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

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you will also find, if you get in, that a good bit of the public health lectures that you get in med school will draw many more lines between groups of people in ways that seem very arbitrary and potentially unfair. public health =/= irrationally championing for "civil" race/gender issues.
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ElCapone said:
I agree with Wile here because of what she's hinted at (in bold). It's not your genetic makeup, but your environment that plays a big role: Your average Pacific Islander in the Pacific is not going to have a higher chance of being obese than your average American here in 'Merica.

It's because of how different those environments are in terms of physical activity and food delivery. I don't know much about the Pacific Islander diet, but I'd argue that an extremely high chunk of it is much lower in calories than what we eat. Whataburger and McDonalds isn't exactly the best thing to feed yourself or your kids. Add to this the problem of the socioeconomic worse off having much higher obesity and mortality rates in part to environmental situations such as food deserts and having a lack of time or knowledge to cook healthy meals for their kids (Hard to do that when you're working 2 to 3 jobs a day to provide for your family).

That being said, calories are calories. With a lack of substantive physical activity, eating a large amount of fish (@Wile) and red meat (@SunsFuns) are both likely to result in a large caloric intake since our bodies can convert protein, along with anything and everything, into calories and extra fat padding. There might also be cultural aspects to this in that if those differences really do exist, it's because of the differences in food preparation. Pacific Islanders may rely more on traditional methods of cooking their fish (that result in less caloric garbage being added) while relying on our "unhealthy" methods for preparing their red meat - and vice versa for Americans.

So the answer is that both Pacific Islanders and Caucasians are likely to have the same genetic factors, on average, for obesity. It's just that differential environmental and lifestyle conditions result in vastly different outcomes, if there are any.
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This is factually incorrect. As someone has already mentioned the discrepancy in weight has been explained using genetic factors. The islanders that started eating diet similar to westerners are more likely to gain weight consuming exact same amount and type of food when controlled for all other factors.
 
Also, a lot of people in this thread are missing a point. Just because 35 BMI is extremely obese doesn't mean this metric is a good one. What if the number would change to 20 or even 15 BMI? I bet you can save even more on health insurance costs. Do you see a problem with employing this metric now? The fact that 35 is pretty high and hard to reach is a moot point. All the reasons in favor of that number can also apply to lower numbers.
 
A metric doesn't need to be perfect. It just needs to work within normal, expected parameters.

A BMI can be thought of as to exclude a certain percentage of physicians. Lowering it would increase the percentage of physicians excluded. At some point, there's a cost-benefit inflection between the cost of retaining physicians (higher demand for a particular <35 BMI group of physician means more cost of obtaining those physicians) and the benefit from inspiring patients or not having to cater to specific needs / damages caused by >35 BMI people (uh... chair breakage?)

While I admit that they probably pulled 35 BMI out of their ass, the line of reasoning cannot continue all the way downward to the lower numbers.

And, even if we could optimize a BMI requirement where the benefits outweigh the nominal cost, the actual cost of instituting the requirement, conducting the studies, and applying the standards and regulations may not be worth it in the end.

Which is why they probably pulled 35 BMI out of their ass.
 
Morsetlis said:
A metric doesn't need to be perfect. It just needs to work within normal, expected parameters.

A BMI can be thought of as to exclude a certain percentage of physicians. Lowering it would increase the percentage of physicians excluded. At some point, there's a cost-benefit inflection between the cost of retaining physicians (higher demand for a particular <35 BMI group of physician means more cost of obtaining those physicians) and the benefit from inspiring patients or not having to cater to specific needs / damages caused by >35 BMI people (uh... chair breakage?)

While I admit that they probably pulled 35 BMI out of their ass, the line of reasoning cannot continue all the way downward to the lower numbers.

And, even if we could optimize a BMI requirement where the benefits outweigh the nominal cost, the actual cost of instituting the requirement, conducting the studies, and applying the standards and regulations may not be worth it in the end.

Which is why they probably pulled 35 BMI out of their ass.
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This stands as potentially the smartest post in here. Especially the first sentence
 
If the hospital wants this as their policy, and it doesn't break any laws (I don't believe it does) then let them. If they miss out on good doctors, and patient care suffers, ultimately that will fall back on the hospital and they'll be forced to reevaluate. It's not like this policy forces the hospital to only hire incompetent doctors, and there are still plenty of hospitals in the country, even in the area, that would hire someone with a BMI greater than 35.

As far as using BMI goes, yes it's a little unreliable, but I would imagine the number of weight lifters/body builders who fit into the >35 catagory is very low. So much so that arguing that extreme is kind of irrelevent. Especially considering that doctors/healthcare professionals who are >35 for that reason are probably nonexistent. However, if it does come up, let that person make their case, don't just throw out the whole policy based on the one possible exception.
 
