Read an Excerpt

Chapter 1


Body Image Blues

Sounding the Alarm



Too many American children, particularly girls, are afraid to gain weight. The compelling wish to be thin or stay thin at all costs provides the seeds for a lifetime of intense, unrelenting, counterproductive conflict between hunger and eating, or between the body they were born with and, as diet advertisements promise, "the body you always wanted." Ironically, hand in hand with the greatest weight-loss campaign ever known, an epidemic number of Americans have become unhealthily fat.

It is startling to recognize that this conflicted way of relating to our bodies is now the norm in our country. But the outrage of our shock may drain into resignation when we realize just how big this problem has become. After all, what can we do if so many people battle their bodies? My goal is to make you believe there is plenty we can do. The house is burning, but we now know enough about the fuel that is feeding this fire to put it out--if we take action together. First, let's sound the alarm.


Beauty and the Body


Between 65 and 85 percent of adult women in the United States do not feel good about their bodies. Many men are affected as well. Most say this is because they are or feel fat, which may or may not reflect being fat. This dissatisfaction is not trivial. Surveys show that a lot of women would trade several years of life and career success for the opportunity to permanently lose fifteen to twenty pounds. Most of these unhappy individuals routinely engage in unhealthy dieting that in turn leaves them obsessed with food and ashamed of their hunger.

By the time they are in eighth grade, roughly 75 percent of our still-growing girls have adopted this distrust of and bad feelings about their bodies and have learned that they too should try to take control of the matter by dieting. At a time in their lives when they should feel secure in their body's growth, developing confidence in habits that would help them to become healthy adults with diverse, healthy weights, American children are increasingly worried about size. Kids who should be focusing on tasks that will help them grow intellectually, emotionally, artistically, socially, and physically are instead distracted and anxious about weight. Mothers feel helpless to intervene, fearful their daughters may be excluded for being too large. Fathers do not know what to say when their naturally rounding pubescent girls ask, "Am I fat?"

We see the toll of poor body image on younger and younger children. Once thought of as an adolescent problem, now almost half of normal weight third- to sixth-grade girls say they would "like to lose weight," and up to one-third say they have already tried dieting. We have not taught these kids to feel integrity in their bodies, nor that we want them to eat well for health and well-being. Instead, from a very early age they have learned to feel there is something wrong with them. Girls from the richest country in the world have been raised to worry first and foremost that they are not the size or shape they have come to believe they should be and that they cannot trust their natural hunger.


Body-Image Messages

How often do you:

* Talk about feeling fat?

* Say you should go on a diet or talk about being on a weight-loss diet?

* Bemoan that you have gone off your diet and that you have eaten "too much"--again!

* Imply you were "bad" for eating something?

* Speak negatively about one or more body parts (e.g., "I hate my thighs!")?

* Make fun of or criticize people's size or shape?

* Comment negatively about how much people eat?



Male Body-Image Worries

Boys are not immune to body-image concerns, although only a handful of studies have measured how boys and men feel about their bodies. Perhaps this is because the number of males who develop a diagnosable eating disorder is small. Fewer than 1 percent of men are diagnosed with these debilitating disorders, compared to between 5 and 10 percent of girls. The difference is even greater for partial-syndrome eating disorders (in which several, but not all of the criteria for a full-blown, diagnosable eating disorder are met). Estimates suggest that 30 percent of postpubescent females have partial-syndrome eating disorders, compared to only 2 percent of males.

Nonetheless, body dissatisfaction in males is on the increase. For most boys, the appearance of body fat is cause for some unhappiness, but it is the rise in their desire for a "ripped" (highly muscular) look that has drawn the most attention. For example, in 1972, only 18 percent of males said they "disliked their upper torso," but by 2004 the percentage had risen to between 45 and 55 percent.

While few studies exist, there is consensus that males have been affected by a significant rise in the number of images of "ideal" pumped-up men in today's mass media. A recent cover of Men's Health magazine offers an example of the standard that men are now challenged to achieve:


"Get the abs that drive women wild. Only four weeks to be the trim, muscular guy you've always known you could be!"


The heightened focus on bodybuilding, excessive musculature, and unnatural leanness is less motivated by health than by a growing insecurity about appearance in boys and men. Bodybuilding as a sport has been around for some time, but an increase in compulsive weightlifting and consumption of bulking-up substances has clearly gone hand in hand with changes in media images of men. We've also seen a rise in products that can be purchased to supposedly achieve the "ideal" male look. Most alarming is the increase--even among boys of middle school age--in use of anabolic steroids to build muscles and exaggerate male sexual characteristics.

