Reality Check: Why Don't Fat Women Get Checked for Cancer of the Nasty Bits?

The Rotund points out a recent Reuters article about how clinically obese women are less likely to be screened for cervical, breast, and colorectal cancer. And of course, researchers and journalists just can't imagine why.

It's not certain why obese women are less likely to get these screening tests, as few studies have been designed to look at the underlying reasons

Well, here's one: Stigma and Discrimination in Weight Management and Obesity, by Kelly Brownell and Rebecca Pugh. A few highlights (with my emphasis):

24% of nurses said they are 'repulsed' by obese persons

Numerous studies^2-6 document explicit negative attitudes about obesity among physicians, nurses, dieticians, and medical students. These attitudes include: obese people lack self-control and are lazy, obesity is caused by character flaws, and failure to lose weight is due only to noncompliance.

Among physicians, 17% reported reluctance to provide pelvic exams to very obese women, and 83% indicated reluctance to provide a pelvic exam if the patient herself was hesitant.¹² Given that overweight women may hesitate to obtain exams and that physicians are reluctant to perform exams on obese or reluctant women, many overweight women may not receive necessary preventive care.

Efforts to reduce bias toward obese people have been limited. One intervention study¹⁷ attempted to reduce stigma toward obese patients among medical students. Before random assignment to a control group or an education intervention using videos, written materials, and role-playing exercises, the majority of medical students in the study characterized obese individuals as lazy, sloppy, and lacking in self-control, despite the students indicating that they had an accurate understanding of obesity's cause. After the intervention, students demonstrated significantly improved attitudes and beliefs about obesity compared with the control group. One year later, the effectiveness of the intervention was still evident.¹⁷

Here's another one: Barriers to routine gynelogical cancer screening for White and African-American obese women, by Amy, Aalborg, Lyons and Keranen.

The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were 'moderately' or 'very concerned' about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them.

I find that bit about having been on weight loss programs five or more times fascinating. Because the logical conclusion is, these are women who know bloody well that diets won't work for them--and also know bloody well that no matter what they see their doctors for, including a fucking pap smear, they'll be told to go on yet another diet.

24% of nurses are repulsed by fat people. 17% of doctors don't want to put a speculum up a fat woman's vagina. (Do they enjoy giving pelvics to thin women? 'Cause, ew.) A majority of medical students think fat people are "lazy, sloppy, and lacking in self-control."

Yeah, it's a total fucking mystery why fat women don't want to have their most vulnerable body parts, the ones culturally designated as most shameful, poked and prodded by medical professionals. How could we ever begin to figure that one out?