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I've read that Frank Mir wants to go to medical school when he's done with MMA, and his BMI has been as high as 33.
 
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Morsetlis said:
A metric doesn't need to be perfect. It just needs to work within normal, expected parameters.

A BMI can be thought of as to exclude a certain percentage of physicians. Lowering it would increase the percentage of physicians excluded. At some point, there's a cost-benefit inflection between the cost of retaining physicians (higher demand for a particular <35 BMI group of physician means more cost of obtaining those physicians) and the benefit from inspiring patients or not having to cater to specific needs / damages caused by >35 BMI people (uh... chair breakage?)

While I admit that they probably pulled 35 BMI out of their ass, the line of reasoning cannot continue all the way downward to the lower numbers.

And, even if we could optimize a BMI requirement where the benefits outweigh the nominal cost, the actual cost of instituting the requirement, conducting the studies, and applying the standards and regulations may not be worth it in the end.

Which is why they probably pulled 35 BMI out of their ass.
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Weight adjusted for height (which is what BMI is) when plotted against survival and many other measures of health assumes a J curve with the best outcomes in the range of 20-24.9 with upward slopes at 25 and greater and 19.9 and lower. BMI of 25-29.9 is considered "overweight" and BMI of 30 or higher is "obese". In most research studies of surgical treatment of obesity, patients are eligible for surgery with a BMI or 40 or a BMI of 35 with concommitant conditions such as diabetes.
 
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Morsetlis said:
A metric doesn't need to be perfect. It just needs to work within normal, expected parameters.

A BMI can be thought of as to exclude a certain percentage of physicians. Lowering it would increase the percentage of physicians excluded. At some point, there's a cost-benefit inflection between the cost of retaining physicians (higher demand for a particular <35 BMI group of physician means more cost of obtaining those physicians) and the benefit from inspiring patients or not having to cater to specific needs / damages caused by >35 BMI people (uh... chair breakage?)

While I admit that they probably pulled 35 BMI out of their ass, the line of reasoning cannot continue all the way downward to the lower numbers.

And, even if we could optimize a BMI requirement where the benefits outweigh the nominal cost, the actual cost of instituting the requirement, conducting the studies, and applying the standards and regulations may not be worth it in the end.

Which is why they probably pulled 35 BMI out of their ass.
Click to expand...
Not disagreeing with your analysis, but you're operating on a premise that it is OK for a hospital to conduct a hiring process with a goal of minimizing its healthcare costs. I believe it is pretty unethical to use such a factor when making a determination on who should get the job.

My point however, was not about what will minimize the costs. I was basically replying to people who thought there are other reasons, just a s good for an employer to discriminate on the basis of weight. For all intends and purposes using 20 BMI instead of 35 provides a good point as to why such metric should not be used altogether.
 
SunsFun said:
Not disagreeing with your analysis, but you're operating on a premise that it is OK for a hospital to conduct a hiring process with a goal of minimizing its healthcare costs. I believe it is pretty unethical to use such a factor when making a determination on who should get the job.

My point however, was not about what will minimize the costs. I was basically replying to people who thought there are other reasons, just a s good for an employer to discriminate on the basis of weight. For all intends and purposes using 20 BMI instead of 35 provides a good point as to why such metric should not be used altogether.
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Actually I think this is a major issue that hasnt been addressed.... if this is the rationale that hospitals are using then what is to stop employers of all types doing this very thing? Businesses other than hospitals lose money on sickly employees.

I think the "we want to project a healthy image" or "because you will not be taken seriously when you tell your patient to lose weight" is a more defensible argument.... at least it pertains specifically to medicine and the ability for the hospital to accomplish its professional goals (same rationale for denying fat hooters girls.... unless you are in iowa or the dakotas :laugh:)
 
SunsFun said:
Start here:

http://blog.foreignpolicy.com/posts/2011/02/14/more_on_overweight_islanders
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From what I found, those findings are based on only 1 hard-core study: http://www.ncbi.nlm.nih.gov/pubmed/10377604

It would be much more persuasive if multiple studies were able to confirm this across multiple populations.

Secondly, it also raises some important questions: Are those guys truly Hawaiians? (Cross-cultural mixing). What is a "traditional Hawaiian" diet? And what were the "American" foods given to them? How were these "American" foods prepared? The study authors might as well have given them high calorie laden American foods versus healthier "traditional" foods.

I can't answer these questions since I can't access the full length article.
 
ElCapone said:
From what I found, those findings are based on only 1 hard-core study: http://www.ncbi.nlm.nih.gov/pubmed/10377604

It would be much more persuasive if multiple studies were able to confirm this across multiple populations.

