A hospital in the Lone Star State has decided that not everything should be bigger by regulating potential employees based on their body mass index (BMI).

However, under heavy criticism (yay puns), this hospital in Victoria, Texas, has ended the policy (or, in the very-not-eloquent words of Jezebel, “reverses the terribly dumb no fatties rule”).

The hospital’s CEO justified the policy by saying: “We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.” In other words, it wanted its health workers to have professional personal appearances.

The BMI requirement for this rule is less than 35 (here’s a useful chart). This policy is not illegal in Texas, nor is it illegal in any state besides Michigan (its anti-weight discrimination law was enacted in 1976).

Basically, we have one side saying that obesity is unprofessional in a healthcare environment and another side saying that it isn’t and that if it is, it shouldn’t matter because that would be discrimination.

Is obesity a disability? A disease? A direct result of personal choices? Or an unfortunate condition caused by one’s financial background? Since it is likely a combination of all the above, it becomes complicated (remember the huge debate on whether airlines are obliged to provide two seats for the morbidly obese? That was a polarizing debate). In addition, unlike race, gender, and sexuality, it is controllable to a certain degree*. Being obese also has intrinsic negative health consequences that are not caused by society discrimination.

In my opinion, there is no question that this hospital is discriminating based on weight (the fact that this is technically legal in 49 states still shocks me) and the CEO might had as well admitted that he and the patients did not like looking at fat people.

But to what degree can a hospital require its employees to “look professional?” It certainly can forbid them from cursing or smoking or not wearing uniforms, but can they ban them from face tattoos? Eating fast food in front of the patients? Or smelling bad? How far can hospitals go before it becomes unethical? We also must keep in mind that a mission of all hospitals is to provide the patients the most comfortable environment possible.

If obesity is a result of personal choice, it certainly is not that different from smelling bad, and I am guessing that the CEO holds this view. As a society, we already “look discriminate:” we don’t ever see fat news anchors or obese clothing store clerks, and at this modern era, an obese person being elected as president is quite unimaginable. We “look discriminate,” we just don’t write them down (I can already see it: “The President of the United States of America must be a native-born U.S. citizen, lived in the U.S. for at least fourteen years, an age of at least 35 and BMI of at most 35”). If you have the option of hiring two people with the exact same expertise and one is obese while the other one is not, which one do you hire?

Obesity is not simply a result of personal choice, and this was one reason why the hospital’s discriminatory policy was rightfully under heavy attack. But the question still persists: How much can hospitals demand from their employees to ensure a quality environment for their patients?

*An interesting article Grace wrote about recently that looks at obesity at a different angle in case you missed it.

Photo credit: John Henry Mostyn/Flickr

“It’s no fun being a kid when you’re fat.”

“It’s hard being a little girl when you’re not.”

This is the rhetoric used by the Strong4Life Obesity Campaign recently launched in Georgia.  According an  ABC news article, the campaign uses negative portrayals of obese children to “scare” parents into awareness about the issue.

To view the campaign propaganda, check out the following videos.

http://www.youtube.com/watch?v=aaFhB1fu31k

With childhood obesity on the rise, it seems that Strong4Life is attempting a new angle.  Instead of promulgating positive messages of healthy eating and exercise, the campaign is instead relying on negativity and shame to galvanize parents into action.

In one video, an obese boy looks into the camera and asks, “Mom, why am I fat?”  Such images are startling and heartbreaking…as intended by the campaign organizers.

The recent firestorm of controversy raises two important questions.

First, are these videos effective?  Strong4Life cites that public service announcements which showed the harsh realities of drug-use were highly effective in the 90’s anti-drug campaign.  These recent print ads and videos are similarly eye-catching, but it is still unclear whether the “shock-value” will translate into action.

