Body image includes:
- How we perceive our bodies visually
- How we feel about our physical appearance; how we think and talk to ourselves about our bodies
- Our sense of how other people view our bodies
- Our sense of our bodies in physical space (kinesthetic perception)
- Our level of connectedness to our bodies
Body image is a widespread preoccupation. In one study of college students, 74.4% of the normal-weight women stated that they thought about their weight or appearance “all the time” or “frequently.” But the women weren’t alone; the study also found that 46% of the normal-weight men surveyed responded the same way.
Encouragement to focus on appearance is at an all-time high in this culture, and with it comes the potential for a significant increase in negative body image. According to the authors of The Adonis Complex, “There’s often a vicious circle here: the more a person focuses on his body, the worse he tends to feel about how he looks – obsession breeds discontent.”
Poor body image increases the risk for extreme weight/body control behaviors. Researchers have found that increased preoccupation with appearance and body dissatisfaction put people at greater risk for engaging in dangerous practices to control weight and size. Extreme dieting, exercise compulsion, laxative abuse, vomiting, smoking and use of anabolic steroids have all been associated with negative body image.
Body image, whether negative or positive, is shaped by a variety of factors:
- Comments from family, friends and others about our, their, and other people’s bodies, both positive and negative
- Ideals that we develop about physical appearance
- The frequency with which we compare ourselves to others
- Exposure to images of idealized versus normal bodies
- The experience of physical activity
- The experience of abuse, including sexual, physical, and emotional abuse
- The experience of prejudice and discrimination based on race, ethnicity, religion, ability, sexual orientation or gender identity
- Sensory experiences, including pleasure, pain and illness
Many of these factors are controllable; some of them are not. Having a healthy body image involves understanding the controllable factors and taking steps to preserve this aspect of mental health. Go to What Can We Do to Boost Body Image below, for specific suggestions.
Positive and Negative Body Image
We have a positive body image when we have a realistic perception of our bodies AND we enjoy them just as they are. Positive body image involves understanding that healthy attractive bodies come in many shapes and sizes, and that physical appearance says very little about our character or value as a person. Healthy body image means that our assessment of our bodies is kept separate from our sense of self-esteem, and it ensures that we don’t spend an unreasonable amount of time worrying about food, weight and calories.
Negative body image can involve a distorted perception of size or shape, as well as more global feelings of shame, awkwardness, and anxiety about the body. People with negative body image tend to feel that their size or shape is a sign of personal failure, and that it is a very important indicator of worth. Poor body image has been linked to diminished mental performance, low self-esteem, anxiety, depression, sexual dysfunction, dieting and eating disorders.
Body Dysmorphic Disorder (BDD) is a particularly intense form of negative body image. People with BDD are so obsessed with perceived flaws in their appearance that it affects relationships with family and friends, as well as creating problems with work or school. BDD can result in anxiety, depression, and even thoughts about suicide. Fortunately, BDD is very treatable with a combination of medication and therapy. According to the BDD Treatment Program at Rhode Island Hospital, “People who get treatment become less preoccupied with their appearance, feel better emotionally, and function better in their wider lives.”
Current Physical Ideals
Joan Brumberg, author of The Body Project, notes that the female ideal, and the pressure to achieve it, have become unrelenting. Not only are women encouraged to be thin, they are presented with a physical ideal that is diametrically opposed to the softness and curves more natural to the female body. The flip side of this experience is an ideal based upon exaggeration of male physiology. The authors of The Adonis Complex, state that hyper-muscularity has become increasingly important to men as a symbol of masculinity.
These ideals are not only biologically unattainable for most people, but downright dangerous. Just take a look at Barbie and GI Joe Extreme. If Barbie were life-sized, she’d be at 76% of a healthy body weight – a weight consistent with acute hospitalization. And GI Joe would have biceps almost as big as his waist, and bigger than most competitive body-builders!
Very few women possess the genetics to naturally produce the ultra-long, thin body type so widely promoted, and when they do, it isn’t usually accompanied by large breasts. Moreover, there are limits to how little body fat a woman can possess and still have normal hormonal functioning. Below a certain level of body fat and dietary fat, a woman’s body cannot produce the estrogen needed for ovulation and menstruation. A woman also develops a higher risk of stress fractures because normal bone breakdown is accelerated in the absence of estrogen, and osteoporosis becomes more likely. (Click here to learn more about amenorrhea.)
The same thing goes for 6-pack abs and the “ripped” look being promoted to men; the ability to have very defined abdominal muscles is genetically endowed, and the hyper-muscled physique of action figures and male fitness models is impossible to achieve without illegal anabolic steroids. UCLA’s Student Nutrition Action Committee (SNAC) webpage on Body Image and Eating Disorders puts it very succinctly:
“It’s physiologically impossible to gain unlimited pounds of pure, bulging muscle mass while maintaining an ultra-lean, ripped body – even when following the “perfect” training and diet program. Once you reach your maximal muscle mass, any further gains will come from both muscle AND fat. So, men who have greater muscle mass/size tend to have higher body fat percentages as well.”
