From Struggle to Strength: Redefining Body Image and Eating

Obesity is a medical disease characterized by a chronic metabolic dysregulation of energy in which there is a higher than normal weight set-point that is defended by a host of metabolic adaptations. Obesity is a worldwide problem that causes not only medical consequences but also may cause disturbances in psychosocial functioning. This may be due to weight bias and stigmatization in part or whole.

Psychosocial Aspects & Obesity

Obesity is a disease that is visible and can affect how people are treated. Previously left without treatment and with bias and misinformation, it can lead to complex neurobehavioral and psychological effects. Research is becoming more sophisticated. It used to be just hypothetical posturing on what causes overweight/obesity. Then, it moved to simple comparisons of factors between people of normal body weight versus excess body weight. As science progressed, studies improved to look at which came first: excess weight or psychosocial aspects, basically to distinguish the “chicken from the egg.” These latter studies have shown that obesity, by itself, does not appear to be necessarily associated with psychopathological outcomes. Rather, obesity can cause negative psychological aspects. The internalization of negative information, which is typically based on misinformation about the disease of obesity itself, can lead to psychological discomfort and negative body image which can then lead to the development of eating disorders. Body image is a component of self-image and psychological well-being substantially depends on a health body image. Research has shown that people with obesity more often over estimate their body size than underestimate it and may be dissatisfied with their body and this may remain even after having lost weight. Moreover,certain individuals with obesity are at greater risk of psychiatric disorder, especially persons with depression. Those at higher risk for disturbed body image are people with childhood-onset or adolescence-onset obesity, women and people suffering from a binge-eating disorder.

The implications of this are three fold: (1) it should not be assumed that there are psychological issues present with obesity, (2) clinically significant mood symptoms should be proactively treated as part of the treatment of obesity, and (3) attention should be paid to the existence and treatment of overweight/obesity so as not to induce adverse psychological conditions, such as negative body image or binge eating. With regard to binge eating, it is the loss of control that is most associated with negative psychological aspects. Therefore, restoring control may be the first goal of treatment. There are FDA approved and off label pharmacotherapy options (prescription medications) that are used for both binge eating disorder and overweight/obesity.

Body Dissatisfaction

 Body dissatisfaction is a risk factor for the development of eating disorders and also represents a core psychopathologic factor of eating disorders. These are things that can cause or increase body dissatisfaction or be a sign that is is present:

• Appearance pressures: Pressures we feel to look like an appearance ideal and to be beautiful, glamorous and attractive. internalization of appearance ideals

• Upward appearance comparison: the tendency to make physical appearance comparisons with more attractive targets (e.g., fashion models, actors)

• Avoidance: taking any measure to avoid seeing and/or feeling their body such as: Avoiding mirrors. Wearing large clothes to not have to feel the fabric and/or see their shape reflected. Avoiding hugging others or any other form of physical touch. Avoiding touch themselves.

• Body checking: Body checking is the habit of seeking information about your body’s weight, shape, size, or appearance. Everyone checks the mirror in the office restroom before a meeting or in their bathroom before a Zoom hangout to be sure there’s no spinach in their teeth. Lots of people step on a scale every few days to make sure they’re in a healthy weight range for them. And plenty of people take measurements or before-and-after selfies to track their fitness journeys. Compulsively pinching loose skin, measuring body parts, weighing yourself multiple times daily, and other monitoring behaviors can all end up worsening your mood, intensify feelings that your body is imperfect, or increase the fear of losing control.

Body image assessment tool

Here is a tool you can you to assess body image.

Body Appreciation Scale

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Download PDF • 82KB

Addressing negative body image

Preventing and addressing negative body image is a core component of treating overweight/obesity. The following are steps you can take.

Step 1: Practice Forgiveness

Stop punishing yourself for your mistakes. Accept that you are not perfect and be gentle with yourself when you are confronted with your shortcomings. You are valued by your friends and colleagues because of who you are, not because you are faultless.

