ABSTRACT BACKGROUND: Obese women are reported to be at higher risk from gynecological cancers than nonobese women, yet these women are less likely to get cancer-screening tests. The specific

factors that contribute to obese women not obtaining timely cancer screening have not been identified. OBJECTIVE: To investigate the factors that contribute to lower rates of gynecological

cancer screening as related to women's body size. DESIGN: A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m2, including 60 women

with BMI>55 kg/m2, was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (_N_=129) were surveyed

women's BMI increased. Women with BMI>55 kg/m2 had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). 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. CONCLUSION: Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce

the weight barriers to these tests and improve the quality of the health care experience. Providers should receive specific training related to care of large women. Access through your

institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print

issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to

local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT

BEING VIEWED BY OTHERS ASSOCIATION BETWEEN SOCIODEMOGRAPHIC FACTORS AND HEALTH BELIEFS RELATED TO BREAST CANCER SCREENING BEHAVIOR AMONG NORTHERN THAI WOMEN: A HOSPITAL-BASED STUDY Article

Open access 31 March 2024 THE NONLINEAR ASSOCIATION BETWEEN BODY ROUNDNESS INDEX AND INFERTILITY IN MARRIED WOMEN Article Open access 18 January 2025 IMPACT OF A RISK BASED BREAST SCREENING

DECISION AID ON UNDERSTANDING, ACCEPTANCE AND DECISION MAKING Article Open access 08 August 2023 REFERENCES * Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ . Overweight, obesity, and

mortality from cancer in a prospectively studied cohort of U.S. adults. _N Engl J Med_ 2003; 348: 1625–1638. Article  Google Scholar  * Wee CC, McCarthy EP, Davis RB, Phillips RS . Screening

for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? _Ann Intern Med_ 2000; 132: 697–704. Article  CAS  Google Scholar  * Fontaine K, Bartlett S . Access

and use of medical care among obese persons. _Obes Res_ 2000; 8: 403–406. Article  CAS  Google Scholar  * Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among

US adults, 1999–2000. _JAMA_ 2002; 288: 1723–1727. Article  Google Scholar  * Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH . Trends and correlates of class 3 obesity in the United

States from 1990 through 2000. _JAMA_ 2002; 288: 1758–1761. Article  Google Scholar  * McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ et al. Screening and interventions for

obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. _Ann Intern Med_ 2003; 139: 933–949. Article  Google Scholar  * Taplin SH, Ichikawa L, Yood MU, Manos

MM, Geiger AM, Weinmann S . Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? _J Natl Cancer Inst_ 2004; 96: 1518–1527. Article  Google

Scholar  * Puhl R, Brownell K . Bias, discrimination, and obesity. _Obes Res_ 2001; 9: 788–805. Article  CAS  Google Scholar  * Teachman BA, Brownell KD . Implicit anti-fat bias among health

professionals: is anyone immune? _Int J Obes Relat Metab Disord_ 2001; 25: 1525–1531. Article  CAS  Google Scholar  * Teachman B, Brownell K . Implicit anti-fat bias among health

professionals: is anyone immune? _Int J Obes Relat Metab Disord_ 2001; 25: 1525–1531. Article  CAS  Google Scholar  * Puhl RM, Brownell KD . Psychosocial origins of obesity stigma: toward

changing a powerful and pervasive bias. _Obes Rev_ 2003; 4: 213–227. Article  CAS  Google Scholar  * Rowland ML . Self-reported weight and height. _Am J Clin Nutr_ 1990; 52: 1125–1133.

