come as you are

We all deserve quality health care, but people in bigger bodies are often shut out. That's why some providers have worked out a new approach that aims to treat the person actually sitting in their exam room rather than the one they would be if only they lost weight.

- BETHANY BROOKSHIRE

WHEN JACQUELYN GILL, PH.D., BEGAN TRYING TO GET PREGNANT AT 33, ALL ANYONE WANTED TO TALK ABOUT WAS HER WEIGHT.

Though she describes herself as fat, her doctors had never commented on her size, likely because she was essentially healthy. "My blood pressure was always low, and I never had high cholesterol," says Gill, a professor of ecology at the University of Maine in Orono.

But when she had difficulty conceiving and started seeing a parade of specialists, things changed. "Every time I would go in for an appointment, I was told 'Lose as much weight as you can for a year and then come back," says the now 43-year-old. And try she did: "I would yo-yo diet-lose some weight and then bounce back and weigh even more."

Her gynecologist suspected that Gill's trouble conceiving had to do with polycystic ovarian syndrome (PCOS). This condition may affect fertility and can also lead to weight gain. Also, a previous doctor had diagnosed her with adenomyosis, a condition in which the tissue lining the uterus grows into the muscular wall of the organ instead of remaining inside, causing heavy, painful periods and a thickened uterine lining, but Gill had never been toldit was merely written in her chart.

Her ob/gyn then treated her for her suspected PCOS, but the adenomyosis went untreated for three years, she says, as the focus was all on the need for her to lose weight.

This situation isn't uncommon, says Emily Jungheim, M.D., a reproductive endocrinologist, an infertility specialist at Northwestern University in Chicago, and a board member of the American Board of Obstetrics & Gynecology. But while many doctors counsel weight loss before they will help a woman in a larger body to become pregnant, there's not much data to back up that recommendation. "Weight loss doesn't necessarily translate into better outcomes," says Dr. Jungheim.