someone of regular weight unless it was a sit-down administration job."
"I wanted to bring out a personal experience that happened, say, maybe 10 years ago. I was close to 150 [pounds] overweight. I was seeking employment as a nurse. I must say to be truthful, I didn't look healthy. I was a young woman but appeared older than I was. At the time no one had to tell me why I was unable to obtain employment; common sense told me why. I was applying for a position in a field that promotes health [and] I didn't at that time promote the idea of taking care of my health, let alone attempting to take care of the health of the patients. I started to take care of me first, lost all the extra pounds, started swimming laps and walking more, and I felt great. When I applied for a job as a nurse, yes, I was hired right away! What I am saying is I do get their point."
"It brings to mind the old anecdote about the town with two barbers. One had beautifully coiffed hair and the other's hair was an absolute mess. Which one would you choose? The one with the bad hair, of course, because he obviously cut the other one's hair."
In an interesting twist to this discussion, the hospital that triggered it has since rescinded its decision to prohibit the hiring of obese workers. Nobody there is saying why. Nevertheless, I think it's a good bet that the debate will only get more heated as the obesity epidemic intensifies and employers — including hospitals — struggle with the spiraling cost of providing health coverage for their workers, and with the question of how to set a good example for their communities.
Want to add your voice to the conversation? Email me at firstname.lastname@example.org.