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Weight Bias in Healthcare Hiring

In the late 1990s, obesity became a billable code. That means that doctors could list obesity as a health care diagnosis and receive payment through insurance companies, Medicaid and Medicare. Since that time, obesity has been at the forefront of public health issues. A desire to eradicate obesity from the population has become evident, and it has even extended into healthcare hiring practices. In 2012, a Texas hospital issued a policy those with a body mass index (BMI) over 35 need not apply. The rationale for the policy, however, was not health related. Rather, it stated that the individual's appearance should be fitting to the image the healthcare organization wished to project.

According to the CDC, a little over one-third of adults in the United States are obese. In the case of the Texas hospital, that would mean that one out of three applicants would have been turned away because of their size. The CDC further states that weight bias in hiring does exist and that overweight people are less likely to be hired or to be viewed more negatively than other candidates. Some employers further view overweight individuals as lazy, less competent or lacking self discipline. Employers may even believe that overweight individuals "brought it on themselves", even though many medical conditions can cause increased weight gain and members of different ethnic or racial groups are more likely to be obese than others.

Unfortunately, there is currently no recourse for an overweight individual if they experience discrimination in hiring, at a healthcare facility or elsewhere. Only one state, Michigan, and six cities, Washington, DC, San Francisco, CA, Santa Cruz, CA, Binghamton, NY, Urbana, IL, and Madison, WI, prevent weight discrimination in hiring. There have been a few cases where individuals with obesity fell under the American with Disabilities Act (ADA) protection. In those instances, the individuals were protected because their disease (obesity) required appropriate accommodation through the organization. The U.S. Equal Employment Opportunity Commission (EEOC) does caution employers about height and weight inquiries, however. The EEOC recommends that employers not base employment decisions based on height or weight unless employers can demonstrate it is a bona fide occupational qualification.
Photo by Sarah Pflug courtesy of

The Rudd Center for Food Policy and Obesity has further identified weight stigma in hiring as a problem. Furthermore, the World Health Organization (WHO) and Healthy People 2020, list unemployment as a social determinant of health.  If health care organizations are truly concerned about health of all people and its consumers (including potential employees), they would recognize that refusing to hire an overweight individual does not improve health; it hinders health. By refusing to hire an overweight individual, organizations are denying the person access to medical services because the individual is not able to obtain employer sponsored insurance, organizations are reducing available financial resources because of an individual's inability to obtain employment, organizations are decreasing an obese individual's social support by isolating them from work related peers, and organizations are decreasing socioeconomic opportunities by limiting an individual's ability to be self-sufficient.


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