Weight Bias: A Barrier to Gynecologic Care

Rebecca M. Puhl, PhD


November 03, 2010

Strategies to Reduce Weight Bias in the Women's Healthcare Setting

In the United States, two thirds of adults are overweight or obese, which means that most patients treated by healthcare providers are struggling with their weight. Medical management of obesity requires consistent healthcare to help patients improve lifestyle behaviors, treat comorbid conditions, and prevent adverse health outcomes associated with excess body weight. Unfortunately, body weight may also be a barrier to obtaining quality healthcare, especially in a setting that offers gynecologic services.

Research in the past decade has consistently demonstrated that obese women delay routine gynecologic cancer screenings and are less likely to be screened for cervical and breast cancer with Papanicolaou smears and mammography, respectively, even after adjustment for other known barriers to care.[1,2,3,4] A potential contributor to this problem may be weight bias in the healthcare environment. Obese patients commonly report that they are embarrassed and reluctant to obtain routine gynecologic examinations because of their weight. Many report feeling anxious and embarrassed by the process of being weighed, and they avoid seeking healthcare services because they have experienced negative attitudes from providers in the past.

These issues were highlighted in a study by Amy and colleagues,[5] who surveyed 498 overweight and obese women (who had health insurance and good access to healthcare) about their healthcare experiences. Similar to previous research, the study found high rates of avoidance and delay of healthcare services among obese women. When the researchers asked study participants to explain these healthcare decisions, women reported their body weight to be a significant barrier in obtaining gynecologic treatment. Specifically, 46% of women reported that small gowns, narrow examination tables, and medical equipment too small for their body size were barriers to receiving gynecologic care. Thirty-five percent stated that they delayed gynecologic cancer screenings because they were embarrassed about being weighed, and 36% reported negative attitudes from their healthcare providers. Of additional concern was the percentage of women who reported these barriers to gynecologic care, which rose with increasing body mass index (BMI). This finding indicates that those who were heaviest reported the most weight-related barriers and bias.

Unfortunately, these barriers are compounded by negative weight-based stereotypes about obese patients typically held by healthcare providers. Research has consistently documented attitudes among providers that obese patients are nonadherent, lazy, and dishonest and lack discipline.[6] Recent studies also indicate that physicians report feeling substantially less respect toward their heavier patients than thinner patients.[7]


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