Does Cleveland Clinic’s Toby Cosgrove really hate fat people?

Dr. Toby Cosgrove

CLEVELAND, Ohio — Cleveland Clinic CEO Toby Cosgrove’s contribution to the health reform debate has been to trumpet the problems with obesity and, through that, the idea of taking personal responsibility for health-care costs. He’s made his rounds on The New York Times, NPR, the Wall Street Journal and CNN, among other places, noting that while the Clinic can avoid hiring smokers, it can’t turn down the obese.

“We are protecting people who are overweight rather than giving people a social stigma,” he told The Wall Street Journal Health Blog.

Cosgrove got some blowback on that position on Wednesday at the Clinic’s own Obesity Summit 2009. Walter Lindstrom Jr., founder of the Obesity Law & Advocacy Center in California, told Cosgrove he was demonizing overweight people, and he characterized Cosgrove’s public remarks as “unfortunate and misguided,” according to The Plain Dealer.

The Associated Press said Cosgrove was told he was creating a “bias mentality” against the obese.

“Do you wish you hadn’t said it?” asked Lindstrom, according to The Plain Dealer.

Cosgrove responded that his comments were meant to focus the health-care debate on the costs of obesity, and the Clinic issued a statement on Thursday stating: “We do not discriminate against obese individuals. In fact, we have invested millions of dollars in health and wellness programs for our employees, free of charge, to help them live a healthy lifestyle.”

But Cosgrove has cutely danced on the line between the issue of obesity and hoping that the obese would be classified like smokers, which would mean employers could avoid hiring them. Along with his lament in the Wall Street Journal about society protecting the obese, New York Times reporter David Leonhardt wrote in August that Cosgrove told him he would stop hiring fat people.

When he mentioned this to me during a recent phone conversation, I told him that I thought many people might consider it unfair. He was unapologetic.
“Why is it unfair?” he asked. “Has anyone ever shown the law of conservation of matter doesn’t apply?” People’s weight is a reflection of how much they eat and how active they are. The country has grown fat because it’s consuming more calories and burning fewer. Our national weight problem brings huge costs, both medical and economic. Yet our anti-obesity efforts have none of the urgency of our antismoking efforts. “We should declare obesity a disease and say we’re going to help you get over it,” Cosgrove said.

But Cosgrove has already clarified — or at least softened — those provocative statements. He told NPR he didn’t want to stop hiring the obese, adding: “What I said was that we are concerned about the obesity problem, not about people who are obese.” That’s a mantra he had also used on CNN soon after The New York Times piece, and other venues since.

No matter which statement he sticks to, physicians and the public agree with Cosgrove. There’s a consensus that somehow there needs to be incentives to stay healthy or, instead of penalties, rewards for people for healthy living.

Already in the private sector, through wellness outsourcing programs, and through state legislation considering wellness incentives for business, policymakers and individuals see a need to encourage people to live healthier.

Plus, by putting the Clinic out front on this issue, Cosgrove is generating a huge win for the health system. He can position the Clinic as a leader in wellness; continue to maximize the President Obama visit in July and elevate himself and the Clinic in the area of public policy; and even reap financial benefits.

Cosgrove mentions in his media interviews the wellness initiatives within the health system that have cut thousands of pounds off his employees. But waiting in the wings, just months away, is a profit-driven Clinic wellness enterprise that will reach out to the public and create new revenue for the health system.

The blowback also signifies that his comments, taken as a whole, may have gone too far. He should want to be an intellectual Dr. Phil of wellness, giving tough love to a nation in dire need of instituting personal responsibility. But he’s coming off to some as the bully who picks on the fat kid in the playground.

The worst thing that could happen now is Cosgrove lets his recent speech be the last word in his campaign, bothered by the delivery of his message. The campaign is paying dividends.

But he does need to modulate the message. He risks not only upsetting advocates from the Obesity Law & Advocacy Center, but the growing pop-culture movement defending what it considers an obsession with obesity, and the obese customers who would be apt to accept his message and try to get healthier — and possibly slow momentum on the change he thinks is necessary to keep health care afloat.

[Front-page photo courtesy of Flickr user tobyotter]

Chris Seper MedCity News

Chris Seper is the CEO at MedCity Media, which publishes MedCityNews.com. He is also a senior writer at MedCity News. Reach him at chris@medcitynews.com.