Every day, however, we are told that these unattainable bodies are normal, desirable, and achievable. We compare ourselves to these ideals and feel displeased with our bodies for being so different, and when we fail to make ourselves over in the image of these ideals, we feel even worse because we can’t seem to succeed at something so supposedly straightforward. (For further discussion of the realities of weight and health, check out our page on weight concerns.)
Studies at Stanford University and the University of Massachusetts found that 70% of college women say they feel worse about their own looks after reading women’s magazines. And a 2006 study published in the journal of Psychology of Men and Masculinity showed that not only did watching prime-time television and music videos appear to make men more uncomfortable with themselves, but that the discomfort led to sexual problems and risky behaviors. “People see the same images over and over and start to believe it’s a version of reality,” says Deborah Schooler, one of the researchers. “If those bodies are real and that’s possible, but you can’t attain it, how can you not feel bad about your own body?”
The media is a powerful conduit for transmission and reinforcement of cultural beliefs and values, and while it may not be exclusively responsible for determining the standards for physical attractiveness, it makes escaping frequent exposure to these images and attitudes almost impossible. Advertising, in particular, creates a seductive and toxic mix of messages for men and women. Jean Kilbourne, creator of the award-winning documentary Killing Us Softly, and author of Can’t Buy My Love: How Advertising Changes The Way We Think and Feel, says the impact on eating problems and body image may not be absolute, but it is real:
“…these images certainly contribute to the body-hatred…and to some of the resulting eating problems, which range from bulimia to compulsive overeating, to simply being obsessed with controlling one’s appetite. Advertising does promote abusive and abnormal attitudes about eating, drinking, and thinness. It thus provides fertile soil for these obsessions to take root in and creates a climate of denial in which these diseases flourish.”
Intolerance of body diversity has a lot to do with the meaning of size and shape in our culture. Being thin and/or muscular has become associated with being “hard-working, successful, popular, beautiful, strong, and self-disciplined.” Being “fat” is associated with being “lazy, ignorant, hated, ugly, weak, and lacking in will-power.” As a result, “fat” isn’t a description like tall or redhead – it’s an indication of moral character: fat is bad. Size prejudice is absorbed at a very young age; children as young as five have ascribed negative characteristics to silhouettes of fatter children. In part, this is because size prejudice is also widely reinforced; media, friends, family, and even well-respected health professionals can echo the message that fatness is inherently wrong and dangerous, thereby exacerbating the pressure to control our bodies.
Family, Friends, and Lovers
If we grew up surrounded by people who spent a lot of time focused on their bodies (or ours), or who worried a lot about eating and exercise, chances are that we do, too. We learn from other people about the things that are considered important, and if appearance is considered critical, we’re going to feel that spending lots of time and energy on image is the right thing to do.
Sometimes the pressure from family isn’t about thinness as an aesthetic ideal. Sometimes it’s about the struggle to become integrated into a culture from another racial, ethnic, or religious background. Becky Thompson, in her book A Hunger So Wide and So Deep, says, “The culture of thinness in models has been used, erroneously, to dismiss the eating problems among women of color based on the notion that they are not interested in, or affected by a culture that demands thinness.” Research indicates that for African-American, Asian-American, and Latina women, increased assimilation into the “white culture” results in higher levels of body dissatisfaction. Anecdotal evidence suggests that the same may be true for men who come to accept being body-focused as the price of succeeding in American society.
Peers and friends strengthen the development of body image through what researchers call “appearance training.” Conversations about clothes, looks, and attractiveness provide a context for paying attention to and interpreting appearance-related information. Friendships are particularly important in body image development because of the sheer amount of time involved, the value placed on friendships, and the ways in which friends create shared norms and expectations about appearance.
And when the group “vibe” about body image trends towards the negative, it’s difficult not to get dragged down. People report widely that their dining halls, bathrooms, locker-rooms and dorm rooms are filled with “bad body talk”: “I’ve got to get rid of this gut.” “Ugh, I hate the cellulite on my thighs.” “I feel fat.” Listening to so many of these conversations tends to reinforce the need to focus on appearance and make comparisons between ours and other’s bodies. It also increases the likelihood that we will find our appearance lacking.