Secondly, it also raises some important questions: Are those guys truly Hawaiians? (Cross-cultural mixing). What is a "traditional Hawaiian" diet? And what were the "American" foods given to them? How were these "American" foods prepared? The study authors might as well have given them high calorie laden American foods versus healthier "traditional" foods.

I can't answer these questions since I can't access the full length article.
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There are more studies like this, I am just too lazy to search. Anyway, why this is something that is so hard for you to believe? It makes sense that people who used to eat coconuts and fish for thousands of years are not as good in managing to burn tons of extra calories that meats and grains from western diet bring.
 
SpecterGT260 said:
Actually I think this is a major issue that hasnt been addressed.... if this is the rationale that hospitals are using then what is to stop employers of all types doing this very thing? Businesses other than hospitals lose money on sickly employees.

I think the "we want to project a healthy image" or "because you will not be taken seriously when you tell your patient to lose weight" is a more defensible argument.... at least it pertains specifically to medicine and the ability for the hospital to accomplish its professional goals (same rationale for denying fat hooters girls.... unless you are in iowa or the dakotas :laugh:)
Click to expand...

I see exactly what you're saying. But unless it is shown that overweight doctors will not be taken seriously just assuming so feels icky. And my example of using 20 BMI instead of 35 would provide even healthier image for the hospital, don't you think?

Also, I live in a state with a lot of hot girls and any time I go to hooters I manage to notice quite a few overwheight girls :cool:
 
SunsFun said:
I see exactly what you're saying. But unless it is shown that overweight doctors will not be taken seriously just assuming so feels icky. And my example of using 20 BMI instead of 35 would provide even healthier image for the hospital, don't you think?

Also, I live in a state with a lot of hot girls and any time I go to hooters I manage to notice quite a few overwheight girls :cool:
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I know. Nothing about this is entirely rational. I'm just saying that the healthcare cost thing doesnt seem defensible (and possibly illegal depending on how healthcare legislation is worded relating to employers providing insurance). I do not think you can deny insurance based on pre-existing conditions, and as a co-morbidity it is not unreasonable to see a lawyer argue that obesity is a "pre-existing condition". So an employer doing this for healthcare cost reasons might be breaking a rule..... but I am not sure (and many things like this are ambiguous when in print until there are court cases to define them)
 
SunsFun said:
I see exactly what you're saying. But unless it is shown that overweight doctors will not be taken seriously just assuming so feels icky. And my example of using 20 BMI instead of 35 would provide even healthier image for the hospital, don't you think?

Also, I live in a state with a lot of hot girls and any time I go to hooters I manage to notice quite a few overwheight girls :cool:
Click to expand...

A 20 BMI is in the middle of the range considered healthy (18-22). I don't think there's any proof of a health benefit of a BMI of 19 vs 21, and there's a negative health risk if you're under 18.

It's also a really dumb statistic. It's just a rule of thumb, meant to be easily calculable. You could probably get a better metric using fractional powers, and definitely if you include waist circumference and body fat.

You would do even better if you included a lipid panel.
 
Im just not sure if some people actually think this is a big deal or if we are just discussing this for the sake of discussion.... Some people are suggesting an arc welder to fix a broken screen door... duct tape (BMI) will suffice.
 
SunsFun said:
I see exactly what you're saying. But unless it is shown that overweight doctors will not be taken seriously just assuming so feels icky. And my example of using 20 BMI instead of 35 would provide even healthier image for the hospital, don't you think?

Also, I live in a state with a lot of hot girls and any time I go to hooters I manage to notice quite a few overwheight girls :cool:
Click to expand...


Given the proportion of Americans who are overweight or obese, or even normal weight (BMI 20-24.9), you'd be hard-pressed to hire enough nurses, social workers, lab techs, etc to cover the hospital shifts if you were to restrict BMI to 20 or less. (It would eliminate about 80-90% of the employment pool)

As it is, BMI >35 eliminates about 8% of men and 17% of women. I was surprised by that, I didn't expect that there were such a large proportion of fatties in the US.
 
SpecterGT260 said:
Im just not sure if some people actually think this is a big deal or if we are just discussing this for the sake of discussion.... Some people are suggesting an arc welder to fix a broken screen door... duct tape (BMI) will suffice.
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To get to the nuts and bolts - BMI is sensitive, but not specific.

Fine for a screening test, but isn't really a great direct indicator and shouldn't be used for employment (if you're going to fire someone for obesity, better get out the calipers).
 
What if you have a bodybuilder who is very muscular do they get denied? Football players? How will this hospital have an ortho department?
 
