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

Physicians and the public agree with with Cleveland Clinic CEO Toby Cosgrove that personal responsibility needs to be a factor in the health-care debate. But has his provocative talk on obesity gone too far?

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]