Then there’s the issue of romance. Media messages, particularly those from advertising, strongly emphasize the role of appearance in romantic success. “Getting” the guy or the girl is reduced to possessing a stereotypical set of physical attributes, with no appreciation for personality, background, values, or beliefs. But studies suggest that people’s perceptions may not accurately reflect the body type preferred by a potential partner. Among heterosexuals, research using silhouettes of the opposite sex revealed a large gap between the perception and reality of attractiveness for both men and women. The body ideal that men THOUGHT women preferred was actually 15-20 lbs. more muscular than the one female respondants actually preferred. And the female silhouette that most men idealized was significantly bigger than the one the women expected them to prefer.
Research studies on body image issues in LGBTQ populations reflect the diversity and complexity of this community:
- One study of 263 lesbian women found that although they were generally more critical of social norms concerning the roles of women, they were not so critical of expectations about women’s weight and appearance. 48% of the participants had dieted in the past 3 months, almost half were dissatisfied with their weight, and low self-esteem was strongly linked to body dissatisfaction.
- One study found that gay men diet more, are more fearful of becoming fat, and are more dissatisfied with their bodies in general as well as with their degree of muscularity than heterosexual men. Gay men were also more likely than heterosexual men to hold distorted cognitions about the importance of having an ideal physique. (It is important to note, however, that body image experts like Dr. Roberto Olivardia, co-author of The Adonis Complex, feel that gay men, because they have already confronted perceptions of not being masculine, may simply be more be more likely than heterosexual men to acknowledge and get support around struggles with body dissatisfaction.)
- Researchers speculate that transgendered individuals may be particularly at risk for body dissatisfaction and eating disorders, due to issues around estrangement from the body, dealing with biological gender, and managing the physiological aspects of surgery and hormone shots.
Medical Standards and Medical Professionals
Unfortunately, the healthcare setting is another place where we can struggle to maintain a positive relationship with our bodies. In 1998, the National Heart, Lung and Blood Institute released their Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Body Mass Index was promoted as an important factor in the new system for formally classifying weight status, and since then primary care providers have been widely encouraged to apply these classifications in their routine evaluations of patients. Some insurance companies are even providing fiscal incentives to clinicians for every BMI calculated. Aggressive approaches to the obesity “epidemic” are being heavily marketed to clinicians by insurers, pharmaceutical companies, the weight loss industry and some researchers, so it isn’t surprising that both patients and providers are feeling the pressure to focus on weight.
This is particularly unfortunate, because there is a growing body of research which suggests that it may be more helpful to encourage people to focus on changes in eating and activity without reference to weight or size. Canada’s public health campaign VITALITY encourages Canadians to enjoy eating, being active and feeling good about themselves, rather than focusing on weight reduction and ideal body shapes.
A similar approach was piloted as part of a California study. The study compared changes in weight, labwork, eating behavior, eating attitudes, and psychology (self-esteem, depression, body image) between two groups of women receiving 6 months of weekly group education. The first group received behavior-based weight loss education which included nutrition information, moderate calorie and fat restriction, keeping a food diary, and monitoring weight. The second group used a Health At Every Size (HAES) approach which focused on body acceptance, decreasing restrictive eating, increasing attendance to internal cues for hunger and satiety, nutrition information, and addressing barriers to enjoyable physical activity.
The results were pretty striking. At the two-year follow-up point, the HAES group showed sustained and significant improvements in total cholesterol, LDL, blood pressure, moderate physical activity, restricted eating, susceptibility to hunger, body dissatisfaction, and self-esteem. The diet group did not sustain positive changes in any of these areas, and in fact, self-esteem was shown to be significantly worse at the two-year follow-up point. Fifty-three per cent of the diet participants expressed feelings of failure, compared with 0% of the HAES group.
It’s important to remember, too, that medical providers are not protected from the influence of the wider culture by virtue of their training or education. They are inundated with the same images, messages, and societal pressures, which can and do travel with them into patient-care interactions, further influenced by medical provider’s feelings about their own relationship with size, shape, food, and exercise. So if we experience weight prejudice in a medical setting, it’s important to remember that there are very powerful forces at work, and that we have a right to receive respectful and supportive medical care – not the least of which is balanced, accurate information about the relationship between weight and health.
There are many triggers for body preoccupation and negative body image in our daily lives, one of the most compelling being that few of us can ever comfortably achieve and maintain the type of body promoted as ideal. Beyond this, however, we can be struck by feelings of body dissatisfaction that don’t seem to have any objective basis in our bodies. We can have vague, negative feelings of dissatisfaction that persist whether our bodies change significantly or not, and we can suddenly be struck by a negative feeling even if we started the day relatively comfortable with our body image. If our stomach or our thighs couldn’t possibly have changed drastically since we woke up, what’s going on?
