Download Dr. Michael Pertschuk, Brandywine Hospital Body image—how we

Reprinted
August 2016
Dr. Michael Pertschuk, Brandywine Hospital
B
ody image—how we see our physical selves and how we
judge what we see—is not always an accurate picture of
reality. Our perceptions are colored by what others tell us,
by experience, by comparisons with those around us and the images
society promotes as ideals.
Body image develops over time and adapts to change, but
slowly. People who’ve lost or gained a lot of weight are notorious
for misperceiving their bodies, because change in perceptions lags
behind actual physical change. We all experience a similar feeling
with aging, as we tend to see ourselves as younger than we actually are. A classic example is being shocked at how old everyone else
looks at a class reunion.
In the U.S. today, as many as 7 million women and 1 million
men battle eating disorders including anorexia nervosa, bulimia
nervosa and binge eating, according to the National Eating Disorders Association—that’s over 2 in 100 people. With these potentially life-threatening conditions, patients experience a wildly inaccurate self-perception.
How is it possible for someone who otherwise
seems in touch with reality to so badly misperceive her (or his) body? How can a 17-year-old
Michael Pertschuk, M.D., is a member of the Medical
Staff and Medical Director of the Eating Disorders
Unit at Brandywine Hospital. He has 20+ years of
experience managing inpatient, residential and partial hospital eating
disorders treatment programs. He’s authored numerous research articles
and appeared on the Dr. Oz Show, Oprah and GMA.
girl of average height see her 65-pound body as “obese”? These
remain challenging questions with only partial answers.
ROLE OF MASS MEDIA
There’s more to eating disorders than body image problems. Matters as diverse as trauma and family patterns of eating meals also
contribute. And although eating disorders existed centuries before
the influence of mass media, there’s a strong sense that contemporary media—along with peer pressure and family attitudes toward
weight—play a significant role in developing body image.
A striking piece of evidence of mass media’s impact is the increase
in eating disorders following a shift in images of beauty from fullfigured females to stick figures in the 1960s, as personified by the
model Twiggy. At 112 pounds and about 5 feet 8 inches, Twiggy was
described as “boyish” and presented a new look from other models.
Unfortunately this unnatural and unhealthy look has become
even more extreme. In fact, by current modeling standards, Twiggy
would be considered a bit on the heavy side. According to Models.
com, a desirable weight for a 5-foot-8-inch fashion model today
would be about 90 pounds!
In the 1970s, there was a sudden and marked increase in identified cases of eating disorders. Before then anorexia nervosa was an
obscure disorder the average physician never encountered. But by
the 1980s, there were enough recognized cases of the disease for
treatment centers to open up around the country.
And a whole new eating disorder diagnosis was officially recognized in psychiatry—bulimia nervosa—defined by weight preoccupation and a pattern of binge eating and compensating behavior,
most often purging. It’s hard to imagine
that the surge of eating disorder cases and
the change in beauty standards were entirely
coincidental.
THE LOSE-LOSE OF
THE “IDEAL” IMAGE
Girls (and boys) in our society are bombarded with images of “ideal” bodies—
on TV, online, on our phones, in magazines and elsewhere. There’s a real concern
that pre-teens and teenagers exposed to
these images will buy into these “ideals.”
Unfortunately, if they do, it’s a lose-lose
situation.
If they achieve an anorectic weight, they
also get all the health and emotional consequences of malnutrition that go with it. If
they “fail” to achieve their ideal body, their
self-esteem suffers, and they consider themselves “unattractive” or “fat” because they
don’t look like fashion models.
Although there’s been ongoing concern
about the unhealthy thinness of models, the
fashion industry has been strikingly unsuccessful in changing its practices. However,
outside the U.S., in France in 2015 and
Israel in 2013, laws were passed attempting
to eliminate images of unhealthy thinness
from the media.
Israel set a minimum Body Mass Index
(BMI), for models, and if a model drops
below that mark, she can’t work. For
example, with a BMI of 18.5, a 5-foot-
8-inch model has to weigh at least 122
pounds. The law also requires a model to
obtain a certificate of health before a photo
shoot and that photographic images that
are altered (for example, using Photoshop)
must be labeled as manipulated.
We must all remember there’s nothing
preordained about having super-thin
models represent ideals of feminine beauty,
but there is a serious chance that a shift away
could save much grief and some lives.
WHAT PARENTS CAN DO
Parents have a significant impact on
their teens’ eating habits and body image.
Most teens learn more from good examples
than parental lectures, so follow healthy
eating habits, share family meals, promote
physical activity, use positive language—
not fat/thin but healthy/unhealthy—and
praise achievement not just looks. Counter
negative messages that bombard teens from
the media and monitor their online and
social media use. And talk with your teens
both as a family and as a team with your
family doctor.
TREATMENT OPTIONS
There’s a wide range of treatment options
available—from weekly counseling to acute
hospital care—to help teens and adults
get back on track with their lives. What’s
needed depends on the extent and severity
of symptoms, related health issues and
availability of family support, among other
issues. Initial assessment by an eating disorder specialist can help provide direction
on choices and options.
The good news is that following through
with treatment leads to improvement in
most cases. ♦
KNOW THE SYMPTOMS
T
ypical symptoms and behaviors
that may indicate body image
issues include:
• Dieting or overeating to excess
• Eating only certain types and
amounts of food
• Avoiding social situations that
include food
• “Playing” with food, but not eating it
• Visiting the bathroom immediately
after eating
• Wearing loose clothing to hide
weight loss
• Exercising compulsively
• Obsessing over weight and
weighing oneself compulsively
• Thinking and talking obsessively
about body image and weight
• Withdrawing from family and
friends
• Being hypersensitive to comments
about food, exercise, weight or
body appearance
• Feeling depressed or having great
anxiety or low self-esteem