Don’t Let Negativity Weigh You Down
By Martha Peaslee Levine, MD
Where do we start when considering body image? The Office on Women’s Health, part of the U.S. Department of Health and Human Services, describes body image as “what you think and how you feel when you look in the mirror or when you picture yourself in your mind. This includes how you feel about your appearance; what you think about your body itself, such as your height and weight; and how you feel within your own skin.” (The bolding and underlining are my emphasis.)
Body image is more than one thing. It is not just how you see yourself when you look in the mirror, but also how you see yourself in your own mind. This can be very different; I can attest to that. As I get older, I seem to hold a much younger version of myself in my mind. I can get surprised when I look in the mirror and see my mother.
This is even harder for our clients. When they think about themselves, they often have extremely distorted views. Some patients come to me emaciated, yet worry they will break the scale or exam table during their medical appointments. Others have described their belief the floor is breaking underneath them when they walk. This is one of the first things we need to remember when working with our clients. They often do not have a realistic view of their body.
Michael Nakhla and I presented a poster at the Academy of Eating Disorders Conference in Prague, which demonstrated some of the challenges in perceptions individuals with eating disorders face. Mike, who is a photographer, took pictures of clients within our program and then had them photoshop the image to what they actually thought they looked like and their ideal body image. Even though they were looking at an image of what they looked like, those who struggled with eating disorders changed the images until they were clearly distorted. Women who did not struggle with eating disorders did not have this same reaction to their photographs. How our clients see themselves is one aspect that drives their eating disorders. While we can’t argue this version of themselves away, we can try to help them find acceptance.
One client who I work with is now at a healthy weight. She sees herself in a much more negative light, describing herself as “fat”. I will not be able to convince her otherwise. But she can accept she needs to be at this weight when we discuss other aspects that are important to her—how she wasn’t able to be successful in classes before because she was so undernourished; how she now has energy to walk upstairs and isn’t dizzy when she stands up. Focusing on what her body can do instead of how it looks has helped her become more accepting of her recovery and her body.
What are some factors that influence body image? Certainly, exposure to media impacts how individuals feel about themselves. Previous work demonstrated this connection in Fiji when television was introduced. Before TV came, the culture accepted various shapes and sizes. Women were happy with their bodies and there were no eating disorders. After TV, things changed. Body image dissatisfaction and eating disorders emerged. Recently, this effect has been replicated in Bhutan. A study in the Nordic Journal of Psychiatry (2018) documented that exposing this last country to TV also brought a pressure to be thinner, look thinner, and to regulate one’s appearance based on media rather than their peer group.
In addition to media, family influences how individuals feel about their bodies. When something you say gets repeated by your child, you realize how closely they are watching. It is no wonder body image dissatisfaction in women is significantly related to their mothers’ body dissatisfaction. I have worked with clients who struggle with recovery often because of their mothers’ own struggles. Mothers will ask their daughters if certain jeans make them look fat—how can that not lead to an ongoing critical view when daughters try on their own jeans? Comments from male family members, especially dads, often precipitate dieting. Critical messages related to food are linked to body image shame, inflexible eating, and disordered eating. Individuals with eating disorders have often been teased or bullied by their families and their peers. We need to help our clients consider the casual way that individuals, especially women, toss out critical comments about body image and food.
It is not just families, friends, or other lay people who can skew our view of our bodies. Coaches and physicians can cause damage when they offer comments or advice to individuals without considering the context or potential results. One young woman in my clinic describes, after struggling with an eating disorder, she started to have a healthy relationship with food. She felt good about herself and her body. However, when she went to see her psychiatrist, her doctor made a comment that since she weighed 180 pounds, she needed to lose weight. That comment started her off on another restriction cycle. Coaches make comments to their athletes that can lead to a focus on body appearance rather than strength and health. In an opinion piece, Mary Cain says, “I Was the Fastest Girl in America, Until I Joined Nike.” Her male coaches were convinced she had to get “thinner, and thinner, and thinner.” Then, her body started breaking down.