The rhetoric of the campaign is entirely negative.  “Stop sugarcoating it, Georgia,” the ads demand.  And instead do what?  The Stop4Life campaign does not provide any positive guidance.  It sensationalizes childhood obesity, but once the buzz dies down, will parents imbibe the message and attempt to instill healthier behaviors in their children?

Even if parents do compel their children to lose weight, how feasible is weight-loss and keeping the extra pounds off?  A recent article in the New York Times suggests that once obese, children may be condemned to the “fat trap.” Scientific studies have shown that losing weight is difficult because diets send the body into starvation-mode.  Moreover, keeping the weight off is even harder- the New York Times article chronicles one woman’s effort to maintain her weight-loss which includes exercising every day, counting every calorie, carrying a scale around- even on vacations ‑and still she is overweight.

More importantly, the campaign raises the question of whether it is ethical to use obese children as the spokespeople.  In an era where we try to encourage children to build self-esteem and embrace their bodies, is a campaign where children admit their shame over their condition a step in the right direction?

Although parents and children need to take accountability for their own health, the Strong4Life campaign seems to take it a step too far.  It turns a war against obesity into a war against obese individuals.  It implies that obesity is a shameful condition.  It implies that parents of obese children are entirely at fault.  It accepts the teasing and bullying of obese children without challenging its cruelty.

The videos breed further intolerance toward obese children and their families.  What the campaign, and the larger public, fails to understand is that losing weight for an obese individual is not the same as slimming down for the average person.  We try to lose a pant size.  They try to lose 100 pounds.  We cut fries and soda.  They need to go on medically supervised diets.  An Atlantic Monthly article points out that often, it’s not that obese children and their families don’t care, but rather, that losing weight is a whole different ball game.  Although the campaign is well intentioned, it only further propagates the myth of obesity and weight-loss.

Obese children are already vulnerable and marginalized; we don’t need to put them up on billboards.  There are other ways of calling attention to the issue without using these children as a neon-sign.

Credit: Bruce Thomson/Flickr

Full confession: I used to be a fat kid.  I was a scrawny, sickly toddler until my concerned grandparents decided to plump me up.  So, between the ages of three and five, I went from underweight to severely overweight.

According to a recent Associated Press release, an 8-year old boy from Cleveland Heights, Ohio, is being placed into foster care because his family has failed to control his weight, which the state has determined to be a form of “medical neglect.”  Weighing slightly over 200 pounds, the boy suffers from severe obesity; most boys his age are only 60 pounds.  Despite the mother’s protests that she has tried her best to help him, the state has determined that it is in the boy’s interest to be temporarily placed in a foster home.  Cuyahoga County (my home county!) is of the opinion that putting children temporarily in foster care is more ethical than obesity surgery or other drastic recourses to promote weight loss.

This scenario raises an interesting ethical question: When is the state justified in taking children out of their parents’ custody?

I think we can all agree that in cases of neglect or abuse, the state is justified in its paternalism.  Minors are not afforded full rights; thus, the state is the best arbiter of their well-being in cases where the parents have demonstrated clear incompetence.

Severe obesity however, is a more contentious case.  Unlike other forms of neglect such as starvation or refusing a child medical care, failing to control a child’s weight is not the fault of the parent alone.  There are behavioral and genetic factors involved.  Although the details of this case have not been released due to privacy reasons, it is possible that the boy is genetically predisposed to obesity.  It is possible that his mother has tried to compel him to exercise and eat less, but he refuses.  In addition, obesity is not equivalent to starvation or lack of medical attention because it does not place the child in imminent danger.  Given these circumstances, it would be unjust and most likely traumatic to remove the boy from his family.

Speaking from personal experience, my grandparents did not feed me to maliciously clog my arteries or “medically neglect” me.  My weight spiraled out of control because I loved ice cream and candy (like every normal five-year old).  Certainly, they tried to restrict my intake, but since when did children always do what their parents or guardians wanted?

