Devil’s advocate: Obesity and the burden of responsibility

This month, I reviewed a worker who was too fat to fit comfortably behind his desk. Was this a medical matter? Was he fit for work? Was he disabled?


Last month, I saw the most obese child I have ever seen, waddling through Los Angeles airport. He was about 10 years old, and looked like Violet Beauregarde being taken to Willy Wonka’s Juicing Room. My colleague asked me whether I thought this was child abuse.


We are in the midst of an epidemic of obesity. It is no surprise that this was a hot topic at the American Occupational Health Conference, discussed over hearty breakfasts, calorific lunches, muffin-fuelled intervals, and 16-ounce steak dinners. Delegates really did chew the fat on this issue.


But how much responsibility does the healthcare profession have to set an example?


Setting standards


Recently, obese nurses were targeted to set a better example.1 I can’t see any particular reason why the focus fell on them, except that there are more nurses than all other healthcare workers added together. Doctors also give front-line advice, and I can think of plenty who are overweight and obese. They are also renowned for their high rates of poor health behaviours, such as drinking and drug misuse.


If healthcare workers have a responsibility to set an example, at what point does behaviour become unacceptable? Already some candidates are deemed ill-suited to initial medical and nursing training programmes due to health reasons – those who might transmit blood-borne viruses, and those with certain psychological histories, for example. (It is ironic as we face the obesity epidemic that we are more inclined to turn away under-eaters than over-eaters.)


The natural implication of being an exemplar is that health selection criteria for would-be doctors and nurses would be extended to obesity, and that current practitioners would be deemed unfit to practice if they become too over weight (lest they set a bad example).


OH response


If healthcare workers in general have a responsibility to set an example, then it follows that healthcare workers who support healthcare workers – OH specialists – have an even greater responsibility.


Body Mass Index (BMI) is still “the best measure there is”.1 Allowance should be made for muscular athletes and pregnant women, and some mathematical allowance for taller workers, but for most people, a healthy weight lies between 18.5 and 25.


Are OH specialists with a BMI over 25 (overweight), or at most 30 (obese), unfit to practice? Should the more exacting standard (25) apply to the most influential practitioners, to OH team leaders, and to consultants?


Dr Richard Preece is a consultant OH physician.


References


1. Healthy Weight, Healthy Lives: One Year On 

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