Cleveland Clinic CEO Toby Cosgrove, MD, has been taking heavy flak since he told the New York Times that he would not hire obese people if it was legal.
Cosgrove, a surgeon, apologized to staff last week in an e-mail message, but he didn't back away from his essential point. "My objective was to spark discussion about premature causes of death, but some of my comments were hurtful to our community. That was certainly not my intent, and for that I apologize," he told employees. "Those of us who care for patients are deeply motivated to heal, but medicine and surgery can only go so far. There is much more we could do to prevent chronic diseases if we take measures to eat healthier, exercise and quit smoking."
Critics have interpreted Cosgrove's remarks as a form of blame the victim—that society is being asked to pick up the increased medical costs for obese people who lack the discipline to take care of themselves—even as new medical research shows that obesity may be linked to heredity and other factors that may be difficult or even beyond an individual's control. Obesity also disproportionately affects poor and working class Americans who may not have the awareness of proper nutrition, nor the money, nor ready access to nutritious, fresh, and healthy fruits and vegetables.
As the CEO of a prestigious health system, Cosgrove's words carry extra weight, the points he raises cannot be dismissed in the name of sensitivity or political correctness. Obesity is killing this nation, literally and financially. About 60% of Americans are either overweight or obese. According to the Centers for Disease Control and Prevention, obesity-related medical care costs the nation about $147 billion a year, and obese people spent $1,429 (42%) more for medical care in 2006 than did normal weight people. This is not a static cost. The CDC study notes that the proportion of all annual medical costs that are due to obesity increased from 6.5% in 1998 to 9.1% in 2006. Does anyone expect that—left ignored—this alarming trend will reverse or even slow down as the nation ages?
So, when Cosgrove talks about rejecting obese job applicants, he is just saying out loud what a lot of employers are thinking, and probably already doing. I would not be surprised to learn that many employers who are otherwise color blind and gender neutral give obese job applicants rigorous scrutiny. Small businesses that have seen triple-digit increases in the cost of providing health insurance over the last decade might be particularly susceptible to such a trend. If this is happening, it's not because these businesses think overweight and obese people are undisciplined or unattractive. It's because overweight people cost businesses more money in higher health insurance costs, sick days, and lost productivity. A study in California released in July estimated that the lost productivity and other economic fallout associated with overweight, obesity, and physical inactivity cost that state $20.3 billion in 2006.
That brings us back to Cosgrove. No one sees the devastating effects of obesity on a human body more so than the healthcare professionals who deal with the damage. As a surgeon, Cosgrove is speaking from a front-row seat when he talks about obesity as this generation's great public health menace, with the potential to harm tens of millions of Americans. In that respect, he's dead right. His sense of urgency is understandable.
This nation has a pretty good record for raising public awareness on health issues like smoking, pollution, alcohol abuse, drunken driving, and wearing seatbelts. So far, we've talked a lot about obesity but we haven't done much beyond that. It's time for a coordinated national dialogue on obesity, from which could emerge an action plan that must include raising public awareness. The challenges will be daunting, because the issues around obesity are far more complex than any other public health issue. Not everyone smokes. Not everyone drinks alcohol. Not everyone drives a car. Everyone eats.
If we are going to recognize substantial savings from any healthcare reform, the healthcare consumers have to be on board, committed to healthier living. At the same time, taking action on overweight and obesity cannot mean demonizing the 60% of Americans who fall into either of those categories.