We have to question: can the state do a better job?  Although the Cuyahoga County social worker who has been in charge of this case for 20 months has determined that the boy will be better off separated from his mother, is foster care the most ethical way to help him lose weight?  Is being in foster care better than having an indulgent mother who lets you eat too much?  The state fails to take into account that the boy is happy and well-adjusted with his mother.  Placing him foster care to protect his health seems likely to harm his psychosocial well-being, and the state should not be the one making this trade-off.

Allowing Ohio to take away children in cases of severe obesity sets a dangerous precedent.  It implies that the state can discipline our children better than we can.  Cuyahoga County is arguing that the state is justified because obesity is a precursor to serious medical problems in the future, but this line of thinking careens down a slippery slope.  What is next?  Taking your child away failing for school?  Taking your child away for joining a gang?  Taking your child away for having a severe eating disorder?  Each of these also has grave future implications.  Does Ohio, the new “nanny state” propose to babysit these children too?

From the tumblr page, Weighty.

Math? A.

Reading? B+.

Writing? B-.

Science? A-.

Physical Education? Pass.

BMI? What?!

Yes, this is now what a typical report card looks like in Malaysia.  According to a BBC news article, the Malaysian government has mandated schools to record students’ BMI on their report cards as an effort in the national campaign against obesity.  Teachers are now required to measure the height and weight of their students.

Although the government claims that this is merely an effort to make parents more aware of their children’s weight and to help them monitor their health, it has stirred up quite the controversy in the West.  Anyone who has ever hid a report card from a parent knows why—fear and shame.

To learn about the policy, click on this video (after the jump):

[youtube=http://www.youtube.com/watch?v=vMcsorhNkyE]

This policy brings up two interesting ethical issues (besides the whole Big Brother thing).

First, is BMI inherently different than a grade in a subject or a pass/fail in gym class?  If it is ethical to assign grades as a measure of effort and intelligence and a pass/fail benchmark as an assessment of physical fitness, why is it un-ethical to report BMI?  BMI is also a reflection of the individual student.  BMI is also changeable.  If we motivate students to study harder, exercise more, and behave better by issuing report cards with grades,  why is it unethical to motivate students to become healthier by the same mechanism?

A broader ethical issue is whether using shame/fear of punishment is an acceptable catalyst for positive behavior.  Report cards are not only informational for parents; they are also tools for parents to shame/punishment if their child performs poorly. Is this type of consequence-driven, negative-reinforcement ultimately beneficial?  Do the health and educational benefits outweigh the blows to self-esteem?  Malaysian teenage girls seem to think, yes!  They are in favor of this measure that will help them better self-motive to stay in shape.

So maybe this hullabaloo is much ado about nothing.  We can all agree that a campaign against obesity is a positive step—maybe it just looks different in different countries and different cultures.  In the U.S, we censure corporations and the fast-food culture.  In Malaysia, they crack down on the kids, through report cards.  Different cultures do things differently.  Malaysia doesn’t stick its nose in our business, so maybe we should not shove our outrage in theirs.

This also reminds me of the infamous Amy Chua, author of Battle Hymn of the Tiger Mother.  In her controversial Wall Street Journal article, Chua writes that:

Chinese mothers can say to their daughters, “Hey fatty—lose some weight.” By contrast, Western parents have to tiptoe around the issue, talking in terms of “health” and never ever mentioning the f-word.

Is she right?  Maybe our culture coddles children and assumes that anything and everything will deal an insufferable blow to their self-esteem.

My friend from Singapore recently told me that in his home-country, overweight and obese children were required to join the “Trim and Fit” club where they were given an apple at recess and made to run laps.  While I was horrified, he appeared perfectly nonchalant.  Apparently, the success rate was amazingly high while traumatization was low.  In fact, club members were not picked on mainly because it was an accepted and normal part of school.

Maybe reporting BMI on report cards will also become an uncontroversial norm.  After all, BMI is a number; F is not for fat. Cultural relativism is alive and well.