Hospital in Texas won't hire people w/BMI over 35?

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SpecterGT260 said:
how variable do you think bone density is? and how much do you think this impacts overall weight?
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Density wasn't the best wording. More like thickness and density, which is highly variable. Just look at wrist sizes, I have like 6 inch wrists, while my endomorph friends will have like 8 inch wrists even though they are the same height and not fat. This difference in bone makes a big difference in weight. There are too many variables that BMI does not take into account.
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I dont think skeleton is going to factor in to BMI too highly..... but ok
 
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Height and weight are cheap and easy to measure. There is a ton (if you'll pardon the pun) of epidemiologic data showing that elevated BMI is correlated with some poor outcomes.

I agree that this is all about controlling costs.
 
LizzyM said:
Height and weight are cheap and easy to measure. There is a ton (if you'll pardon the pun) of epidemiologic data showing that elevated BMI is correlated with some poor outcomes.

I agree that this is all about controlling costs.
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but I won't pardon the rhyme :eyebrow:
 
SpecterGT260 said:
I dont think skeleton is going to factor in to BMI too highly..... but ok
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Well you're wrong, and honestly just scapegoating the issue.

LizzyM said:
Height and weight are cheap and easy to measure. There is a ton (if you'll pardon the pun) of epidemiologic data showing that elevated BMI is correlated with some poor outcomes.

I agree that this is all about controlling costs.
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A bodyfat percentage test with calipers takes like 5 minutes, is that really going to be that much more expensive? And if you're rejecting people for a job, you should probably try to make your test somewhat accurate.
 
LizzyM said:
Do you know what a BMI of 35 looks like?

5'3" and 197 pounds
5'8" and 230 pounds
6'0" and 258 pounds

That's big; that's not a muscle-bound weight lifter.
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I agree. Even weight lifters shouldn't have a huge problem with this BMI limit.
 
Aerus said:
I agree. Even weight lifters shouldn't have a huge problem with this BMI limit.
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I hate your signature so much, but agree with your statement.



Sliceofbread... Everyone knows body builders have trouble with BMI. But whens the last time you met a physician (or any clinical staff) who was jacked [and tan]? Maybe as residents, but not as attendings (exceptions always exists -- but rarely!)
 
sliceofbread136 said:
Well your wrong, and honestly just scapegoating the issue.



A bodyfat percentage test with calipers takes like 5 minutes, is that really going to be that much more expensive? And if you're rejecting people for a job, you should probably try to make your test somewhat accurate.
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you're*
cite your sources please. The skeleton is only about 20% of the average person's body weight. This % diminishes for people with more soft tissues like muscle and fat as you are suggesting. I dont think the fluctuation in frame/density around this 20% mark will skew results too far one way or the other. As I said before, I would have to gain 40 lbs to hit 35, so if I wanted to blame my skeleton it would have to gain density by 100%ish. I dont think total body weight contribution varies by more than a few percent... 5-7% in either direction. But I do not have hard data on that.
 
Holy FranZ said:
I hate your signature so much, but agree with your statement.



Sliceofbread... Everyone knows body builders have trouble with BMI. But when the last time you met a physician (or any clinical staff) who was jacked [and tan]? Maybe as residents, but not as attendings (exceptions always exists -- but rarely!)
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Haterz gonn' hate. ;)

JK.
 
Holy FranZ said:
I hate your signature so much, but agree with your statement.



Sliceofbread... Everyone knows body builders have trouble with BMI. But when the last time you met a physician (or any clinical staff) who was jacked [and tan]? Maybe as residents, but not as attendings (exceptions always exists -- but rarely!)
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This isn't just for the doctors, it's for every employee. I've seen some jacked nurse assistants. I don't honestly have too much of a problem with using BMI, but why use it when there are much better alternatives? And I don't think price is really an issue, measuring body fat percentage is only slightly harder than measuring BMI.
 
sliceofbread136 said:
This isn't just for the doctors, it's for every employee. I've seen some jacked nurse assistants. I don't honestly have too much of a problem with using BMI, but why use it when there are much better alternatives? And I don't think price is really an issue, measuring body fat percentage is only slightly harder than measuring BMI.
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Some of the biggest (muscular) guys I know don't break the bmi of 35 though... You need to be fat and jacked to break it.