Article  CAS  Google Scholar  * National Taskforce on the Prevention and Treatment of Obesity. Medical care for obese patients: advice for health care professionals. _Am Fam Physician_ 2002;

65: 81–88. * U.S. Department of Health and Human Services. _Healthy People 2010_, 2nd edn. US Government Printing Office: Washington, DC, 2000. * Steptoe A, Kerry S, Rink E, Hilton S . The

impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease. _Am J Public Health_ 2001;

91: 265–269. Article  CAS  Google Scholar  * Runkle C, Osterholm A, Hoban R, McAdam E, Tull R . Brief negotiation program for promoting behavior change: the Kaiser Permanente approach to

continuing professional development. _Educ Health (Abingdon)_ 2000; 13: 377–386. Article  CAS  Google Scholar  * Whitlock EP, Orleans CT, Pender N, Allan J . Evaluating primary care

behavioral counseling interventions: an evidence-based approach. _Am J Prev Med_ 2002; 22: 267–284. Article  Google Scholar  * Glasgow RE, Goldstein MG, Ockene JK, Pronk NP . Translating

what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care. _Am J Prev Med_ 2004; 27: 88–101. Article  Google Scholar  *

Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB et al. Primary care physicians’ attitudes about obesity and its treatment. _Obes Res_ 2003; 11: 1168–1177. Article 

Google Scholar  * Kristeller JL, Hoerr RA . Physician attitudes toward managing obesity: differences among six specialty groups. _Prev Med_ 1997; 26: 542–549. Article  CAS  Google Scholar  *

Wadden TA, Anderson DA, Foster GD, Bennett A, Steinberg C, Sarwer DB . Obese women's perceptions of their physicians' weight management attitudes and practices. _Arch Fam Med_

2000; 9: 854–860. Article  CAS  Google Scholar  * Wiese HJ, Wilson JF, Jones RA, Neises M . Obesity stigma reduction in medical students. _Int J Obes Relat Metab Disord_ 1992; 16: 859–868.

CAS  Google Scholar  * Wigton RS, McGaghie WC . The effect of obesity on medical students' approach to patients with abdominal pain. _J Gen Intern Med_ 2001; 16: 262–265. Article  CAS 

Google Scholar  * Sackett DL . The arrogance of preventive medicine. _Can Med Assoc J_ 2002; 167: 363–364. Google Scholar  * Getz L, Sigurdsson JA, Hetlevik I . Is opportunistic disease

prevention in the consultation ethically justifiable? _BMJ_ 2003; 327: 498–500. Article  Google Scholar  * Sarlio-Lahteenkorva S, Rissanen A, Kaprio J . A descriptive study of weight loss

maintenance: 6 and 15 year follow-up of initially overweight adults. _Int J Obes Relat Metab Disord_ 2000; 24: 116–125. Article  CAS  Google Scholar  Download references ACKNOWLEDGEMENTS The

research was supported by California Cancer Research Grant #99-00492V-10225 and the California Agricultural Experiment Station. We thank our many study participants for offering insights

into their medical experiences, the California Black Women's Project, Michelle Soeffer, MS, for project management and data entry, and Mark Hudes, PhD, for statistical support. AUTHOR

INFORMATION AUTHORS AND AFFILIATIONS * Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA N K Amy * Division of Research, Kaiser Permanente

Northern California, Oakland, CA, USA A Aalborg * Connections Women's Health Consulting, Oakland, CA, USA P Lyons & L Keranen Authors * N K Amy View author publications You can also

search for this author inPubMed Google Scholar * A Aalborg View author publications You can also search for this author inPubMed Google Scholar * P Lyons View author publications You can

also search for this author inPubMed Google Scholar * L Keranen View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to N

K Amy. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Amy, N., Aalborg, A., Lyons, P. _et al._ Barriers to routine gynecological cancer screening for

White and African-American obese women. _Int J Obes_ 30, 147–155 (2006). https://doi.org/10.1038/sj.ijo.0803105 Download citation * Received: 15 July 2004 * Revised: 14 February 2005 *

Accepted: 18 April 2005 * Published: 04 October 2005 * Issue Date: 01 January 2006 * DOI: https://doi.org/10.1038/sj.ijo.0803105 SHARE THIS ARTICLE Anyone you share the following link with

will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt

content-sharing initiative KEYWORDS * women * barrier * gynecological cancer * mammogram * African-American