Become aware of times when you derive a sense of self-worth from performance or perfection. Understand that you do not need to be a certain way to be worthy of love.

One way to remind yourself that you are worthy, even when you’re not performing well, is to put a sticky note near your desk or in your wallet with a message reminding you to be gentle and kind with yourself.

There is no sense in punishing your future for the mistakes of your past. Forgive yourself, grow from it, and then let it go.

Melanie Koulouris

Step 2: Employ a Growth Mindset

At the heart of Carol Dweck’s research is the impact of our mindset on wellbeing. She found that whether we have a fixed or growth mindset influences our happiness. Do you view challenges as impossible obstacles or as opportunities to grow? Employing a growth mindset is more helpful.

Embrace rather than avoid challenges, persist in finding meaning in them, and don’t give up on yourself. When you find you are criticizing yourself and negatively comparing yourself with others, try to find inspiration in their successes and strengths instead of feeling threatened.

Step 3: Express Gratitude

Feeling gratitude is very powerful (Emmons & McCullough, 2003). Rather than wishing for what we do not have, there is strength in appreciating what we do have, right now. You can choose to write a gratitude journal or go for gratitude walks. By focusing on our blessings we employ a gentler inner voice and move the focus away from our shortcomings and outward to the world, with all its beauty.

Step 4: Find the Right Level of Generosity

Raj Raghunathan (2016) has identified three different reciprocity styles: giver, taker, and matcher. Givers are the most generous people, and generosity is a great way of employing compassion. However, givers can be both the most successful and least successful people, as they may fall into a pattern of selfless giving that ignores their own needs.

For generosity to work in favor of your well-being, it cannot be selfless. So, when being generous, make sure you are aware of your own needs before progressing. Then consciously choose the recipient of your generosity, the resources you have available, and your level of energy based on what will support your own well-being.

Also, have fun being generous. See the difference you make and do not forget to give back to yourself. Doing good for others makes us happy, but only if it does not reduce our own levels of well-being.

Step 5: Be Mindful

Mindfulness has been found to have a positive impact on self-compassion, as it has a tendency to lessen self-judgment (Kabat-Zinn, 2014). Strive to always be in the moment and to be aware of what is happening right now, without judgment and labeling.

Allow what you think or feel to have its moment; don’t give it the microphone or hide it in the corner. Allow it to come, and then, without attachment, let it go.

A Take-Home Message on Body Image

You are worthy of love. So, next time you do not rise to the expectations you have for yourself, take a moment to pause and reassess. Be mindful of the difficult emotions that arise. Forgive yourself and recognize that you are only human. See if you can identify how to do it differently next time. Be grateful for the opportunity you had in the first place and for your persistence to try again. Finally, accept yourself. You are not perfect. And yes, you likely could have done better. But chances are, you did just fine. And often, that’s more than enough.

Body Image & Rainier Medical

This information is incorporated into the Rainier Medical programs in the following ways (not inclusive list):

• Acknowledgement of the majority role of genetics and environment in the determination of an individual’s weight

• Medical treatment of the medical condition of overweight/obesity and its causes and effects without assumption of behavioral cause

• Focus on longitudinal medical treatment and access to expert obesity care, and engineering one’s environment for prevention of weight regain, rather than “willpower”

• Focus on holistic and comprehensive care

• People-First language as recommended by the Obesity Action Coalition

• Avoiding terms such as diet, good or bad food, cheating

• Medical treatment for hunger, lack of satiety, disordered eating, and binge eating disorder

• Health first approach to reaching a healthier weight

• Health goals for treatment, not weight goals

• Positive, long term, and “good enough” approach to lifestyle measures

• Encouraging flexibility and adaptability in nutrition

• Encouraging individuals to “self-select” programs and plans

• Using goal setting by individuals via motivational interviewing

• Emphasizing the health benefits of long term modest weight reduction over short term “goal weights”

Take Back Your Body Image,

Valerie Hope-Slocum Sutherland, MD

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