Hospital: Fat Folks Need Not Apply

Jamie Reidy comments on a Texas hospital’s possibly discriminatory policy against hiring obese workers.


HLN’s Craig Johnson reports that Citizens Medical Center, located in Victoria, TX, is requiring:

its employees “fit with a representational image or specific mental projection of the job of a healthcare professional”… Potential employees must have a BMI of less than 35 (185 lbs for someone who is 5-1; or 265 lbs for someone who is 6-1).

This approach is legal in Texas, as well as many other states.

I really don’t see the big deal. (Pun intended.)

Employees at a medical center should look healthy! They also shouldn’t be smokers; it’s hard for a physician to tell a patient to lay off the cigarettes when the orderly reeks of Marlboro Lights.

I wouldn’t go to an overweight personal trainer, or a dentist with bad teeth, either. Ditto a dermatologist with a tan, or a tattoo artist with “Moom” on his arm.

Do you think this hospital’s policy is fair?

Photo by: Tobyotter

About Jamie Reidy

Jamie Reidy is a former U.S. Army officer turned little blue pill pusher turned author. His first book "Hard Sell: The Evolution of A Viagra Salesman"
served as the basis for the movie "Love and Other Drugs" starring Jake Gyllenhaal. Jamie is currently writing his new book, "Game On: One Fanatic's Fantastic, Foolish and Futile Attempt to Attend 365 Sporting Events in 365 Days." He discovered his latest story featured on Good Men Project - "Hope Shoots and Scores" - on Day 39 of his crazy journey.


  1. Copyleft says:

    Yes, clearly medical workers should ‘fit with a representational image’ of the profession. Therefore, all doctors should be required to look like House or Marcus Welby in order to put the patients at ease and inspire confidence.

    Oh, and all the nurses should be young and attractive women who flirt with the male patients. TV shows us the way!

  2. Would they openly tell those with a missing limb they won’t be hired as well? How about those who are underweight?

    It is discriminatory and whilst I can see the implications for fitter trainers, I don’t see how health professionals ALL have to be a certain weight range. Hell there are nurses who double as security and a 300lb might be quite handy to control an unruly patient.

    If they’re after fit and health applicants then they need to expand it, do they strike off asthma patients, anyone with any sort of defect, those who can’t run a mile, those who smoke, those with high blood pressure, just how far are they willing to go?

    And with the population now reaching a level where quite a lot of people are overweight then is it really going to be a good idea to strike off up to half the population as candidates for roles? I really don’t care if my nurse is overweight, as long as they can do the job. If it’s a specialist role in physical therapy and exercise/personal trainer I might prefer someone to look more athletic but if they’re overweight and can do the required exercise then I probably won’t care. You can know your stuff without having to live it perfectly, how many experts in the field of women’s health are men n vice versa?

  3. With the rising numbers of baby boomers soon entering nursing homes and aged care facilities, many of whom will have medical complications that must be managed appropriately; having trained staff to care for them is going to become harder and harder the more “restraints” society imposes on “fitness for work” based on appearance.

    I would rather my elderly parents were cared for by caring, empathetic qualified staff, regardless of their body-size than by skinny looking dudes who got the job just because they fit certain aesthetic criteria.

    Just sayin’

  4. I would not seek medical care at a facility that judges health based solely on BMI. BMI should only be used for average-sized people. The accuracy of the measurement decreases dramatically at both ends of the spectrum (very thin and very obese). Many commenters have already made this point, but I’d like to reiterate that muscle mass will most definitely contribute to a higher BMI. If this criteria is based solely on the way they want their employees to look, it is most definitely discriminatory. If this is about employing healthy people, they should also perform health screenings, including blood work, on all new hires to get a well-rounded picture of the health of their employees. Using BMI alone to make a judgement on a person’s health is poor medical practice.

  5. Hi Jamie,
    When I first saw the title on FB that was my first thought. Hey, I am trying to get healthy in a hospital. I don’t want to see people that are obese taking care of me. I want strong, healthy people taking care of me. I once went to an alternative healer who was supposed to be an amazing acupuncturist in NYC. She was obese and could hardly walk, could hardly breathe and i never went back to her again. I am so sensitive to stuff like that. If I see someone who is supposedly offering excellent care to me and they aren’t taking care of themselves, something is very wrong. Thanks for having that question as a debate on The GMP.

    • You are most certainly free to get the practitioners you prefer. Will you be asking each of them for internal verification of their health? I have high cholesterol due to genetics but I am medium height and slim. If you saw me next to one of my relatives, who is visibly heavier than I am you’d probably choose me, but her cholesterol has always been lower than mine. She’s stronger than I am as well and given the state of her garden (she grows much of her own food and is a vegan), has more physical stamina.

      Appearances can be, sometimes, deceiving, so if health in your practitioner is important to you, I’d suggest you ask them for blood-work to make sure that the internal health matches your external view and bias. Sometimes those slender folks smoke, take appetite suppressants, and have more bodyfat on their slender frame, than bigger stockier people do on their bulky frames.

      Just a thought.

    • “If I see someone who is supposedly offering excellent care to me and they aren’t taking care of themselves, something is very wrong.”

      Why? What is wrong? I’m actually serious with that question. Just think about it. A doctor isn’t a life coach, a mentor, or a role model. More importantly, you’re an adult and thus able to distinguish the understand that there may be value in what someone says with regards to your health, even if they do not practice it themselves. Doctors are there to tell you about your health; you’re not there to examine the doctor’s health. Your doctor’s personal life (including his health) really doesn’t affect whether s/he can effectively treat your or advise you about your health.

      Also, I’ll echo everything Julie said.