I'm 6'2, and would need to be 272 lbs to be AT 35... If I ever hit that, someone shoot me.
 
SpecterGT260 said:
you're*
cite your sources please. The skeleton is only about 20% of the average person's body weight. This % diminishes for people with more soft tissues like muscle and fat as you are suggesting. I dont think the fluctuation in frame/density around this 20% mark will skew results too far one way or the other. As I said before, I would have to gain 40 lbs to hit 35, so if I wanted to blame my skeleton it would have to gain density by 100%ish. I dont think total body weight contribution varies by more than a few percent... 5-7% in either direction. But I do not have hard data on that.
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Ah the grammar nazi internet tough guy :thumbup:

A quick google search didn't show me any data and that's as far as I'm willing to look. You can believe frame size has no effect on your weight all you want, I'll just continue staying in reality. And gaining 40 pounds of muscle isn't as much as you think. I went from 6 ft 125 to 6 ft 180 and still don't look jacked.
 
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Holy FranZ said:
Some of the biggest (muscular) guys I know don't break the bmi of 35 though... You need to be fat and jacked to break it.



I'm 6'2, and would need to be 272 lbs to be AT 35... If I ever hit that, someone shoot me.
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But still, you could be less fat than a non-jacked guy and not get the job while the other guy does.
 
sliceofbread136 said:
Ah the grammar nazi internet tough guy :thumbup:

A quick google search didn't show me any data and that's as far as I'm willing to look. You can believe frame size has no effect on your weight all you want, I'll just continue staying in reality. And gaining 40 pounds of muscle isn't as much as you think. I went from 6 ft 125 to 6 ft 180 and still don't look jacked.
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you're the one who just up and told me I am wrong with no data to back it. A little grammar correction is well deserved ;)
All sources show skeleton weight of about 15-20% of total body weight. Do the math. A 6' person with normal BMI (24, cuz that is what the calculator spit out at me for a 180lbs dude) has a skeletal weight of ~32 lbs. if someone was WAY out of range on skeleton and has a 30% of body weight due to their skeleton (50% deviation is big in almost all cases so I feel it is fine here) the skeleton would weigh 50 lbs. So lets add in another 18 lbs to account for this and we get a BMI of 27. 3 pts of BMI for going silly with the skeleton. That is all I am saying. your BMI is not heavily dependent on your skeleton. Even doubling your skeleton doesnt get you there. Fat/muscle variability >>>> skeleton variability
 
SpecterGT260 said:
you're the one who just up and told me I am wrong with no data to back it. A little grammar correction is well deserved ;)
All sources show skeleton weight of about 15-20% of total body weight. Do the math. A 6' person with normal BMI (24, cuz that is what the calculator spit out at me for a 180lbs dude) has a skeletal weight of ~32 lbs. if someone was WAY out of range on skeleton and has a 30% of body weight due to their skeleton (50% deviation is big in almost all cases so I feel it is fine here) the skeleton would weigh 50 lbs. So lets add in another 18 lbs to account for this and we get a BMI of 27. 3 pts of BMI for going silly with the skeleton. That is all I am saying. your BMI is not heavily dependent on your skeleton. Even doubling your skeleton doesnt get you there. Fat/muscle variability >>>> skeleton variability
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You're also arguing with no data either...

Skeletal weight is just another variable that isn't taken into account by BMI. In your little scenario, that's 18 pounds that isn't fat. 18 pounds is alot of weight to just assume is fat. Why not just measure how much fat a person actually has rather than guessing it indirectly with BMI?
 
