It’s time to ban obesity in NHS employees

What a brave letter! Yet, recently I heard of a hospital trust which successfully reduces staff absenteeism by providing physiotherapy sessions to prevent or treat back problems. So why not provide whatever is necessary to support overweight staff to lose weight?

However, since this is unlikely to be successful, why not make exercise sessions and low calorie meals compulsory – well, staff are supposed to set a good example to patients are they not? Of course a little training might be needed on how to deal with the paper work while doing press-ups, jogging round the roof and roller-skating along the corridors.

Then again, why not make it compulsory for them to give blood and be organ donors too? Hmm...Encouraging posters could exclaim, 'You know it makes sense!'

Hmm... soon the NHS could be practising what it preaches...Not.

Sir,

I agree in principle with Fouin’s call to “ban obesity in NHS employees”[1]. However, the author's aspiration is highly ambitious and obviously controversial. For the many existing NHS employees who are obese, the best we can do for them is to get them to acknowledge they are putting their own health at significant risk and then encourage them to improve their body mass index. However, whilst we can bring the horses to water, we cannot make them drink.

As Fouin suggests, meaningful intervention might be possible with respect to future NHS employees. There is good awareness in the NHS of Equality and Diversity, not least amongst those who sit on interview panels. Intriguingly, the Equality Act 2010, the UK legislation which dictates the agenda in this area, does not prohibit discrimination on the grounds of adiposity or body mass index[2]. In other words it is legal to discriminate on the basis of obesity. The Act describes nine “protected characteristics” e.g. age, race, sex etc. Body habitus is not a protected characteristic under the Law as it stands.

If people knew that the NHS could and would discriminate against obese job applicants, that would eventually alter the average body mass index of the NHS workforce. This will take a long time.

However a catalyst for change in the workforce could come from this age of austerity. The NHS is undergoing an unprecedented process of consolidation across the board. Where consolidation occurs, existing staff may find themselves having to apply for an ever shrinking number of posts. Potentially, if Fouin’s wish is granted, obese NHS staff will face a stark choice: lose weight or perhaps, lose their jobs.

Job security would be a menacing “stick” to wield against the seemingly insoluble problem of obesity, but desperate times call for desperate measures. Obesity is a Colossal public health threat; whatever carrots have been deployed by successive British Governments to date do not seem to have had any real impact.

Fouin has stimulated a much needed debate about hard choices. Let’s hope the politicians can match his audacity.

References:

[1] It’s time to ban obesity in NHS employees. Fouin F L P. BMJ 2013; 347:f4646

[2] UK Equality Act 2010. http://www.legislation.gov.uk/ukpga/2010/15/contents (accessed 29-07-13)

The author makes an interesting point that has, understandably, sparked some debate. He is not asking that health professionals be “perfect”, as some have suggested, more that they set an example their patients.

All health professionals who have face to face contact with patients have opportunities to influence their behavior. From surgeons to phlebotomists, we engage patients in conversation as part of our day to day activity. We can reasonable deduce from their appearance and odour (I refer to the distinctive smell of tobacco) whether they are obese or whether they smoke and we all know that smoking and obesity directly contribute to ill health. It is reasonable to assume that we may feel compelled to give advice to these patients who are choosing to jeopardise their health through their behavior; and indeed some of us are obliged and trained to do so.

However, how can we advise our patients to lose weight with any authority if we ourselves are overweight? Could we really have the audacity to give brief interventional advice to a smoker whilst smelling of cigarettes ourselves? I believe our integrity as clinicians would be damaged if we engage in such overt hypocrisy.

So the argument that the NHS should require their employees to have a normal BMI is, in my opinion, laudable. I think it could justifiably apply to all front line staff given the above argument.

However, although this may be applicable during recruitment, in practice it would be impractical to implement to existing staff or to those whose body habitus changes during employment. I have seen firsthand how difficult it is to implement a comparable policy within the Armed Forces. Despite having excellent physical training instructors and facilities combined with plenty of motivation and ample time, there are still soldiers who struggle with obesity. Moreover, there is the problem of those who’s BMI is, seemingly, out of their control due to co-existing medical problems such as back pain or lower limb problems. They could not be discriminated against due to their disability.

Additionally, do we really know enough about the science of obesity to let people's body habitus start dictating their employment in this way? The interesting essay by Gary Taubes1 would suggest not.

There is no doubt; we should do all we can to encourage NHS staff to set an example to the rest of society in terms of lifestyle and behavior on both an organisational and a personal level. How can we expect our patients to engage in healthy behaviours if we ourselves do not? But this is easier said than done.

1. Taubes G. The science of obesity: what do we really know about what makes us fat? BMJ 2013;346:f1050

I'm glad the author of this article is not MY doctor! Talk about NO bedside manner or caring! Plus this article is ludicrous and discriminatory towards human beings! Being human IS to fault. Human is NOT perfect, unless this author is, but to even suggest such a thing is inhumane! We do NOT live in a communist country where things like this can be dictated!

I am a patient who goes to the doctor as needed, more so than others because I have a neurological muscle disease which makes mobility next to impossible as it brings on severe muscle spasms. So yes, I am an overweight woman finishing menopause (which brings on a lot of new changes), and there is nothing I can do about it except to COUNT CALORIES and range of motion exercise a few times a day "if" I am able. Unfortunately, that is not enough even as I TRY and I TRY only to now know Dr's STILL JUDGE ME because of it?!

This kind of enforcement, such as another Commenter stated . . . WHERE would it end? The patients would be upheld to the same, if not already! Inhumane!

One of the things I LIKE about Dr's is THEY are 'human' too, so you KNOW they will fail somewhere. Start enforcing things like this, and more WILL become enforced, invaded upon our privacy, and it will end up going to far. There ARE reasons things like this do NOT exist now. You cannot inflict something like this on HUMANS.

Again, how would this affect the patients? To be made to feel as perfection must be embraced at ALL times? This is where psychological disorders start to occur.

Please, excuse me, author, if you ARE so perfect and I am the one to miserably fail and NEVER be able to reach nor maintain such absurdity.

I am APPALLED at even the THOUGHT of what was mentioned in this article! Talk about discrimination, you have it!

If you implement a system of firing employees who are overweight, or don't eat a certain way, or who live a lifestyle that does not "meet YOUR standards" and that continued through to ALL OTHER PHYSICIANS, I would NEVER go to the doctor! I would feel INFERIOR to the HIGH standards of doctors!

Yes, I am 'just' a patient, but "I" would be under the scrutiny of ALL doctors, have MORE 'bad things' noted in my medical records, etc. The list goes on and on.