We must also be aware of unique pressures world events, like COVID-19, place on our patients. Today in therapy, because many of us are sheltering in place, clients made comments about weight and eating. One young woman who struggles with anxiety but doesn’t have an eating disorder talked about instead of the freshman fifteen, she was struggling with the Covid fifteen—how to not gain 15 pounds while she stayed at home. Women who struggle with eating disorders were having trouble maintaining their meal plan because they felt they weren’t doing anything, just laying around. When I reminded them their meal plan was not based on them being very active but was what their body needed to stay healthy, they were able to acknowledge that truth. Yet it was clear they didn’t really believe me.
Anxiety and other illnesses are often associated with eating disorders. Anxiety can develop related to fear of negative evaluations by others. In eating disorders, individuals worry about how their bodies’ weight and shape are being evaluated by others. Consider this worry if others in your life, people whose opinions you respect—your parents, coaches, teachers, physicians—or people with whom you want to connect—your peers—comment negatively about your body. How do you counteract these negative evaluations? It is hard, but not impossible.
We need to remind our clients it will take work and time. When I talk with clients about reframing their negative thoughts, I often get the response, “I’ve tried.” Reframing is not telling yourself the new thought once. It is over and over. I liken it to a wheel wearing a rut in a dirt road. That is where the wheel is going to naturally go. If it is a negative thought, that is where their mind will slip—into the negative thought pattern. To challenge this thought, it is as if they have to pick the wheel up and move it over and start creating a new pattern. It is hard work and their mind will slip easily back into the negative thought pattern. Yet with practice and practice and more practice, they can craft the new pattern of positive thoughts.
What are some tools that can help individuals identify and understand these negative thoughts?
My Body Experiences from Then to Now –
This exercise has individuals look at different periods of their lives and consider, what did they look like? What were key influences on how they felt about their looks? Individuals are encouraged to consider important cultural and interpersonal influences. Ages are broken up as early and late stages of both childhood and adolescence.
This can be a powerful exercise. It allows individuals to look at what was going on in their lives and what messages they may have been given. I remind clients they might have believed something when they were little and someone said something to them. But, now they are older, they can consider whether they still want to believe this about themselves. It is hard to challenge things we have been told—that we are not pretty enough or smart enough or good enough or thin enough or graceful enough…the list can go on. Yet, when we get further along in our lives, we need to consider: do I still need to believe that? Do I want to carry those negative words with me? Perhaps that person made those comments more out of their own insecurities rather than anything that was true.
Body Intelligence: Its needs and rhythms –
Within this exercise, if someone was going to move into your body for the day, what important information would they need to know about it? This would include rest, feeding, watering, light/outdoors, physical activity, touching, soothing, healing – what keeps it functioning well? That may be one of the most important things to consider about bodies and how to combat negative body image. We all want to feel healthy and energetic and alive. We want to be able to think and focus. Those are ways we can tell if we are adequately fueling our bodies. We need to focus on health at whatever size we are. If we are shorter than we want to be, do we put ourselves on a rack every day to stretch ourselves out? If our feet are bigger than our friends, do we cram them into too small of shoes? Why do we expect our bodies to look one way instead of accepting the way they are? Often it is because of the messages we hear.
As champions in this field, we need to encourage positive messages. We need to encourage health and if body love is not possible, then encourage body acceptance. We need to thank our body for what it does for us and how it helps us experience life rather than trying to shame it. We need to make positive connections in our lives and in our minds so we can release or deflect the negative. That negativity can weigh us down. It is time to drop some of the baggage we are dragging along and set ourselves free.
About the author:
Martha Peaslee Levine, MD is an Associate Professor of Pediatrics, Psychiatry and Humanities at the Penn State College of Medicine. She is Medical Director of the Young Adult PHP and IOP in the Eating Disorders Clinic at Penn State Heath. Dr. Levine enjoys writing and encourages her clients to journal as a way to discover new thoughts. She is the proud author of a number of children’s books and is actively working on more to come.