About those calipers... their reliability is not as good as a scale and stadiometer. It is also much easier for prospective employees to understand... you weigh x at height y, you aren't getting hired.
 
you werent really listening....
http://en.wikipedia.org/wiki/Human_skeleton
15-20% and that number is repeated in about everything that I searched (and I am assuming that you searched as well).
in my "little scenario" even going to the extreme by assuming a 50% variability from average we only gain 3 to BMI... which means in your "little scenario" only people with BMI of >32 could even be considered as a problem here and the true number is probably well lower than that.
I dont give a damn how you measure it or how you want texas to measure it.... i'm just saying your argument of skeleton is incorrect.
 
SpecterGT260 said:
you werent really listening....
http://en.wikipedia.org/wiki/Human_skeleton
15-20% and that number is repeated in about everything that I searched (and I am assuming that you searched as well).
in my "little scenario" even going to the extreme by assuming a 50% variability from average we only gain 3 to BMI... which means in your "little scenario" only people with BMI of >32 could even be considered as a problem here and the true number is probably well lower than that.
I dont give a damn how you measure it or how you want texas to measure it.... i'm just saying your argument of skeleton is incorrect.
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I dont see how my argument is incorrect? You just said people who would have a BMI under 35 could be over 35 due to a larger frame. That is a factor of inaccuracy in using BMI, and is only one of many.

And why are you always such a passive aggressive D-bag? Seriously, learn to talk without talking down, and maybe you'll make a friend one day.
 
LizzyM said:
About those calipers... their reliability is not as good as a scale and stadiometer. It is also much easier for prospective employees to understand... you weigh x at height y, you aren't getting hired.
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I don't think the calipers are as inaccurate as you think, and professionals can approximate bodyfat fairly well with them.

I'm not claiming calipers would be perfect, just better.
 
SpecterGT260 said:
I dont think skeleton is going to factor in to BMI too highly..... but ok
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sliceofbread136 said:
Well you're wrong, and honestly just scapegoating the issue.

.
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right... so when I gave my position and otherwise dropped it (i.e. "but ok...") I was the one being the D-bag.

:laugh: all I said is that the skeleton will have a minimal impact and that is what I showed. I did not say that it would have no effect. I said it would be small and not really worth noting and you just down my throat. And yet I am the d-bag. You are brilliant :thumbup:

you go read as many of my threads/posts as you want to - I don't talk down to anyone until some tool-bag decides to call me out on a technicality or get super pissy over disagreeing as you did above. I doubt you will find a single instance of me instigating
 
SpecterGT260 said:
right... so when I gave my position and otherwise dropped it (i.e. "but ok...") I was the one being the D-bag.

:laugh: all I said is that the skeleton will have a minimal impact and that is what I showed. I did not say that it would have no effect. I said it would be small and not really worth notingand you just down my throat. And yet I am the d-bag. You are brilliant :thumbup:

you go read as many of my threads/posts as you want to - I don't talk down to anyone until some tool-bag decides to call me out on a technicality or get super pissy over disagreeing as you did above. I doubt you will find a single instance of me instigating
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Don't see how you showed that at all. In your made up scenario you added 18 pounds to the hypothetical person, which would be statistically significant on the BMI spectra and definitely worth noting.

And EVERY thread I see you post in you end up talking down to people. Yes I said you were wrong (still think you're wrong despite you "proving" otherwise) and scape goating the issue being talked about (bmi measurement, not bone density), don't see how that's inflammatory. You on the other hand, are a jerk. Thank you for illustrating it more with the quoted post.
 
sliceofbread136 said:
Don't see how you showed that at all. In your made up scenario you added 18 pounds to the hypothetical person, which would be statistically significant on the BMI spectra and definitely worth noting.

