Love Your Body2

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Love Your Body Day: 

Love Your Body Day Tina Grace Barbaro Reviewed by Katie Hecksel AMSA Women in Medicine July 2005 Mid-October

Does this look familiar?: 

Does this look familiar? Salvador Dali, 'Swans Reflecting Elephants'

Swans Reflecting Elephants: 

Swans Reflecting Elephants Dali captured the way that so many of us perceive our bodies… …that is, we are all amazing in our own unique ways, yet when we look in the mirror we are so consumed with each little flaw that we become unable to appreciate our own beauty.

“Body Image” is…: 

'Body Image' is… internal representation of one’s own outer appearance which reflects physical and perceptual dimensions [1] a multidimensional construct, influenced by biologic, psychologic, and social factors [1] related highly to an individual’s self-esteem and self-concept, including sexuality, familial relationships, and identity Poor Body image and lower self-esteem result in dissatisfaction with oneself. If these body-related concerns are intense enough, they may catalyze behaviors that are aimed at changing one’s physique to reduce discontent [2] In its extremes, this discontent manifests as disordered eating patterns or pathways toward depression [3]

Body Image in the US: 

Body Image in the US In a recent U.S. study, almost half of the surveyed women had negative evaluations of their own overall appearance and were dissatisfied with their weight and lower and mid-torso [4]. BUT IT’S NOT JUST ADULTS… By middle school, 20% to 50% of girls in the US say that they feel too fat. [5] One study found that 40% of adolescent girls believed that they were overweight, even though most of these girls fell in the normal weight range [6].

“Ideal” vs. “Average”: 

'Ideal' vs. 'Average' Given increased obesity for adolescent girls and women, the gap between the average and the ideal has expanded; models used to weigh about 8% less than the average woman, they now weigh 23% less [7]. It’s NOT just a female issue… Typical growth for boys is characterized by quick gains in height, but not necessarily in muscle or weight. This is in striking contrast to the ideal body image for men, which has become increasingly muscular [8].

Body Image varies with Race and Ethnicity: 

Body Image varies with Race and Ethnicity African American women, as compared with Caucasian women, typically report less body image dissatisfaction [9]. Among other ethnic groups, body image dissatisfaction appears to be related to the degree of acculturation. As Asian and Hispanic American individuals acculturate to American customs, body image dissatisfaction appears to increase and mirror that of Caucasian Americans [7]

Body Image and Health: 

Body Image and Health Overwhelming dissatisfaction with body shape and weight is often linked to one of two extremes in weight-related disorders: obesity and disordered eating. Obesity is more prevalent than the eating disorders, anorexia nervosa and bulimia nervosa; however, all of these disorders lead to significant negative effects on the individual’s physical and psychologic health and often impact their socioeconomic opportunities during childhood and adolescence and into adulthood.

The Role of Cosmetic Surgery: 

The Role of Cosmetic Surgery Another recent phenomenon is the use of cosmetic surgery to alter one’s appearance. In 2003, there were 8.3 million procedures (surgical and nonsurgical) done: 322,975 liposuctions on women 61,646 liposuctions on men [10] 280,401 breast enlargement procedures representing an increase of 177% since 1997 From 2002 to 2003, the number of girls who were 18 years of age and younger who got breast implants increased almost 400%, from 3872 to 11,326 cases [11].

Eating Disorders: 

Eating Disorders Eating disorders are no longer a condition of the daughters of wealthy,educated and successful families, as they originally were characterized. Rather they affect all socioeconomic and major ethnic groups [12]. The definition of eating disorders also has expanded, as evidenced in the DSMIV, which includes: anorexia nervosa: characterized by restrictive eating patterns and significant weight loss bulimia nervosa: characterized by binge-purge cycles Eating disorder not otherwise specified (ENDOS): eating disorders that do not meet the criteria for any specific eating disorder [13].

Prevalence of Eating Disorders: 

Prevalence of Eating Disorders The prevalence of eating disorders has increased over the last 50 years [14]. Internationally, anorexia nervosa involves 0.5% to 1% of girls and women in late adolescence and early adulthood and bulimia nervosa affects 1% to 3% of adolescent and young adult girls/women. Overall, it is estimated that boys account for 5% to 15% of cases anorexia and bulimia nervosa [12].

Co-Morbitities Associated with Eating Disorders: 

Co-Morbitities Associated with Eating Disorders Eating disorders often occur in conjunction with other problems, such as anxiety disorders, depression, and substance abuse. Women who have eating disorders experience serious morbidity and high mortality, particularly as a result of anorexia nervosa. Morbidity concerns include myocardial impairment, osteoporosis, and amenorrhea, which often linger in the rehabilitation phase and following recovery. Mortality results from malnutrition and cardiac failure, as well as suicide. Eating disorders, like obesity, also represent a significant burden to society. Anorexia nervosa is the third most common chronic illness in the United States [15].

