*Originally published on wellness.com

There is a tension among the millions of women who fail to fall into the defined window of the Body Mass Index and how they are to find appropriate healthcare, not to mention a relationship with a physician that nourishes self-esteem. There are relatively few medical doctors who have signed on to the body positive movement, an important effort which emphasizes we should move beyond 21st century ideals of what a perfect figure looks like.

Unfortunately, many in the medical field don’t see past the fat and often miss serious medical conditions, as a recent New York Times article reports.

Many physicians, whom we often expect should know better, attribute being overweight solely to dietary habits. Weight gain is only partially related to self-control; extra pounds are also the result of genetic, biological and environmental influences.

Sadly, because of bias in medicine about body size, many women dread doctor appointments, or avoid them altogether for fear of feeling humiliated and not taken seriously. Yet, dodging medicine prevents us from getting needed care.  There is a way to deal with physicians that makes our office visits less awkward and painful.

Here are some ways overweight women can have a better doctor appointment:

1. Be your own advocate and don’t worry about being too assertive. We can influence our doctors to be more compassionate. Some research suggests that the needed ingredients for respectful relationships in medicine are assertiveness (including appropriately expressing negative feelings), confidence about asking questions, and not being too passive. If your doctor immediately brings up your weight and you are not ready to talk about it, say so.  Sometimes, I even suggest to people that they bring up their weight first to get it out of the way.

Something like, “I’m still working on my weight, but I’m here for other reasons.”  Remember, these days, physicians have boxes they have to check off indicating they have provided a certain level of care and this involves documenting that they have discussed several topics. If you bring it up, they don’t have to.

2. Treat a medical visit like a business meeting. Set an agenda and share control of the visit. Physicians have a bunch of things they need to get through and document, but you have your own needs.  Write down the questions and issues you have for the medical encounter and if possible, email or fax these questions ahead of time.  And write down all the answers and information you get during the visit. With electronic medical records, you can even send a note to the medical team with what you hope to accomplish during the appointment. Be specific and keep questions concise. Try to have no more than three topics per appointment.

3. Don’t expect your doctor to be an expert on weight loss. No disrespect intended towards physicians that are appropriately trained in talking with patients about losing weight and nutrition. However, the reality is, many docs offer superficial advice that does not take into account that different food strategies work for different metabolisms, nuances of lifestyle and food availability, other medical conditions, etc. Since office visits are so structured and time-limited these days, physicians rarely are able to counsel patients adequately.

If you feel you need help in losing weight, seek out experts who help people with this all the time, (a nutritionist or dietitian), weight loss apps that have empirical validity, and any formal weight loss program that fits your interest.  Also, keep in mind, most people who struggle with their weight have done so for a long time and know the approaches that work and those that don’t.

4. If you’re not feeling safe, get a new doctor. In order for any of us to make a change, we need to feel relaxed and secure.  Decades of research suggests that when we trust our physicians, we are more likely to take care of ourselves.  Don’t feel pressured to be a “good patient” and stay with a clinician who does not respect you.

Feeling entitled to take control of your medical care can help you feel more engaged and comfortable in your life and your body, no matter what your size.

To learn more about Tamara McClintock Greenberg and her work, visit https://www.tamara-greenberg.com/. You can find her on Twitter @TMcGreenberg. Her two most recent books are Psychodynamic Perspectives on Aging and Illness (2nd Ed.) and When Someone You Love Has a Chronic Illness, both are available on her website.