The authors admit this in the paper. They write: "This is a cross-sectional study, which only allows us to identify associations, not causal relationships."

What makes the Citizens Medical Center policy particularly ugly is that they justify it by arguing that their patients don't want to see obese people people it doesn't fit with their "mental projection" of a healthcare professional. That is simply disgusting. The same thing could have been said years ago (or maybe today) about certain other groups, such as black health care workers, LGBT workers, or Jewish workers.

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