Hospitals Are Allowed to Not Hire Fat People

Smokers must step outside to puff. Mandatory drug screening eliminates users from employment whether they’re high on the job or not. Now the Texas Tribune reports that Citizens Medical Center in Victoria, Texas, is adding another health issue to the list of workplace no-nos: obesity. 

If your body mass index (BMI) is over 35, you can’t get a job at Citizens Medical. Or so the outcry would have you believe.

Go ahead, say how unfair that is, how Citizens Medical is cutting off its nose to spite its face because management is more concerned with peoples’ looks than their skill sets. Then tell yourself, “If it were me, I’d sue the bastards.” 

If you did, you might be in for a rude shock: Only the state of Michigan and six other cities ban employment discrimination based on size. For the rest of us, unless a negotiated contract states otherwise, the “employment at will” philosophy allows making weight a factor in the hiring decision. Citizens Medical and other employers are within their rights to reject overweight and obese job applicants.

There is however, a right way and a wrong way to do this. The wrong way is to put each applicant on a scale and send those that don't meet the standard packing without further consideration. The right way, and the one Citizens Medical claims to follow, is to alert the candidate to the issue and support his or her efforts to remedy it. This approach is a "win-win" for both candidate and employer; it helps the candidate make a positive lifestyle change and helps the employer combat the spiraling costs associated with a U.S. population that is rapidly losing the battle of the bulge.

The media coverage would have you believe that the Citizens Medical policy is a blanket "fat people need not apply" approach. The facts state otherwise. According to a George Washington University Medical Center study, a BMI of 35 is commonly classified as “severely obese.” BMIs between 25 and 30 are rated “overweight;” BMIs between 30 and 35 are rated “moderately obese.” In short, there are two categories of above normal weight candidates that could work at Citizens Medical. According to this table from the NIH Website that links BMI numbers with heights and weights, a 6-foot person could weigh up to 250 pounds and meet Citizens Medical standards.

Candidates with higher BMIs don’t forfeit their chance of working automatically, according to hospital CEO David Brown. They are offered help; those who accept remain active candidates while those who refuse must look elsewhere. It sounds more like a "toughlove" approach than the "fat need not apply" approach the media would have you believe.

I can see the anti-discrimination lobby responding with something like, “What about the bodybuilder who has a BMI of 36 but only 7% body fat? What about someone on medication with a side effect of weight gain?”

They raise legitimate concerns regarding the implementation of anti-obesity policies. For the Citizens Medical policy to avoid litigation, it is vital that the medical evaluation identify obesity readings that result from above-average muscle mass, chronic conditions, or prescription drug side effects. Rejection based on either an inaccurate obesity ruling or obesity resulting from other conditions could be subject to litigation. That's why it's vital that the medical evaluation that is part of employment application  include more than a simple weigh-in and allow room for the exercise of common sense. It must include a medical history that includes a record of any chronic conditions and preseciption drug use. Folks responsible for medical evaluations at Citizens or other employers hopefully have enough common sense to differentiate a toned-to-the-hilt specimen from a couch potato, and enough authority to waive the obesity rule if extenuating circumstances exist.

However, the costs of workplace obesity are an equally legitimate concern. The numbers are grim; the CDC reports that approximately one-third of American adults are obese. In January, 2011, McKinsey & Co. reported that the U.S. spent $160 billion on obesity-related medical expenses and $450 billion on indirect expenses. This doubles the 2001 amount, and is expected to double again by 2018. The associated costs are making headlines in media such as USA Today, U.S. News & World Report, Yahoo!, and NPR. Obesity costs are rising 3.6% a year. Employers are aware of this, 87% of large companies will implement or enhance policies to promote healthy lifestyles.

Citizens Medical is not alone in its concern about workplace obesity. But the media circus might have hindered its policy’s effectiveness. Has the drive to obtain an expose derailed an idea that might otherwise have motivated skilled people burdened by weight issues to turn themselves around and live more healthy and productive lives? Populating the workplace with attractive people wasn’t the prime motive behind the Citizens Medical anti-obesity policy. Giving people a chance at self-redemption was.