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Tags: Cleveland, Cleveland Clinic, health insurance, hospitals, Northeast Ohio, Ohio, Politics, Toby Cosgrove, US healthcare reform

Comments Post a comment

It is amazing what Dr. Delos “Toby” Cosgrove can say and get away with. Having been employed at CCHS for a number of years, Cosgrove is nicknamed “the dictator” by some of the employees. Why you ask? Simple. The intentions of the dear dictator are clear and I personally understand them. He wants people to get healthy and live long and normal lives. First, he banned smoking from the entire premesis. Next, he changed the cafeteria menu from and made it into a baked-chip factory. Now, he is saying that if you are obese and if he had the choice, he would not hire you! This coming from a man who just accepted a six million dollar donation for the construction costs applied to the expansion of Hillcrest. Money is green, granted. If the money came from an obese donor, would he have accepted? That’s the problem with Toby. The dictator should not be allowed to tell ANYONE how they should live their lives, espically the employees like myself who have spent years building the foundation and reputation of the hospital system at CCHS and it’s affilates. Some of these people he was referring to are smokers, are overweight, and so on. Does that give him the right to go on a personal crusade and humiliate people? This is our face of the franchise? To me, the shame of it is, the fact that he feels inclined to say these things and not be held accountable for it. He called obesity an “addiction”, if this is true, he should take a stand against all addictions surrounding our society today, such as drugs, gambling, drinking, etc. I would consider myself a decent employee with a healthy attitude, but this is wrong! This guy needs to apologize to ALL of the employees at the CCHS!

Comment by Frank Jacetty — September 10, 2009 @ 5:46 pm

Dr. Cosgrove fails to realize that there are other reasons why a person could be obese…….hypothyroidism, metabolic conditions, not to mention drugs like Predisone (which I am sure he has probably perscribed sometime in his career)
I feel that Dr. Cosgrove was extremely bias and “FULL OF HIMSELF” since I have seen obese people STRUGGLE with weight loss. Dr. Cosgrove has made a nice salary over the years off of the people he now condemns. I understand that we can all lower our risk factors by maintaining a good diet, excersise, quit smoking, drinking etc. however, to say if he had his “choice” he would not hire an obese person, what’s next? I have grey hair, my family has a history of cancer……..will I not be considered as an employable person in his eyes?
Not only does he need to apologize to the employees of the CCHS that have made the place what it is ..he needs public apologize to all the persons he has offended by making such unprofessional statements. I hope many obese employees sue his condecending ass!

Comment by mecatee — September 11, 2009 @ 11:53 am

I agree with Dr. Cosgrove. While some ( very few ) people have a conditions such as hypothyroidism, metabolic conditions, and side effects of prescribed drugs, most obese people are obese because of poor diet and poor exercise habits. Don’t believe me? Think about the days before fast food before cars – America did not have half as many obese citizens or obesity related diseases. Think about that and then think about the obese people you know or have seen. Were they eating at the time you saw them? They probably were just eating, about to eat, or thinking about eating. Were they high energy>? Did they look motivated and productive? I have seen obese people at buffets with plates overflowing, lazily floating through the day. Is this just as bad as someone smoking cigarettes? Yes, because it leads to increased health care costs for everyone. Should I be more sensitive to fatties? Yes. Should I have to pay for their gluttony? I hope not.

Comment by Will Power — September 11, 2009 @ 1:04 pm

As long as someone other than you (whether that is the government or your employer) is paying your out of control health care costs because your choice in lifestyle is directly causing unsustainable premium inflation, they should have every right to demand healthy lifestyles in return.

Or else they SHOULD charge you 1000′s more a year for you to retain your right to make poor choices. I suspect if given the option between paying $5000 more a year in out of pocket premiums to retain your right to smoke and sit around eating cheetos and not exercise, most people would find it within themselves to enter a new phase of healthy lifestyles.

The longer we as a country make excuses for conditions that are, on a broad scheme of things, lifestyle related, the longer we as a country enter down the road to bankruptcy. We are an entitled nation. We demand others to pay for our health care. And we demand nothing of ourselves to take responsibility for the poor choices we make. The CEO of Whole Foods just got a boycott for suggesting Americans need to eat healthier, with some proclaiming that American’s are just bad eaters and we must accept it and find a way to pay for the bad choices that we all make.

That attitude is why we have no hope of paying for the health care needs of Americans.