And EVERY thread I see you post in you end up talking down to people. Yes I said you were wrong (still think you're wrong despite you "proving" otherwise) and scape goating the issue being talked about (bmi measurement, not bone density), don't see how that's inflammatory. You on the other hand, are a jerk. Thank you for illustrating it more with the quoted post.
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added 18 lbs by accepting an absurd deviation from norm to skeletal contribution. Nobody said anything about statistically significant... I said the impact is not really worth noting. To demonstrate this I used numbers that no human would likely have and still got an impact of 3 BMI which isnt all that much. The true value is very likely much less than that and fluctuations in the skeleton probably do not sway BMI more than 1 point among individuals. A statistically significant value can be 1/10000000th of an ounce. The stats do not dictate a specific magnitude.

you having a bad day? you need a hug or something? maybe some ointment? I'm not going to shy away just because you think I am being "mean". From my perspective we disagreed and rather than discussing you just attack. Go around to different topics and throw out "you're wrong and just *blanking whatever*" and see how many positive responses you get. I don't think you are dumb enough to actually think it was not inflammatory, but we will see if you are stubborn enough ;)

end of the day - I'm still attempting to discuss the matter at hand rather than being butthurt and calling names. So here it is: my point is that variance in the skeleton is not a large variable in BMI. So your insistence that it does have an impact was never a point of contention. whether or not it is a "major factor" is open to interpretation, but you seem to think that a positive non-zero impact somehow stands as a counterpoint to my initial statement that it will be minimal. IMO <3BMI is pretty minimal and shouldnt be used to complain about a policy that is the prerogative of the hospital and that does not affect you in the first place.

also, you are more than welcome to put me on ignore if you cannot handle it. :thumbup:
 
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SpecterGT260 said:
added 18 lbs by accepting an absurd deviation from norm to skeletal contribution. Nobody said anything about statistically significant... I said the impact is not really worth noting. To demonstrate this I used numbers that no human would likely have and still got an impact of 3 BMI which isnt all that much. The true value is very likely much less than that and fluctuations in the skeleton probably do not sway BMI more than 1 point among individuals. A statistically significant value can be 1/10000000th of an ounce. The stats do not dictate a specific magnitude.

you having a bad day? you need a hug or something? maybe some ointment? I'm not going to shy away just because you think I am being "mean". From my perspective we disagreed and rather than discussing you just attack. Go around to different topics and throw out "you're wrong and just *blanking whatever*" and see how many positive responses you get. I don't think you are dumb enough to actually think it was not inflammatory, but we will see if you are stubborn enough ;)
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I mean statistically significant in the sense that it affects who get's approved and not. Even a BMI of 1 would be statistically significant in that sense, and you provided no data in weight variability of the skeleton, so you really didn't make any points.

And you can argue your points without being condescending/inflammatory (it'll actually be a better debating strategy!). You can be in denial about that all you want, hopefully it will catch up to you one day :thumbup:
 
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sliceofbread136 said:
I don't think the calipers are as inaccurate as you think, and professionals can approximate bodyfat fairly well with them.

I'm not claiming calipers would be perfect, just better.
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Virtualy every pre-employment medical office in America has a scale and stadiometer. I doubt that many have calipers. So right there, you have an added expense.

Inter-rater reliability with calipers is an issue whereas it is much less an issue with the measure of height and weight.
 
I'm a 6'1" 300 playing weight college offensive lineman in better shape than most non athletes I know. I'm "morbidly obese" with great blood pressure and zero health problems. If I kept this weight on when I'm done playing it wouldn't be muscle like it is now, but I can see myself in the 250 range with weights and running. A strict 35 BMI policy is ridiculous for ex athletes that have muscle mass like mine regardless of "most >= 35 BMI-er's are fatties".
 
Perrotfish said:
A hospital we rotate through in Louisiana has similar policies. They blood test everyone for nicotine on hiring, and if you pop positive you aren't hired. They don't refuse to higher the obese, but they have cut all of the desserts and sodas from the cafeterias and part of your pay comes in the form of a bonus for meeting certain health goals. For example they make everyone wear a pedometer, and you get a bonus if you hit your target number of steps.n

I spoke to one of the physicians that implemented the policy and he said it was 100% about controlling costs. People don't realize what a huge chunk of labor costs healthcare is, they estimated it at about 15% of the gross. They found another hospital that implemented a similar program and cut their health insurance costs in half.