Media, Family, & Peers: 

Media, Family, andamp; Peers Media can have a direct influence on audiences and can affect audiences indirectly by altering one’s perceptions of social norms. Although media often is portrayed as the sole culprit in one’s formation of body image and eating attitudes and behavior, research has demonstrated that family and peers also are main sources of influence [16]. Strong evidence exists regarding the influence of mothers as role models and transmitters and reinforcers of social messages around body image and eating for their adolescent daughters [16].

For those of us who are Mothers: 

For those of us who are Mothers As a mother, you can take several steps to ensure that you are communicating positive messages about the way you perceive and manage your own body image: Don’t talk negatively about your own body in front of your daughter Don’t utilize 'fad diets' or practice unhealthy eating habits Model healthy exercise behavior and stress management Encourage your daughter to discuss her fears and concerns about her body with you or with a counselor

The Internet: Friend or Foe?: 

The Internet: Friend or Foe? Young people use the Internet more so than members of any other age group [17]. In the United States, the average adolescent is on the Internet daily, and 74% of households with children have access to the Internet [17]. There are many sites that convey positive health messages to young people, such as those that encourage healthy diets and physical activity:,, Yet several web sites contain health-related information that can be harmful. A disturbing new phenomenon is the emergence of sites that portray disordered eating in a positive light. Classified as ‘‘pro-ana’’ (proanorexia), ‘‘pro-mia’’ (probulimia), or a combination of both, these sites characterize anorexia and bulimia as a lifestyle choice, not a clinical disease over which individuals may have little control [18].

Our Patients are NOT Alone: 

Our Patients are NOT Alone Eating disorders don’t only occur in the general patient population, but among nursing students, medical students, and a vast array of medical professionals. Two recent studies aimed to evaluate the prevalence of eating disorders among medical and nursing students.


Study #1[19]: BMI was calculated for all of the probed students. Eating disorder predispositions appeared in the group of 48 persons (12.4% of studied population) comprised of 32 women and 1 man. Underweight (BMI andlt; 18.5) = 13 people Overweight (25 andlt; BMI andlt; 29.9) = 5 people BMI within normal limits = 30 people More than a half of probed students were terrified by the reflection of being overweight. 14 people reported vomiting or use of laxatives to avoid weight gain


Study #2[20]: Three groups of female students with no statistical differences were compared: university nursing students first-year medical students a comparison group of students studying arts (not related to health care) After controlling for age and ethnicity 20% of the nurse applicants were found to have disordered eating patterns meriting further investigation compared with 19% of medical students and 21% of arts students Thus the results indicate that health care students are just as likely to suffer from disordered eating patterns as our non-clinical counterparts.

How to Develop a Healthy Body Image : 

How to Develop a Healthy Body Image 1. Listen to your body. Eat when you are hungry.  2. Be realistic about a 'healthy body size' for you, taking into account the genetic and environmental components that contribute to the way you look. 3. Exercise regularly in an enjoyable way, regardless of size. Adapted from 'BodyLove: Learning to Like Our Looks and Ourselves,' by Rita Freeman, Ph.D

Guidelines (continued…): 

Guidelines (continued…) 4. Expect normal weekly and monthly changes in weight and shape. 5. Work towards self acceptance and self forgiveness--be gentle with yourself.  6. Ask for support and encouragement from friends and family when life is stressful.  7. Decide how you wish to spend your energy - pursuing the 'perfect body image' or enjoying family, friends, school and, most importantly, life. 

How do you see yourself?: 

How do you see yourself? Regardless of the image reflected in the mirror, women's perceptions of their bodies can fluctuate dramatically from reality. To help recognize symptoms of a negative mindset, review the following checklist of warning signs then determine whether or not you are clinging to a distorted body image.

Warning Signs Checklist: 

Warning Signs Checklist • No matter how much weight you lose, you still view your body as unacceptable or too big. • Do people describe your size in a significantly different way than you do? • You have difficulty accepting compliments about how good you look or how thin you are. • You feel large/fatter on days when you are upset, and smaller/thinner on days when you feel good. • You feel significantly heavier or thinner from day to day, although realistically you know your body couldn't have changed drastically overnight. • After feeling fine emotionally and physically during part of a day, something goes wrong and you react by suddenly feeling fat and or unattractive. Courtesy: Lavinia Rodriguez, Ph.D

If you answered “yes” to any of the warning signs…You may suffer from an Eating Disorder: 

If you answered 'yes' to any of the warning signs… You may suffer from an Eating Disorder


If you believe that you have a poor or inaccurate body image, or if you suffer from disordered eating, please seek help. Talk to your friends, family, a physician, or consult the following resources for more information.