While these drugs are not legal without a prescription, abusers find ways to obtain them, and advice about their use is readily available on the Internet. The effectiveness of these drugs makes them extremely seductive, and most users are either not aware of or deny the serious medical complications that are inevitable with long-term use.


G.I. Joe Bulks Up

A study published in The International Journal of Eating Disorders made the news by reporting curious changes in G.I. Joe, Luke Skywalker, Batman, and several other male action figures over the past thirty years. Findings show that if G.I. Joe was life-size, between 1973 and 1998 his chest would have increased from 44.4 inches to 54.8 inches and his biceps from 12.2 inches to 26.8 inches. The authors noted that, "G.I. Joe now sports larger biceps than any bodybuilder in history." Although his waist increased also (from 31.7 inches to 36.5 inches) he has "the sharply rippled abdominals of an advanced bodybuilder," whereas the early models have far less definition.


Although boys are now pressured into body-image worry along with girls, boys for the most part channel their concerns differently than girls. Boys who feel bad about their bodies are more likely than girls to divert their feelings into external things, such as sports, music, cars, and academics. They learn to use tools to build engines or empires outside of themselves. This focus on external projects that can be accomplished with their bodies may help many boys keep appearance concerns in check.


Girls Internalize Problems

Girls, on the other hand, do the opposite. Girls direct their body-image concerns inward and make their bodies into a project. Joan Blomberg's book The Body Project demonstrates how much time, attention, money, and self-esteem girls spend working on transforming and reshaping their natural endowment. By studying the diaries of girls and women, Blomberg found that a shift has occurred in values and attitudes over the past one hundred years. From their writings we see that women have always been interested in physical attractiveness: longing for a new dress for the dance, wondering whether to encourage or discourage the natural bend or straightness of hair, what color to paint lips, and at what age to begin. But in the first half of the twentieth century, diary entries regularly reflected the common value of the community: character was held as more important than beauty. Early-twentieth-century girls who wished for good looks soon refocused their concern to emphasize good works--a humble wish to be a better person--or at least to project attractiveness by demonstrating deeper qualities, such as honesty, thoughtfulness, generosity, intelligence, humor, and a willingness to work hard.

In contrast, during the last half of the twentieth century, the diary entries of girls changed radically. Gone is the balance of concern between external and internal beauty. This equilibrium is overrun by worry about what shows on the surface. Girls' diaries reflect the preoccupied and anxious belief that outer beauty is paramount. Self-improvement has taken on a different focus entirely. Writings assume an increasingly frantic tone.

In my own work I've often seen the journal entries of clients confirming this urgent, narrow focus:


I wish . . . , I need . . . , I HAVE to lose 5 pounds by the dance, . . . 20 pounds by the wedding, . . . 40 pounds by summer, . . . or I'd rather die!


Or as a gorgeous-by-any-standard five-foot-four-inch, 115-pound eighth grader told me: "I hate my body. I am an ugly, fat freak! I know you don't believe this, but really, looks are everything in school. If I don't lose ten pounds this summer, I might as well not even go to high school."

With heightened concern about external presentation, today's females too often abandon the goal of becoming a more engaging and contributing person. We cannot help but worry about pressures that encourage self-centered insecurity about appearance when studies tell us that one of the best predictors of happiness is an altruistic sense of purpose outside ourselves.


Many people believe that unless body image and eating concerns progress to an eating disorder, there is no reason to be so worried. And since only a small percentage of kids develop eating disorders, it can't be all that bad. But how kids feel in their own skins is not trivial, either to them or to the culture at large. There are four major ways that body-image concerns cost our children, our families, and our society at large.



The Cost of Body-Image Concerns


1. Time, attention, energy, self-esteem, and money drain
At the very least, the mental and emotional drain caused by body dissatisfaction is a huge and painful distraction, consuming a tremendous amount of energy and attention that kids need for more important developmental tasks. Body self-consciousness feels bad, provokes feelings of shame, erodes self-esteem, and makes it very difficult, if not impossible, to concentrate. Kids who routinely worry about their size and shape as they walk down hallways or sit at their desks are anxious and preoccupied students. Kids who feel they are being watched as they eat (or don't eat!) in lunchrooms or who worry about how they look while dressing for or participating in physical education feel awful. Body self-consciousness hampers children's ability to focus on academic, social, daily-living, and other important life skills.


