COMMENTARY

Can a Hospital Say, "Only Thin Doctors Can Work Here"?

Arthur L. Caplan, PhD

Disclosures

May 03, 2012

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Hi. I am Art Caplan, and I am speaking to you today from the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

Today's topic is one that I think will get everybody's attention. To put it bluntly, should hospitals hire employees who are overweight?

A hospital in Texas, Citizens Medical Center, has said that it is not going to hire anybody -- doctors, health staff, nurses -- who is overweight. For them, that means a body mass index of over 35 kg/m2; or in other words, for a 5'10" man, if you weigh more than about 250 lb, you wouldn't get hired at this particular Texas facility.

So, just like people are talking about not hiring employees who smoke at hospitals or nursing homes or clinics, this institution is the first that I know of to say, "We are not going to hire overweight people."

Now, you might think this is illegal, but it isn't. It turns out that there are no laws against discrimination against overweight people except in Michigan, and a few cities have passed these laws.

Maybe overweight can be treated as a disability, but you would have to go to court and fight that, and I'm not sure how it would turn out. So, if the hospital wants to try this in Texas, it probably can without violating any civil rights statutes.

What is the argument that they have for doing this? They say, "Look, if you are going to come in and counsel people about health, you need to have a staff that is slim and fit." It is certainly the case that it is hard to have people say, "Follow what I say, don't do what I do," and I think they are worried that it might not be as attractive to patients to have someone tell them to lose weight who is overweight themselves.

It is also the case that overweight staff sometimes require their own special equipment and furniture, so there can be costs there, and it turns out that overweight people may be absent more just because of health-related problems. There is probably some argument that it raises healthcare insurance costs because of the problems associated with being overweight.

So, maybe there is a case here, but let's look at the pros and cons. On the side of doing this, it may be good for patients and encourage them, maybe it will cut down the costs for the hospital, maybe it will send a message that we expect our staff to maintain good health habits themselves as part of trying to encourage it in others.

What's on the negative side? I can think of a major problem, and that's treating healthcare risks equally. If you want to go after overweight, then who is going to sit in the hospital parking lot and see who is speeding when they come in? Who is going to make sure that someone arriving on a motorcycle or a bicycle is wearing a helmet? Who is going to make sure that they are wearing their seatbelts when they come to work? And to take this a bit further, in Texas, who is going to make sure that they are not riding horses at home because it is dangerous; or own a gun, which turns out to be a big health risk? There are a lot of other equally risky things besides weight that doctors or nurses or healthcare staff might do, and the question is, are we going to control that?

Look, I'm all for trying to set a good example and I think there are plenty of businesses where being thin and being in shape really do matter. I guess if you run a modeling agency it is very important. But I'm not convinced, really, that putting in weight restrictions is the best idea in terms of sending out the right message or a necessary message to patients. Patients, I think, can work with their doctors to try to overcome common problems. Doctors see all kinds of patients with all kinds of habits and all kinds of lifestyles. I think patients can deal with seeing all kinds of healthcare workers with all kinds of habits and all kinds of lifestyles. If they want a thin one, they should be able to pick one, but I don't think the hospital necessarily should have to say that only the thin ones can work here.

Thanks for watching. This is Art Caplan, and I'm at the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

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