The concept of skipping out on medical care because we’re embarrassed about our weight is nothing new. Now, a recent study out of Drexel University has taken a closer look at bias, discrimination and doctor avoidance — especially among women.
“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,” Dr. Janell Mensinger, a psychologist at Drexel University and lead author of the study, said in a statement. “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” — which is different from 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.
The weight-inclusive approach involves training 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, published in the June 2018 issue of the journal Body Image, more than 300 people who identified as women shared data on their body mass index 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 in the statement. “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 Dr. Lauren Streicher, an OB-GYN and associate clinical professor of obstetrics and gynecology at Northwestern University’s The Feinberg School of Medicine writing over at Everyday Health, on how to take control of your next doctor’s appointment — and perhaps not dread it in the future:
- Tell your doctor up front 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 cover-up 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 up front. 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.
By: Kristen Fischer