Love Your Body Day

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Love Your Body Day

• Tina Grace Barbaro
• Reviewed by Katie Hecksel
• AMSA Women in Medicine
• July 2005

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

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Body Image is

• internal representation of ones 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 individuals 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 ones physique to reduce
  discontent 2
• In its extremes, this discontent manifests as
  disordered eating patterns or pathways toward
  depression 3

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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 ITS 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.

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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.
• Its 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.

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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

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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 individuals
  physical and psychologic health and often impact
  their socioeconomic opportunities during
  childhood and adolescence and into adulthood.

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The Role of Cosmetic Surgery

• Another recent phenomenon is the use of cosmetic
  surgery to alter ones 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.

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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.

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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.

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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.

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Media, Family, Peers

• Media can have a direct influence on audiences
  and can affect audiences indirectly by altering
  ones perceptions of social norms.
• Although media often is portrayed as the sole
  culprit in ones 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
  reinforces of social messages around body image
  and eating for their adolescent daughters 16.

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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
• Dont talk negatively about your own
  body in front of your
  daughter
• Dont 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

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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
• www.kidshealth.org,www.teenhealthfx.com,
  www.cdc.gov
• 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.

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Our Patients are NOT Alone

• Eating disorders dont 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.

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• Study 119
• 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
• Overweight (25
• 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

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• Study 220
• 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.

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How to Develop a Healthy Body Image
Adapted from BodyLove Learning to Like Our
Looks and Ourselves, by Rita Freeman, Ph.D

• 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.

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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. 

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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.

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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

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If you answered yes to any of the warning
signsYou may suffer from
an Eating Disorder
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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.
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Internet Resources

• www.about-face.org/
• A non-profit group that combats negative
  and
  distorted images of women in the media
• http//www.bodypositive.com/
• Body positive offers a plethora of resources
  to
  explore ways to appreciate and care for your
  body. Its a fun
  web-site with numerous articles, forums, and fun
  tools to help you love your body.
• www.somethingfishy.org
• 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

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Books

• 200 Ways To Love The Body You Have Marcia
  HutchinsonMore 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 WorkbookThomas F. CashAn
  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
  SwardAfter 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.

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More Books

• 101 Ways to Help Your Daughter Love Her
  BodyBrenda Richardson, Elane RehrJournalist
  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 BookKathy McCoyA 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
  BarbieStacey HandlerThrough 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.

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References

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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, 2004A01.
• 12 Becker AE, Burwell RA, Gilman SE, et al.
  Eating behaviours and attitudes following
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• 13 American Psychiatric Association. Diagnostic
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  edition. Washington, DC7 American Psychiatric
  Association 1994.
• 14 Lucas AR, Beard CM, OFallon WM, et al.
  50-year trends in the incidence of anorexia
  nervosa in Rochester, Minn a population-based
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• 15 Emans SJ. Eating disorders in adolescent
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• 16 Eccles-Parsons J, Adler TF, Kaczala CM.
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• 17 Fallows D. The Internet and daily life.
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• 18 Taylor E. Totally in controlthe rise of
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• 19 Jlawe JJ, Eating disorders among students of
  the Medical University in Bydgoszcz. Przegl Lek.
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• 20 Babar N, Anorexic behavior and attitudes
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