The Biggest Loser: Weighing in on a Body Mass Index Requirement for Potential Employees

By: Keith Langlais

A recent HLN report revealed that Citizens Medical Center located in Victoria, Texas instituted a Body Mass Index (“B.M.I.”) policy requiring potential employees to have a B.M.I of less than 35.[1] Although legal under Texas law, critics believe the hospital policy will most likely be challenged under the Americans with Disabilities Act (“ADA”).[2]

The purpose of the ADA is to eliminate discrimination against those with disabilities.[3]  The ADA recognizes that physical and mental abilities do not diminish the right of the individual to “fully participate in all aspects of society.”[4]  The basic definition of a disability under the ADA is  “a physical or mental impairment that substantially limits one or more major life activities of such individual.”[5]  Is Citizens Medical Center in violation of the ADA for prohibiting obesity in potential employees?

Recent obesity litigation brought in the federal courts under the ADA reveals a complex answer.  E.E.O.C. v. Watkins held that where severe or morbid obesity is caused by an underlying psychological illness, it qualifies as a disability under the ADA.[6]   A more recent Louisiana District Court decision held that severe obesity is a disability under the ADA and does not require an underlying psychological cause.[7]  However, non-severe obesity still requires psychological cause to qualify as a disability under the ADA.[8]  Although neither case is binding precedent in Texas, the holdings may provide compelling arguments for potential plaintiffs bringing suit against Citizens Medical Center under the ADA.  Nevertheless, medical literature tends to use various terms and metrics to describe obesity on the B.M.I. scale.

Definitions of obesity on the B.M.I. scale include but are not limited to the following categories:

Obesity – a B.M.I. of 30 – 39.9

Morbid Obesity – a B.M.I. of 40 or more.[9]

Conversely, the Mayo Clinic defines obesity as a B.M.I. between 30 and 40 and extreme obesity as a B.M.I. of 40 and higher.[10] The Centers for Disease Control and Prevention simply identify a B.M.I. of 30 or higher as obese and do not provide for a B.M.I that would qualify as a person as severe or morbidly obese.[11]  Furthermore, the Louisiana District Court identified severe obesity as any weight 100% “over the norm.”[12]  Since obesity scales tend to differ in precise numbers and exact definitions used,[13] there is potential for an interesting wrinkle in litigation against Citizens Medical Center; particularly if plaintiffs argue under the aforementioned standards for severe obesity/obesity as a disability under the ADA.

A major concern with Citizens Medical Center’s new policy is that it will discriminate against, and eliminate from the employment pool, potentially able-bodied and capable applicants.[14]  Such a concern is especially important because the use of a B.M.I. to measure healthiness might not be the most accurate means of doing so as a B.M.I. score does not take into account lean tissues versus fatty tissues.[15]  Consequently, a healthy athlete or body builder may have a B.M.I. in the range between obese and morbidly obese.[16]  However, interestingly enough, it appears that Citizens Medical Center’s new policy is more concerned with employee aesthetics rather than healthcare.[17]  Will Citizens Medical Center’s policy sink or swim?  Only time and a challenge under the ADA will tell.


[1] Craig Johnson, Texas Hospital Bans Obese Workers?, HLN (April 9, 2012), http://www.hlntv.com/article/2012/04/09/texas-hospital-fat-people-bmi-need-not-apply?hpt=hp_t2.

[2] Id.

[3] Americans with Disabilities Act of 1990, 42 U.S.C. § 12101 (2008).

[4] Id.

[5] Id. § 12102.

[6] E.E.O.C. v. Watkins Motor Lines Inc., 463 F.3d 436, 445 (6th Cir. 2006).

[7] E.E.O.C. v. Res. for Human Dev., Inc., CIV.A. 10-3322, 2011 WL 6091560, at *4, (E.D. La Dec. 12 2011).

[8] Id.

[9] Jane E. Brody, Weight Index Doesn’t Tell the Whole Truth, N.Y. Times (August 30, 2010), http://www.nytimes.com/2010/08/31/health/31brod.html.

[10] Obesity, Mayo Clinic Definition, http://www.mayoclinic.com/health/obesity/DS00314 (last visited April 9, 2012).

[11] About BMI for Adults, Centers for Disease Control and Prevention, http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html (last visited April 9, 2012).

[12] Res. for Human Dev., Inc., 2011 WL 6091560, at *4.

[13] See Obesity, Mayo Clinic Definition, http://www.mayoclinic.com/health/obesity/DS00314 (last visited April 9, 2012); About BMI for Adults, Center for Disease Control and Prevention, http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html (last visited April 9, 2012).

[14] Craig Johnson, Texas Hospital Bans Obese Workers?, HLN (April 9, 2012), http://www.hlntv.com/article/2012/04/09/texas-hospital-fat-people-bmi-need-not-apply?hpt=hp_t2.

[15] Jane E. Brody, Weight Index Doesn’t Tell the Whole Truth, N.Y. Times (August 30, 2010), http://www.nytimes.com/2010/08/31/health/31brod.html.

[16] Id.

[17] Craig Johnson, Texas Hospital Bans Obese Workers?, HLN (April 9, 2012), http://www.hlntv.com/article/2012/04/09/texas-hospital-fat-people-bmi-need-not-apply?hpt=hp_t2.

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