BMI is just a function of height and weight, according to it, most football players and basketball players are overweight or obese. Tom Brady has a BMI of 27.4 at 225 and 6'4, he's overweight, Bryant McKinnie, Raven's tackle, has a BMI of 39.5 at 6'8 and 360, neither of them are fat, I'm just saying that these metrics make a lot less sense than does percent body fat, although I think that it's equally stupid. As long as the physician is competent does it matter?
 
SunsFun said:
Anyway, why this is something that is so hard for you to believe? It makes sense that people who used to eat coconuts and fish for thousands of years are not as good in managing to burn tons of extra calories that meats and grains from western diet bring.
Click to expand...

1) My PI has drilled me hard into always examining the methodology of a study first before making conclusions.

2) The human genetic makeup has not changed that much in thousands of years. I doubt that the genetic differences are really that great.

3) Populations are more homogenous than heterogeneous than you think. What could work for these Pacific Islanders could work for others.

4) No cross-cultural testing. It's been done on these Islanders, but what about people living in different parts of the world? How about the aborigenes.

5) If anything, it should be the other way around. Most likely these guys lived in hunting/fishing communities (this isn't the right technical term for it. Can't remember what it is off the top of my head) in which the amount of excess food would be nil. Their bodies should have adapted the other way around and tried to squeeze out as many calories as possible out of those foods - in other words, they should be getting more calories out of fish and fruit, than "American" stuff like red meat. So, if anything, they should have seen greater weight loss by eating red meat than by eating their stuff.

6) What's the impact factor of that journal?
 
ElCapone said:
1) My PI has drilled me hard into always examining the methodology of a study first before making conclusions.

2) The human genetic makeup has not changed that much in thousands of years. I doubt that the genetic differences are really that great.

3) Populations are more homogenous than heterogeneous than you think. What could work for these Pacific Islanders could work for others.

4) No cross-cultural testing. It's been done on these Islanders, but what about people living in different parts of the world? How about the aborigenes.

5) If anything, it should be the other way around. Most likely these guys lived in hunting/fishing communities (this isn't the right technical term for it. Can't remember what it is off the top of my head) in which the amount of excess food would be nil. Their bodies should have adapted the other way around and tried to squeeze out as many calories as possible out of those foods - in other words, they should be getting more calories out of fish and fruit, than "American" stuff like red meat. So, if anything, they should have seen greater weight loss by eating red meat than by eating their stuff.

6) What's the impact factor of that journal?
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Genetic differences account for distinct morphological differences between peoples. There is no reason to assume that qualities that are not outwardly obvious like metabolism might also be affected. Except for northern europeans most human races are unlikely to retain lactase expression into adulthood, as an example.
 
SpecterGT260 said:
Genetic differences account for distinct morphological differences between peoples. There is no reason to assume that qualities that are not outwardly obvious like metabolism might also be affected. Except for northern europeans most human races are unlikely to retain lactase expression into adulthood, as an example.
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Actually responding to the person before you, but he wrote too much.

The whole 99.9% similarity of human genomes thing is kind of irrelevant. There's plenty of room for variation in the remaining genome. We share a decent amount of similarity with all life on Earth.

If your argument is that selection hasn't happened, for the most part you're right. There's still plenty of drift and bottle-necking going on in human populations, and that's enough for a lot of variation. Then you have big selective pressures like the domestication of cattle or the plague that actually have changed the genetic composition of human populations.
 
johnnydrama said:
Actually responding to the person before you, but he wrote too much.

The whole 99.9% similarity of human genomes thing is kind of irrelevant. There's plenty of room for variation in the remaining genome. We share a decent amount of similarity with all life on Earth.

If your argument is that selection hasn't happened, for the most part you're right. There's still plenty of drift and bottle-necking going on in human populations, and that's enough for a lot of variation. Then you have big selective pressures like the domestication of cattle or the plague that actually have changed the genetic composition of human populations.
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so you quoted me to save page real estate? :laugh:
 
Praefectus said:
They have a prerogative to insure that hospital employees represent a healthy lifestyle to patients. For example, Children's Healthcare of Atlanta will test you for tobacco particulate in your bloodstream before they hire you.
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EBTrailRunner said:
I think this is a sensible hiring practice. In my mind, a healthcare professional should strive to project a healthy image to his or her patients. Genetics is a poor justification for obesity. It's not difficult to maintain a BMI less than 35. However, keep in mind that this policy applies to new hires only, and there's no penalty for subsequent weight gain. It doesn't strike me as particularly discriminatory, also considering that this hospital is willing to help job applicants toward meeting their weight requirement.
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:thumbup: Agreed
 
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