Medical centre refusing people with body mass index over 35
Citizens Medical Centre, a hospital in Victoria, Texas, issued a controversial hiring policy in March stating it does not hire anyone with a body mass index (BMI) of 35 or higher. That’s the equivalent of someone who is five feet five inches tall and weighs 210 pounds.
The policy states an employee’s physique “should fit with a representational image or specific mental projection of the job of a health-care professional,” including an appearance that is “free from distraction,” according to the Texas Tribune.
“The majority of our patients are over 65 and they have expectations that cannot be ignored in terms of personal appearance,” David Brown, the hospital’s CEO, told the newspaper. “We have the ability, as an employer, to characterize our process and to have a policy that says what’s best for our business and for our patients.”
While the hiring policy isn’t against the law in Texas — only Michigan and six cities in the United States, including San Francisco and Washington, D.C., ban discrimination against the overweight in hiring — it opens employers up to discrimination complaints.
Weight is not a protected ground in Canada under human rights legislation, but sex and race are, and weight may overlap with some of these protected grounds. This includes women, who typically have a higher BMI than men, and particularly African American women, said Alan Shefman, president of the Edge, a human rights consulting firm in Thornhill, Ont.
“BMI, in itself, could be genetically determined and so there’s going to be maybe a certain ethnic group or population that’s more prone to have higher BMIs but is very, very healthy,” said Mary Forhan, an occupational therapist based in Burlington, Ont., and member of the Canadian Obesity Network.
Some people may also have a medical condition that causes their BMI to be over 35 — such as diabetes or a thyroid condition — so refusing to hire them would be clear grounds for discrimination, said Shefman.
While working at the Ontario Human Rights Commission, Shefman encountered one particular discrimination case where a shoe store fired an employee because she was overweight. The worker filed a complaint with the commission and the board found she had a medical condition that caused her to be overweight, so she won the case, he said.
If there is a concern about an individual’s ability to do the job, employers should test candidates on job requirements instead of setting a BMI limit, said Veronica Jamnik, an exercise physiologist at York University in Toronto who does research on the occupational requirements for public safety workers.
“The BMI alone doesn’t indicate whether you’re competent to do the job,” she said. “It would not tell an employer in wildland forest firefighting, for instance, whether the person is capable of doing the physically demanding component, the critical tasks. The BMI, in and of itself, would not tell you anything.”
Employers should conduct a thorough analysis of the job so they can test appropriately, said Shefman. They should outline the bona fide occupational requirements and additional tasks the job requires and determine how to measure the capability of a candidate to complete them.
For example, a job may require getting into small spaces and if a candidate is large, she may not be able to do the work, he said. In the case of health-care professionals, there may be concern about being able to lift and transport patients.
“If they’re worried about someone being able to do the job of a nurse or a surgeon, then find a way to test that in a fair and just way and, I have a feeling if they did that, they would be very surprised at just how capable individuals with high BMI are,” said Forhan.
BMI is also a poor indicator of overall health because all it really does is classify body size, she said. Someone may have a high BMI whose body composition is very muscular.
“You could have a former NFL player that was a surgeon — it’s unlikely but let’s paint that scenario — and what would you do? Not hire him? I can guarantee their BMI is over 35,” said Forhan.
On the flip side, someone could be very thin with a low BMI but actually be a drug addict — a low BMI doesn’t mean a person is healthy and competent to do the job, said Jamnik.
Hiring based on BMI can significantly reduce an employer’s candidate pool and cause it to lose some really rich human resources in terms of skills, abilities and knowledge, said Forhan.
“When you look at the prevalence of obesity and overweight in our society, you’re actually reducing your applicant pool by a fairly good percentage if you’re going on BMI alone, particularly if you’re looking for a more experienced employee.”
A business would also face reputational issues if it hired in this way as it would hurt the public perception of the organization, said Shefman.
If an employer wants a healthy workforce, it can build the chance to lose weight and be healthy into job opportunities, he said. It can include in the job postings its offerings around health and wellness, such as an on-site gym, a discount for an off-site gym membership or a corporate weight-loss program subsidy such as Weight Watchers.
HR professionals should take some time to reflect on their own weight biases — their values and beliefs about obesity and people living with obesity — to make sure they are not factoring those into their hiring decisions, said Forhan.
“Most will say, ‘I understand what I’m thinking isn’t accurate’ but they might not realize they’re thinking it until they’ve been challenged,” she said. “Going through a reflective process when in an HR capacity is really, really important so that you’re aware of when you might be putting a value judgment on someone based on their size instead of looking at their competencies.”