FWIW the program seems to work. It was kind of cool to watch the entire nursing staff slim down over the course of the year.
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I am healthfreak and this still sounds like a horrible place to work for. Screw their costs, I am not going to change my behavior for your profit margins to go up.
 
BMI was never meant to be used on an individual level. It's for population statistics.

But our culture has an obsession with dumbing everything down.
 
At a Texas hospital I worked at, one of the nurses was welllllllll over 400lbs. You should have seen the looks she got walking down the hall holding on to the wall rails and being out of breath. I might get flamed for this but some people should not give others medical advice when they are not healthy theirselves. Yeah, maybe its a thyroid problem or something but still.
 
Morzh said:
BMI was never meant to be used on an individual level. It's for population statistics.

But our culture has an obsession with dumbing everything down.
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Yeah, and just taking a look at the three examples measurements LizzyM gave should make it apparent that the BMI isn't good and handling numbers that stray too far from the average. I think the ponderal index works a little better when comapring people who are much shorter or taller than average, but still, just height and weight comparisons fail to account for a lot of other important variables. A lot of NFL linemen are technically obese by BMI standards. Yes, they have more fat on them than I do, but a lot of it is muscle, and there are people with more fat on them who aren't over 35 BMI because they don't have all that muscle weight filling out a wide frame.
 
Sephiroth said:
Yeah, and just taking a look at the three examples measurements LizzyM gave should make it apparent that the BMI isn't good and handling numbers that stray too far from the average. I think the ponderal index works a little better when comapring people who are much shorter or taller than average, but still, just height and weight comparisons fail to account for a lot of other important variables. A lot of NFL linemen are technically obese by BMI standards. Yes, they have more fat on them than I do, but a lot of it is muscle, and there are people with more fat on them who aren't over 35 BMI because they don't have all that muscle weight filling out a wide frame.
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poor example.

Heres a "skinnier" one who i'd still say is obese.

C_1_1cJones1__0129.jpg
 
I think there's a logistics point that hasn't been touched on just yet.

What body type is more maneuverable in a hospital - those who are smaller? Or those who are larger? This is certainly an important factor in trauma/coding situations.

FWIW, I'm tiny (Wii Fit says my BMI is 19 & I'm 5'5"), and I see more people like me in the gym than people on the other end of the spectrum. This needs to change, pronto. As someone already said earlier, overweight people DO cost more to treat throughout their lives.
 
SunsFun said:
Weight has a genetic component too. The most obese people in the world right now are the ones who live on the Islands. Their bodies are more adapted to eating fruit and fish and very little red meat. Due to dietary changes they gain weight much easier and retain it more when subjected to the exact same diet as white people for example.
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Wait, WHAT? The most obese people live on islands? Just....what? Wouldn't people eating fruit and fish and very little red meat be thinner?
 
Holy FranZ said:
I hate your signature so much, but agree with your statement.



Sliceofbread... Everyone knows body builders have trouble with BMI. But whens the last time you met a physician (or any clinical staff) who was jacked [and tan]? Maybe as residents, but not as attendings (exceptions always exists -- but rarely!)
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Franz, we're making this happen. Please attend my medical school. We will be the jacked.
 
Wile said:
Wait, WHAT? The most obese people live on islands? Just....what? Wouldn't people eating fruit and fish and very little red meat be thinner?
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Their initial diets consisted of mainly fruit and fish, but their diets have become more western, with larger portions of red meat, hence the weight gain.
 
Yes it is possible to have a BMI >35 while still being "healthy", although those type of muscular people are more rare than the usual condition of just being morbidly obese.

I don't really see the problem, it's the hospital's purview to hire who they want. It gives a choice to the person with a BMI >35, either lose the weight (which is medically recommended) or go to another hospital to work at.
 
