Do any of these sound familiar to you?

Shaping Up is about more than losing weight. It's about a way of life that respects your body, a mental outlook that says "My body deserves the best I can give it." Of course, that means we make every effort we can to get proper nutrition and exercise. What we sometimes forget is that our bodies also need, and deserve, routine preventive health care no matter what our size.

This is especially true of gynecological care. A high body weight is associated with a higher rate of gynecological cancers - uterine, endometrial, and ovarian cancer. This means large women should be more aggressive about getting the proper pelvic examinations and testing than thin women. So why does a recent study show that women of size are getting less routine gynecological care than their thin sisters?

"It's really sad," says study co-author Dr. Kevin Fontaine, "Women feel disempowered by visits to physicians. Women need to be assertive, although this is hard for them."

The study, in the July/August edition of the respected journal Archives of Family Medicine, looked at the number of physician visits in the previous 12 months for women based on their BMI. Their conclusion: "...although obese women visit physicians more often than nonobese women, they appear less likely to use preventive health care services. Delays in the use of these services may account for some of the increased risk of mortality from these cancers."

The authors speculate that "the prospect of getting undressed may make women less likely to seek preventive health care, especially for procedures (e.g. pelvic examination) that involve disrobing and manual manipulation of their bodies." Many of us are so acutely aware of our body size, or so frightened of being confronted by our body size, that the thought of a visit to any doctor is daunting. Women learn early in life to be self-critical about their bodies, to be ashamed of any part of their body they feel is not perfect. Lying on a table in a skimpy exam gown that might not even fit, looking down at your fat thighs (does anyone ever really have thin, cellulite-free thighs?) it's hard not to be self-critical. This recent study tells us that our fear may be costing us our lives.

"From a patient perspective, large patients report being treated by physicians and other medical personnel with disdain and disrespect."

-- Dr. Susan Z. Yanovski
Director, Obesity and Eating Disorders Program
National Institutes of Health

Medical prejudice against large people has been well-documented for years, but many women experience gynecological visits as the most stressful of medical visits. The intimacy of the interaction seems to heighten our vulnerability. Heavier women often have menstrual or fertility problems that are related to their body size, yet some doctors are less than kind when discussing these important issues.

I recall one gynecologist saying to me "You're just too fat. You can't expect anything to be normal when you're just so fat." I understand what he was trying to say, but the judgmental way he said it made me sob all the way home in the car. It was several years before I went to a gynecologist again. Worse, I never told the gynecologist why I didn't go back. In retrospect, I'm sure he had no idea what effect his words would have on me. It would have been better for me, and all the large women who came to that gynecologist, if I had told him how hurtful his words were. Perhaps, if he had known that interchange could result in my avoiding preventive care visits, he would have taken more care with his words.

Study co-author Dr. David Allison points out that there are things women can do to improve their gynecological visits.

"Consumers need to exercise two kinds of skills. First, recognize that some situations are difficult socially and go in prepared that it might not be the most pleasant thing in the world, but you can handle it if you psyche yourself up." Speculums are never going to be pleasant, and it may be that your doctor will need to have a serious talk with you about your weight.

"Second, make positive changes by being assertive, not aggressive. Consumers need to muster up the courage to approach doctors when they feel badly treated, and the self-control to not do it as an attack, but in a spirit of cooperation." Even if your doctor does not make your visit into a "health care horror story", you might want to talk to her about any feelings that may keep you from coming back to get the preventive care we all need.

We must all learn to get the preventive care we need, no matter how difficult it seems. Remember: bigger bodies deserve bigger, better care!

Here are some practical tips to get you through your next visit:

If your gown doesn't fit, ask if they have any larger gowns. There are gowns that will accommodate up to size 60, so if your doctor doesn't have the right size gown, suggest that they order a few in larger sizes.

Take a cassette or CD player with you. Listening to soothing music while you're waiting may take your anxiety down to a more manageable level.

Write down any questions you have for the doctor, or any areas you want to discuss. Put some thought into what you want to happen during your visit, and give your list to the doctor at the beginning of your visit.

If the scale is in a public place, suggest that your doctor move it to a more private area. Some people have found it helpful to look at positive signs posted above the scale such as "I am more than my weight".