2. A crisis of disconnection
Children with poor body image learn to view themselves from the outside in, rather than the inside out. "How I look" becomes more important than "who I am." As a psychotherapist charged with helping people find their true selves, I can tell you this is a very troubling psychological stance--the antithesis of healthy body esteem, in which the goal is to stay connected to what we know as a guide for healthy development.

As teachers across the country try to guide students to find their voice, to write from their hearts, and to think independently, our culture's focus on external appearance provides a counterattack. Mary Pipher's eloquent book Reviving Ophelia caused an intense response in 1994 when she wrote about the ways in which girls today are taught to discount, dissociate, and detach from who they are inside. Her book is just as relevant a decade later. Noted psychologist and eating-disorder treatment specialist Catherine Steiner-Adair, Ed.D., writes:


Adolescent girls experience a split between the "me" who presents to the world her best guess of what will be favorably received, and the "real me" who often does not fit the cultural definition of acceptability. Children begin earlier and earlier to expend a lot of effort trying to guess what that externally defined "right" way to look, think, or feel is, and to hide what is often their true selves both from themselves and from others. Self-worth is laid at the mercy of the latest fad and the judgment of the crowd, based on the most superficial of qualities over which we have remarkably little control.


3. Poor nutrition and spiraling fatness
Negative body image is the number one risk factor for many of the nutrient-deficient, counterproductive, unhealthy, and disordered eating habits that are now routine for many Americans. Instead of being guided by knowledge of good nutrition and natural hunger, eating or not eating is used either to achieve a particular body size or to console ourselves when we fail. While "normal dieting" does not qualify as an eating disorder, eating habits that disregard the primary purpose of eating for nutritional sustenance and satisfaction of hunger are a type of Russian roulette with Mother Nature, jeopardizing the work of the internal weight regulatory system. As a result, many if not most Americans swing from restrictive eating one day to overloads the next, no longer in touch with what it means to eat normally, and often adding pounds along the way.



4. Eating disorders
Last, body-image concerns can lead to life-threatening, developmentally disruptive, energy-draining, and difficult-to-treat eating disorders such as anorexia nervosa and bulimia. As noted in the introduction, eating disorders are complex illnesses that are beyond the scope of this book. If you are interested in learning more about these serious, end-stage body-image problems, see appendix D for a list of recommended books on the subject.


But . . . Don't We Need to Beware of Fatness?

This important question is best answered by a different one: Given the fear of fatness and push for a slim physique that has become a frenzy in the past forty years--with dieting for weight loss now a normal eating style and exercise to burn calories and create "buns of steel" now the rage--have we achieved our goal? Has our fat phobia kept us thin? The statistics to the contrary are mind boggling. Even when adjusted for changing standards, the number of Americans considered overweight has risen from somewhere around 14 percent in the 1960s to over 50 percent today. Obviously something is wrong with our approach. Children grow up today in a culture that holds slimness, especially in women, to be an essential criteria for desirability (ensuring body-image problems), while on the other hand, we grow fatter by the decade (ensuring health-related concerns).

Most of the general public today still embraces dieting, even for teens and children, as a method of weight control, not aware that both research and overwhelming clinical evidence have demonstrated it is counterproductive. Even many physicians have remained uninformed or, in some cases, have discounted the evidence against dieting for weight control. For example, a major study involving nearly 15,000 boys and girls, ages nine through fourteen, reported in the October 2003 Pediatrics that dieting for weight loss, even with moderate food restriction, is not only ineffective, but frequently results in weight gain. Dieters were significantly more likely than nondieters to report excessive or binge eating following or between diets. During three years of follow-up, dieters in the study gained more weight than nondieters. The more often dieting occurred, the more weight was gained. Despite this scientific cautionary tale, efforts to control weight by cutting calories, or strictly limiting an entire food group, seem more a way of life than ever before. The number of diet books purchased in 2003 far surpassed any prior year in history, and as 2004 rolled in we witnessed a virtual explosion of retailers and restaurants hoping to cash in on the latest low-carb weight-loss mania.

Is this the confusing legacy we want to leave our kids? I don't want my children to suffer the effects of an unhealthy body image or an unhealthy body weight. I do not believe in the inevitability of girls' growing up to feel bad about how they look and learning to diet as a rite of passage. You don't either, and that's why you're reading this book. Have you heard the alarm yet? The question is not whether to act to prevent body-image and eating concerns, it is how to proceed.