For the vast majority of people this is a fine measure. For those few who are both fat and muscular, maybe they'll consider dumping some of the fat. For those that are just muscular and reaching a BMI>35....I'm not sure why they'd be applying for a job a hospital since they're professional muscle men/women.
 
I love how people are up in arms about a hospital having hiring practices that are likely implemented to control employee healthcare costs (and as a byproduct client perceptions). Funny how no one is complaining about other obvious instances of hiring people based solely on appearance (Hooters anyone?).
 
CopaceticOne said:
I love how people are up in arms about a hospital having hiring practices that are likely implemented to control employee healthcare costs (and as a byproduct client perceptions). Funny how no one is complaining about other obvious instances of hiring people based solely on appearance (Hooters anyone?).
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Is Hooters offering health insurance these days?
 
CopaceticOne said:
Exactly my point. Standards of employment are all around us. At least this hospital is being forthcoming about what they are doing.
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Well, exactly my point as well. Look at us, how we agree that the obese should be marginalized.

And I have just one thing to say to the haters out there:

images
 
Being from Texas and knowing how terribly fat people are in Houston, I am really ok with this. I understand why it may be discriminatory, but from a cultural standpoint, it is like installing bike lanes in other cities. We just don't have the incentive to be fit like our north eastern friend, nor the need due to the highway sprawl. Also, this is the reason some of the best meals I've ever eaten are in Texas.

Now I'm thinking about Mexican food. Thanks. :smuggrin:
 
Holy FranZ said:
poor example.

Heres a "skinnier" one who i'd still say is obese.

C_1_1cJones1__0129.jpg
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I don't follow. Could you explain why you considered that a poor example, and what point you were making with this one? I didn't pick up on it.
 
As doctor I plan to respect my patient's life choices even if I don't think they will be the most beneficial. I would give my advice about the diet and exercise when I see a need. But, there is no way I would try to force a rational adult that can make his or her own informed decisions to follow my diet plan. This seems very unethical to me. Hospitals trying to monitor smoking, exercise, and dieting of their employees for profit reasons (not even because they actually care) feels like a bigger invasion of personal space and privacy. Look, I can agree that fat people should try to lose weight, but they shouldn't be forced by anyone to do so, especially by their employer. It is their personal choice and showing zero respect for it is just messed up.

Also, homosexual males are more likely to contract certain venereal diseases. Should hospitals stop hiring homosexual men to control their healthcare costs? How about seniors who are more sick than younger people? Should they be let go as well to control insurance costs?
 
This strikes me as something that could quickly devolve into a race issue given that African-Americans and Mexican-Americans are much heavier on average than other groups.
 
SunsFun said:
As doctor I plan to respect my patient's life choices even if I don't think they will be the most beneficial. I would give my advice about the diet and exercise when I see a need. But, there is no way I would try to force a rational adult that can make his or her own informed decisions to follow my diet plan. This seems very unethical to me. Hospitals trying to monitor smoking, exercise, and dieting of their employees for profit reasons (not even because they actually care) feels like a bigger invasion of personal space and privacy. Look, I can agree that fat people should try to lose weight, but they shouldn't be forced by anyone to do so, especially by their employer. It is their personal choice and showing zero respect for it is just messed up.

Also, homosexual males are more likely to contract certain venereal diseases. Should hospitals stop hiring homosexual men to control their healthcare costs? How about seniors who are more sick than younger people? Should they be let go as well to control insurance costs?
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Age is a protected class in the workforce, so that argument is negated by law. I won't touch your landmine re: sexual orientation.

Sure, it is the applicant's "choice" to smoke/maintain a healthy weight/consume alcohol/do drugs/etc just as it is an employer's choice not to hire them for specific reasons. Just because someone doesn't like the rules laid out for a particular job doesn't mean that said rules must be changed provided they are within the framework of the law. Welcome to the real world.
 
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