There are several reasons why women go without basic care from a gynecologist. Typically, insurance is the culprit, but weight insecurities are another.
The concept of skipping out on medical care because we’re embarrassed about our weight is nothing new. But a recent study out of Drexel University shed more light on the topic. The study linked bias, discrimination and doctor avoidance in women with higher body weights.
“What is important here is that women with higher body mass index tend to avoid health care and the reasons for that are often due to their experiences of weight discrimination,” said Janell Mensinger, PhD, lead author of the study.
“We need to help healthcare professionals understand that seeing a provider is highly charged with stress and anxiety, and there are methods to reduce those feelings.”
The solution, Mensinger said, is the “weight-inclusive approach”—that’s different than the norm, the “weight normative approach.” With the latter, advice and action is based on body weights that are considered in the normal range. With that approach, a high BMI often prompts unsolicited weight counseling during visits.
By enacting the weight inclusive approach, it would train health professionals to combat biases against people with higher weights and stop discussions of body size that are unprompted.
Is BMI Keeping Us Away?
In the study, more than 300 women shared data on their body mass index (BMI) as well as experiences with weight stigma, body guilt, body shame, health care stress, and health care avoidance. Though BMI has come under fire, it is still used by doctors to dictate treatment.
“Experiences of weight stigma often lead to self-directed stigma. Self-directed stigma tends to lead to body-related shame and guilt, which then leads to stress regarding the healthcare encounter,” Mensinger explained. “People who are stressed about the encounters tend to avoid them.”
Mensinger said the body normative approach is doing more harm than good.
“We’re talking about a vulnerable population and we’re putting them at a greater risk,” Mensinger said. “We need to be aware of these system-level problems that are keeping people from going to appointments that would be saving lives.”
In the meantime, here are a few suggestions from Lauren Streicher, M.D., to take control of that dreaded gyn visit–and perhaps not dread it in the future.
- Tell your doctor upfront that you don’t want counseling on your weight.
- Ask the doctor to complete the exam first so you can relax and then get into a discussion.
- Bring a shawl as part of your coverup if the gowns are typically too small. Or request a larger gown ahead of time if you’re comfortable asking. You can also ask for a plain piece of fabric (some give it in addition to a gown) to cover up. There’s nothing wrong with mentioning you prefer to keep things on the modest side.
- Refuse to go on the scale and instead get that exam done. If you really need the exam, no one can force you to face the number on the scale. You can get on the scale later.
- Many doctors or midwives may allow you to come in for a consultation so you can talk about your feelings upfront. You may also be able to email or talk to the health care professional over the phone—that way, when you go in, you are in control and know what to expect.