Internet Resources: 

Internet Resources A non-profit group that combats negative and distorted images of women in the media Body positive offers a plethora of resources to explore ways to appreciate and care for your body. It’s a fun web-site with numerous articles, forums, and fun tools to help you love your body. A non-profit group dedicated to raising awareness and providing support to people with Eating Disorders, and their loved-ones Visit the 'Treatment Finder' to discover local and national resources


Books 200 Ways To Love The Body You Have Marcia Hutchinson More than loving your looks, it helps you see the profound role that your body plays in your personal life as well as revealing the ways your body is central to living on this planet and in spiritual growth. The Body Image Workbook Thomas F. Cash An eight-step program to evaluate negative body image, change self-defeating 'private body talk,' and create a more pleasurable, affirming relationship with the body. You Are More Than What You Weigh Sharon Sward After ten years of leading eating disorder groups, the author has developed more than a few exercises that helped drive home the point. Her clients needed help learning to love themselves, no matter what the scales said.

More Books: 

More Books 101 Ways to Help Your Daughter Love Her Body Brenda Richardson, Elane Rehr Journalist Richardson and clinical psychologist Rehr, both mothers of teenage girls, closely examine the experience of girls today, and offer suggestions for counteracting the media, fashion trends, the lure of Barbie and other cultural input that may negatively impact a girl's confidence and self-image. The New Teenage Body Book Kathy McCoy A handbook for teenagers discussing such topics as the male and female bodies, health, grooming, emotions, various aspects of sex, eating disorders, depression, drugs, and sexually transmitted diseases. The Body Burden, Living in the shadow of Barbie Stacey Handler Through autobiographical prose, Stacey openly discloses her battle with body image. She deftly chronicles both her struggles and her triumphs, in the hope of aiding women similarly in pain.


References [1] Sands R. Reconceptualization of body image and drive for thinness. Int J Obes 2000;28: 397– 407. [2] Harter S. Manual: self-perception profile for adolescents. Denver (CO)7 University of Denver; 1988. [3] Ackard DM, Peterson CB. Association between puberty and disordered eating, body image, and other psychological variables. Inter J Eat Disord 2001;29:187– 94. [4] Cash T, Pruzinsky T. Body images: development, deviance, and change. New York7 The Guilford Press; 1990. [5] Koff E, Rierdan J. Perceptions of weight and attitudes toward eating in early adolescent girls. J Adolesc Heatlh 1991;12:307–12. [6] Ozer EM, Brindis CD, Millstein SG, et al. America’s adolescents: are they healthy? San Francisco (CA)7 University of California, School of Medicine; 1998. [7] Kilbourne J. Deadly persuasion: why women and girls must fight the addictive power of advertising. New York7 Free Press; 1999. [8] Leit RA, Pope HG, Gray JJ. Cultural expectations of muscularity in men: the evolution of Playgirl centerfolds. Int J Eat Disord 2001;29:90– 3. [9] Lerner RM. A life-span perspective for early adolescence. In: Lerner RM, Foch TT, editors.Biological-psychosocial interactions in early adolescence. Hillsdale (NJ)7 Erlbaum; 1987. p. 9– 34. [10] Gorman J. Plastic surgery gets a new look. The New York Times April 27, 2004:F6.

References (continued): 

References (continued) [11] Boodman SG. For more teenage girls, adult plastic surgery. Rise in breast implants, other procedures raises doubts about long-term effects. The Washington Post October 26, 2004:A01. [12] Becker AE, Burwell RA, Gilman SE, et al. Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Br J Psychiatry 2002;180:509–14. [13] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC7 American Psychiatric Association; 1994. [14] Lucas AR, Beard CM, O’Fallon WM, et al. 50-year trends in the incidence of anorexia nervosa in Rochester, Minn: a population-based study. Am J Psychiatry 1991;148(7):917– 22. [15] Emans SJ. Eating disorders in adolescent girls. Pediatr Int 2000;42(1):1–7. [16] Eccles-Parsons J, Adler TF, Kaczala CM. Socialization of achievement attitudes and beliefs: parental influences. Child Dev 1982;53:310– 21. [17] Fallows D. The Internet and daily life. August 11, 2004. Pew Charitable Trust. [18] Taylor E. Totally in control—the rise of pro-ana/ pro-mia websites. Oxford (UK)7 Social Issues Research Centre; 2002. [19] Jlawe JJ, Eating disorders among students of the Medical University in Bydgoszcz. Przegl Lek. Jan 01, 2003; 60 Suppl 6:40-42. [20] Babar N, Anorexic behavior and attitudes among female medical and nursing students in a private university hospital. J Pak Med Assoc. June 01, 2002; 52(6): 272-276.

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