  6. wellokaythen says:

    If you read the full newspaper article, you’ll see that the policy is not specifically about having “healthy-looking” employees but about an expected standard of appearance that is “free from distraction.” It’s because of how obese people look, not how healthy obesity is. Presumably, anything about your appearance that could be a distraction could prevent you from being hired. God knows what the limits of that are – too attractive? Too dark-skinned? Boobs are too perky? Funny-looking scar on your eyebrow? Mole on your nose? Too tall? Where does it end?

    Some of the wonderful medical professionals I know would probably not be hired there – too many “distracting” piercings and tattoos.

  7. wellokaythen says:

    This clause is clearly targeted at one population cohort, because it defines the “image of healthiness” in terms of a maximum BMI instead of a BMI range.

    What about being too skinny, if that’s even possible? Some of the most unhealthy people I’ve ever seen are rail-thin. I doubt anorexic staff will give the impression of vibrant, robust good health, but there’s nothing in the hiring policy that prevents them from getting a job there. Your face could be covered with meth-related scabs, but hey, as long as you’re not too fat….

    What’s interesting is that the employer in this case is saying that the policy is necessary because the elderly patients demand a particular appearance. It’s because of “customer feedback,” presumably, in order to meet with the patients’ pre-conceived notions. I remember my Texas grandmother, rest her soul, was adamant that she would never be able to trust an African American doctor or a female doctor. Presumably as a patient she would therefore be able to demand that her local hospital not hire any of those people?

  8. Valter Viglietti says:

    “Do you think this hospital’s policy is fair?”

    – If it’s about looks, no it doesn’t.
    I understand the importance of look when it’s about some profession, but not for healthcare. As someone said, for healthcare would be wiser screening for smokers than weight.

    – If it’s about efficience, it is.
    I mean, if a worker is obese enough so s/he cannot work efficiently, or doing the job as requested, then it’s a kind of “handicap”. You wouldn’t hire a one-armed-man for lifting boxes. 😉

  9. Jamie Reidy says:

    Like in the Army, Citizen’s Medical Center could allow a waiver system for heavily muscled people whose high BMI belies how physically fit they actually are.

    Regardless, this hospital will be getting sued in a matter of time inversely proportional to its average ER admittance.

  10. In business, almost everything comes down to money at some point. My company charges smokers more for health insurance because they tend to cost more over time.

    It is very well documented that is a major contributor to increased health problems. Hence, not employing such people will reduce healthcare costs. It is a questionable move ethically but makes fiscal sense, from a controlling healthcare costs standpoint.

  11. Employees at a medical center should look healthy!
    Emphasis on look. They want to present an certain image of their brand and to them people that “look unhealthy” tarnish the branch.

    Honestly while looks might be important ultimately patients should be going to the places that provide the best medical care and advice.

  12. It’s also about controlling their costs. Healthcare workers are very expensive because they use far more healthcare services than anyone else. Add the fact that most healthcare workers are women (who use significantly more healthcare services), they are trying to control what they can. They can’t refuse to hire women or refuse to provide healthcare services but they can cut down on/out the obese and smokers, who are also more expensive to insure.

    • I think you’re giving them more credit than they deserve. Being concerned with “a representational image or specific mental projection of the job of a healthcare professional,” is not about cutting down the costs of providing services to employees, mate.

  13. I ran the Austin Half Marathon. Well, walk/ran it is more to the truth. I’m in good shape for my age, with a BMI around 21. I cannot say I am a good runner. I saw a huge amount of people heavier than myself, running harder, longer, faster. Fitness and health do not necessarily correlate with size or BMI. Some folks have higher BMIs due to muscle. If you are short and have a well muscled body, your BMI will appear high.
    I think there are some complicated things going on here in the US with weight, food that doesn’t contain too much sugar, preservatives and sodium, and access to exercise.
    But even if a person has a very healthy lifestyle, their body still may never look like a slender athlete. They might have padding or muscle or bulk that isn’t “representational.”

    I’d prefer to see a non smoking deal for hospital employees if we were gonna get all controlling on them. I drive by my local all the time and see smokers outside in scrubs.

    • “I’d prefer to see a non smoking deal for hospital employees if we were gonna get all controlling on them.”

      On the one hand I agree with this, on the other I think that enforcing any sort of behaviour or appearance guidelines on an employee is a bit nuts. I’m not looking to my doctor to be a role model, just to tell me what’s wrong with me and fix it.

      • Well, right. I’m actually not for policing like this at all, but if I had to pick I’d pick tobacco over weight.

        • Ah yeah, I can dig it.

        • Agreed. At least the smoking causes an actual environmental hazard. The hospital in my city have a ban on smoking anywhere on the premises so smokers have to at least go to the edge of the hospital property to smoke (or else get a ticket). Even then however there is still smoke in the area of the hospital.

  14. It depends on their standard. For instance, many people consider me to be thin but I am technically at the lowest end of what is considered obese, because of having a low percentage of body fat. Ironically, muscular people are regularly classed as obese because of their weight, not health. If they don’t consider gender and body fat, they may be denying their strongest and healthiest candidates.

  15. CajunMick says:

    No I don’t.
    I see your point about the overweight personal trainer, the dentist with bad teeth, etc. An implication of incompetence. What gets creepy is the applicant must ‘fit with a representational image or specific mental projection.’
    I am a very stocky guy. While in the service, my weight was over the suggested limit for someone of my height. My superiors gave me every kind of test (PT, pinch tests, etc.) they could. I passed them all. What it did it come down to? This statement- “Soldier, you just don’t look right in that uniform.”
    ‘Look’…’representational image’…’mental projection’- Where’s the substance?
    How about this for fairness: Is the applicant qualified?

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