Comment by The Happy Hospitalist — September 11, 2009 @ 1:52 pm

Dr. Cosgrove is the poster boy for ignorance and intolerance. I am a nurse; it is very disappointing that the chief of one of the biggest health care operations in the world could be so misinformed about the obesity problem and, frankly, so hurtful to individuals who struggle with weight and body image issues that are often a result of a history of physical, mental, and emotional abuse. Dr. Cosgrove is rallying the masses to thrust even greater “social stigma” (his words, not mine) upon those who struggle with obesity.
I am also discouraged that those who state they agree more sensitivity should be shown to overweight individuals refers to these people with pejorative terms such as “fatties” and assumes that all overweight individuals indulge in gluttony.
As far as paying for other’s vices, remember that >60% of the population is overweight or obese–that is more than half of the population. I am certain that the insurance premiums and taxes they pay go a long way towards providing healthcare to smokers, substance and alcohol abusers, etc.
All I can say to Dr. Cosgrove is “Doctor, heal thyself!”

Comment by Trish — September 11, 2009 @ 2:12 pm

There is a direct correlation to America’s en-mass weight gain and the introduction of High Fructose Corn Sweetener in virtually ALL of America’s food products. The sweetener is genetically altered fructose that metabolizes differently than unaltered fructose, sucrose, dextrose, etc. Reports have shown it not only creates more body fat but actually has an addictive quality that makes people crave and ultimately eat more. I suspect it explains the epidemic of diabetes as well. Over the ensuing decades for good or ill food has become pharmacology. Thanks to political manipulations in the WTO cane and beet sugar became prohibitively expensive in this country, which is why most candy manufacturers have left, some moving just over the border into Canada where sugar is much less expensive. HFCS is a liquid and is significantly sweeter and cheaper than sugar. It lends itself well to the food manufacturing process and has fattened the bottom line along with everyone’s waistline.

Comment by GLK — September 11, 2009 @ 2:17 pm

Dear Dr. Cosgrove:

When I was 17 years old I was diagnosed by the Cleveland Clinic with PCOS, Polycystic Ovarian Syndrome. PCOS is the most common endocrine disorder of women affecting 3% to 5%. It causes obesity, infertility, heart disease and diabetes. I am now 62 still a patient at the clinic and little progress has been made on this disease. While I have received good care at the Clinic and drugs help modify some of the symptoms, I still struggle with weight as do 90% of those with this disease. Since you are a surgeon you may not be familiar with PCOS, however, someone in your position should know that there are endocrine and medical conditions that affect your patients – these people do not eat double cheeseburgers and bags of cookies. They exercise and eat a healthy diet and still struggle. Your should show leadership in research that would alleviate these conditions and compassion for the patients that are affected by them. This would be better than derision and job discrimination.

Comment by D. Lynch, Burton, Ohio — September 11, 2009 @ 2:31 pm

Well now, if Toby Cosgrove could have his way, he would not hire obese people.
Who would determine who is obese and who is not? What about so called normal people who have a medical condition or disability? Won’t they have higher medical costs? Where will this end? Cosgrove’s view is both punative and narrow. If we throw out all of the obese people in the world, we will lose almost 70% of the world population. Would he be throwing out some of his own friends and relatives? I find his remark to be insensitive and uncaring. There are more compassionate ways to handle the problem of obesity.

Comment by Monalea Hutchins — September 11, 2009 @ 3:09 pm

I am a registered dietitian. We, as RD’s. are the most over educated under paid of the medical profession. Insurance companies with pay for heart bypass, but not a nutrition consult.
We will not have to worry about the government making us go bankrupt over healthcare, because obesity will do it for us.
I was written up at a hospital where I work for telling a 330#, 5 foot tall lady she could die if she did not lose weight. Now, I can not even address the “white or pink elephants” in the room anymore for fear of ofending them. I really do want to just change my profession.

Comment by Ann LaFontaine, MA, RD, LD — September 11, 2009 @ 3:44 pm

Maybe you should have used a little more compassion when addressing your white or pink elephants! I have been to many doctor’s/health professionals where they can use a class in bedside manner!

Comment by mecatee — September 11, 2009 @ 4:22 pm

Oh God! What next Dr. Cosgrove? Ban gray-haired individuals? People with acne or large skin pores? Ugly people? People with yellow teeth? People with a touch of hair in the nose? Your comments may quite possibly set a dangerous precedent.

