‘Weigh’ out on a limb!

I enjoy my Sunday New York Times, but it is so voluminous I have to carefully select the sections I read. One “can’t skip” segment is the Sunday Magazine, not only for its content but particularly to see the mailed-in readers’ responses to a previous edition. The batch next Sunday should make for an enjoyable and enlightening morning!

The lead article in the magazine this week discussed the possibility of hospitals discriminating against staff who are obese, with one suggestion that obesity should be a barrier to employment just as many hospitals won’t hire anyone who smokes.

Smoking is clearly a habit that is difficult to overcome and has major adverse health effects. Overeating is also a bad habit that is difficult to overcome and has major adverse health effects. Smoking is regulated in a number of ways that have reduced the incidence of smoking, and there are attempts to regulate obesity (eg, banning trans fat from restaurants), although that would have little direct impact on overeating.

I am not yet ready to discriminate employment on the basis of body habitus. Is anyone really convinced that we as a society should single out obesity as a “punishable” self-inflicted condition?

Eating disorders (both overeating and undereating) are associated with excess morbidity and mortality and substantial health care costs. While we are learning more and more about the physiology of appetite control and the pathophysiology of eating disorders, we have a long way to go before we have a good grasp of the appropriate management. Weight reduction surgery has been markedly fine-tuned in recent years, and the health benefits (eg, much improved control of diabetes) are apparent, but all too often, we as clinicians do not consider the surgery until faced with a patient who is already experiencing the clinical complications of obesity. The clinical management of anorexia nervosa or bulimia is suboptimal, and the potential adverse health outcomes are no less of an issue than those complicating obesity.

The health care costs associated with eating disorders — we can read lots about the costs associated with obesity but very little about the health care costs of anorexia — are massive and expanding faster than waistlines. Entrepreneurs seem to be making a healthy profit through the weight loss programs that are advertised day and night on TV and radio. Their solutions seem to be transient in many clients, but it is difficult (impossible?) to get a good handle on the success rate or the recidivism rate. As a profession, we don’t seem to be doing any better.

Experience has convinced me that an eating disorder may well interfere with an employee’s productivity, but that is the case with most chronic medical conditions. That’s not a valid reason to deny employment. Rather it should be an opportunity to offer appropriate care. If in the passage of time it becomes clear that the employee is substandard in his/her work, appropriate disciplinary action is indicated. If the employee is doing a good job, offer encouragement and intensify efforts to help them manage their obesity.