Friday, August 21, 2009

Cleveland Clinic CEO Quoted as Supporting Stigmatization Of and Employment Discrimination Against Obese People

An article published last week on the Wall Street Journal's Health Blog quotes Cleveland Clinic CEO Toby Cosgrove as lamenting the fact that he cannot legally refuse to hire morbidly obese individuals and as supporting stigmatization of, and discrimination against, overweight individuals.

As I reported here in July 2007, the Cleveland Clinic has deemed smokers to be unsuitable for employment. New employees are required to undergo a cotinine test and are refused employment if testing indicates that they smoke or use smokeless tobacco.

According to the article: "The Cleveland Clinic doesn’t hire smokers — part of its effort to “walk the talk” about healthy lifestyles, Cleveland Clinic CEO Toby Cosgrove said in a recent chat with the Health Blog. But, according to Cosgrove, it would be illegal to apply a similar standard to people who are obese, because they’re protected by the Americans with Disabilities Act. “I can’t decide that I’m not going to hire somebody because they’re 400 pounds,” he said. “We don’t hire smokers, and that’s perfectly legal.” Cosgrove questioned that rule, suggesting it could hinder efforts to lower the nation’s obesity rate. “We are protecting people who are overweight rather than giving people a social stigma,” he said."

The Rest of the Story

While the Americans with Disabilities Act protects individuals who are morbidly obese, it does not protect those who are merely obese or overweight. Thus, there is nothing to stop the Cleveland Clinic from refusing to hire anyone who is overweight or obese. The Cleveland Clinic is perfectly free to make being thin a requirement for employment. And it's frightening to know that its CEO is even thinking about doing so.

When the Cleveland Clinic first announced that it would discriminate against smokers, I wrote: "Clearly, by its own reasoning, the Cleveland Clinic's policies and procedures do not reflect a commitment to advocating healthy living. While smoking may account for $75 billion in medical costs, obesity accounts for more than $78 billion (even more than smoking). Yet the Cleveland Clinic has not announced a policy to refuse to hire fat people. If the Cleveland Clinic were true to its word about adopting policies and procedures that reflect a consistent commitment to advocate healthy living, then surely they would institute a policy of refusing to hire people who are overweight or obese. As with smoking, such applicants could be referred to a weight loss program and encouraged to reapply after 90 days if they lose sufficient weight.

Similarly, the Cleveland Clinic doesn't appear to care about the alcohol problem that afflicts American society and causes a huge burden of chronic disease. While smokers need not apply, persons who drink too much alcohol are free to seek employment with this health system that considers itself a leader in "preventative" health and wellness. So are those who engage in unsafe sexual activities, eat far too much fat in their diets, consume high amounts of unhealthy trans-fats, or engage in a sedentary lifestyle and get absolutely no physical activity or exercise.

To be clear, what the Cleveland Clinic is doing is discriminating against smokers in employment. They are justifying this selective and targeted employment discrimination on the grounds that it is important to promote a healthy workforce. Yet they show no desire to actually promote a healthy workforce by making sure that prospective employees are actually healthy. They can be as unhealthy as they want to be, as long as they don't smoke."

Now, it appears that smokers may be just the first group that the Cleveland Clinic is trying to purge from its work force. The overweight and obese appear to be next, as soon as Cosgrove gets word that it is only the morbidly obese who are protected by federal law.

Perhaps even more disturbing than the fact that the Cleveland Clinic is discriminating against smokers and supporting the idea of discriminating against obese individuals is the fact that its CEO is arguing for the intentional stigmatization of fat and overweight people as a measure to reduce obesity. Not only is such a measure doomed for failure because stigmatization tends to paralyze people and to create self-fulfilling prophecies as well as remove any self-efficacy or self-esteem that might allow a person to actually do something about their weight, but such a measure is despicable on its face. Moreover, such a measure would almost certainly exacerbate the serious problem of anorexia and eating disorders by further stigmatizing overweight.

Patients of the Cleveland Clinic can no longer be assured that they are being treated by the best medical, nursing, and ancillary services staff. But they can at least rest better at night knowing that the people who treat them do not smoke. Soon, they won't even have to see overweight people in the Clinic's facilities. It will be staff made up completely of thin nonsmokers. Unfortunately, it will also be a staff that is less qualified to provide medical care than the staffs at other health care facilities.

Which would you rather have?

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