Comment by SuzanneF — September 12, 2009 @ 12:35 am

[...] Will personal responsibility be the most vexing issue in health-care reform? Cleveland Clinic CEO Toby Cosgrove got some blowback on his campaign using the issue of obesity to insert personal responsibility into the health-care reform debate. In one campaign, he becomes the poster boy for intolerance and the champion for physicians hoping for a better way. [...]

Comment by Weekend Rounds: Is personal responsibility the hottest issue in health-care reform? : MedCity News — September 13, 2009 @ 11:03 am

With Cosgrove’s influence and wealth, instead of preaching personal responsibility, he should get together with Tufts University and take on the giant food corporations to rid all the fructose corn syrup crap and sodium out of 3/4′s of the food supply. These corporations should bear some responsibilty for the epidemic of obesity. Also, Cosgrove, a majority of working people do not have the wherewithal or wealth like you do to get gym memberships and purchase organic, healthy foods. Just preach to your own employees and mind your own business with the rest of us!

Oh by the way, I was considering getting a cochlear-ear impant from your “renowned” institution, but after your narrow-minded views of fallible human beings, I wouldn’t send my DOGS to your place!!

Comment by flossydossy — September 13, 2009 @ 12:24 pm

[...] CLEVELAND, Ohio — Cleveland Clinic CEO Toby Cosgrove apologized to employees for any “hurtful” comments connected to a recent national discussion he’s lead about obesity, personal responsibility and health care. [...]

Comment by Cleveland Clinic CEO apologizes to staff for ‘hurtful’ comments in obesity debate : MedCity News — September 14, 2009 @ 11:20 pm

I agree with Mr.Cosgrove said about the obesity epidemic.Medical costs are skyrocketing due to this problem.It causes daibetes,heart problems,breathing troubes as well as inability to ambulate.Also people uninsured that are obese,taxpayers have to pay for more frequent hopitalizations.There are now more xtra wide wheelchairs and big boy beds for these people.Also some of these people have tobe sent out for a cat scan because they are too obese to fit in a regular cat scan machine at a hospital.So I agree with Mr.Cosgrove on the obesity epidemic.

Comment by Julie Walker — September 16, 2009 @ 9:37 am

I also work at the Clinic and I do agree to some degree with Dr. Cosgrove and i’m also over weight. The problem is the ongoing way this man expresses himself and talks to employee’s. There are just as many thin employee’s missing work and running health care cost I have seen it with my own eyes. This was not good for the Clinic there are many over weight patient that come to our campus and once again he put his foot in his mouth. I also wonder why he never makes comments about drinking hummmmm?

Comment by Randall Humphreys — September 17, 2009 @ 8:30 pm

[...] Ohio — Dr. Toby Cosgrove won’t let the backlash and his subsequent apology about obesity keep him from the health-care reform debate. Cosgrove, the [...]

Comment by Apology out of the way, Cleveland Clinic CEO continues with obesity wellness campaign : MedCity News — September 18, 2009 @ 3:53 pm

Google the Associated Press Article titled: Study; Fat people cheaper to treat. You will find a very interesting article from a Dutch study that clarifies that fat people actually end up costing less to medically treat in the long run.
That being said, what a pompous, condescending, boorish buffoon Dr. Cosgrove appears to be. Tobacco use was subsidized and promoted by our own U.S. government with films created on how to smoke during WWII. Some very rich people got a lot richer on that fiasco. Trans fat is the creation of mega corporations and I cringe when I reminisce of the days in my youth in Chicago when the mosquito spray truck went down our street spraying DDT as we danced in the rainbow colors it created.
I will not shirk my responsibility for being overweight, but I will suggest that Dr. Cosgrove get to the core issues and address them. Or is it that the contributions given by big business are more important than the truth.
And by the way Dr. Cosgrove, may I suggest that you concentrate on the log in your own eye before you waste your judgmental life seeking the splinters in others?

Comment by Sylvia — October 18, 2009 @ 12:38 am

CCHS has now conquered another small town hospital, Medina. Has already hit up the night shift people and decreased our wages by 1000.00 per year, and then seeing Tobey taking a limo in today to do his broadcast, what a crock of ##%%. Have always known that about the Clinic, but it has become a reality in my life. Not feeling the love!

Comment by JoAnne — December 2, 2009 @ 5:31 pm