Focusing on our bodies – even in a negative way, can provide a distraction from other struggles in our lives that seem too overwhelming to deal with. Difficult feelings that we don’t know how to handle and difficult problems for which there are no simple solutions, for example, are uncomfortable things to sit with. So we may unconsciously shift our focus to fixing our bodies. After all, we are told every day that complicated and painful aspects of living CAN be resolved by changing our size and shape. Moreover, we are told that the process of changing our bodies is straightforward and unambiguous: eat less and exercise more. That the solution is a band-aid, the process inherently damaging, and the “successful” outcome far from assured, isn’t so compelling in the moment. What is compelling in the moment is the desire for a simple, concrete answer to our distress, something that we feel like we can understand and control.
But here’s the thing: every time we displace distress onto our bodies and then try to “fix” them, we not only enter into a process that has the potential to significantly disrupt our relationship with eating, activity, and body image; we also shut down any possibility of getting real perspective, mastery and peace in our wider lives. Taking a minute to second-guess “I feel fat thoughts,” may help us to feel better about our bodies and make changes in our lives that will be truly transformational.
- Talk back to the media. All media and messages are constructs – NOT reflections of reality. We can choose to use a filter that helps us to understand what an advertiser wants us to believe and then choose whether we want to believe that message. We can also talk back when we see an ad or hear a message that makes us feel bad about ourselves.
- De-emphasize numbers. Neither weight nor Body Mass Index tell us anything substantial about body composition and health. Eating habits, activity patterns, and other self-care choices are much more important. For a more complete discussion of healthy weight, see our page on Weight Concerns.
- Stay off of the scale. It’s really hard to cultivate an attitude of body acceptance and trust when you are basically climbing on the scale to ask if it’s OK to feel good about yourself that day. It is ALWAYS OK to feel good about yourself – don’t let a machine tell you any differently.
- Realize that you cannot change your body type : lightly muscled, bulky, or rounded, you need to appreciate your body and work with your genetic inheritance. As UCLA SNAC says, “Instead of thinking of it as a limit, think of it as your personal best.”
- Stop comparing yourself to others. Your physiology is unique to you; you can’t get a sense of your body’s needs and abilities with someone else’s body as a reference point. And the research has shown that frequent comparing tends to increase negative body image.
- Limit the “body checking” that you do throughout the day. Researchers have also found that negative body image is reinforced by lots of time in front of the mirror, or frequent checks of (perceived) body flaws. Instead, consider rearranging your living space so that you aren’t running into full-length mirrors every time you turn around.
- Move and enjoy your body – not because you have to, but because it makes you feel strong, energized, and peaceful. Walking, swimming, biking, dancing, Ultimate Frisbee – there are many activities that emphasize pleasure rather than controlling your body.
- Spend time with people who have a healthy relationship with food, activity, and their bodies . It will make a difference in how you feel about these issues – and yourself. Also, remember to set a good example for others by refraining from “fat talk” when you are with friends and family. Think of it as the psychic equivalent of second-hand smoke: you don’t want other people exposed to that, right?
- Practice thought -stopping when it comes to negative statements about yourself. Distract yourself, refuse to get into the comments, and focus on what you like about yourself instead. You CAN reprogram your self-talk about your body, and positive statements are needed to replace the old messages. This approach works over time, even if the positive self-talk feels awkward or forced in the beginning.
- Nurture your inner self . Body image is linked to self-esteem for men and women both, so engaging in pastimes that leave you feeling good can actually help you to feel comfortable in your own skin. Particularly helpful are activities that are relaxing, soothing, spiritual, or that allow us to connect to others. Remember: when we don’t have ways to manage stress or anxiety, we are more susceptible to being critical of our bodies.
- Question the degree to which your self -esteem depends on your appearance. Although we are repeatedly told “Change Your Shape and Change Your Life,” basing your happiness on this foundation is likely to lead to failure and frustration, and may prevent you from exploring ways to truly enhance your life.
- Broaden your perspective about health and beauty. Read books about body image, cultural pressures, or media literacy. Google some fine art images on the Web. Fine art collections show that a variety of bodies have been celebrated throughout the ages and in different cultures. Fine art doesn’t exist to create a need for a product, so it isn’t intended to leave you feeling inadequate or anxious. And spend some time with the new research on weight and health listed in our resources section – you’ll be pleasantly illuminated.
- Recognize that size prejudice is a form of discrimination similar to other forms of discrimination. Assumptions that shape and size are indicators of character, morality, intelligence, or success are incorrect and unjust. Celebrate people you know who fly in the face of these generalizations.
Health Education 401.863-2794
Located on the third floor of Health Services.
Confidential information or care is available through individual appointments with a Nutritionist to discuss the many types of eating concerns you may have regarding yourself, a friend, roommate or teammate. Health Education also offers workshops, pamphlets, and reading materials covering these and related issues. Health Education services are free as part of your Health Services fee.
University Health Services 401.863-3953
Located at 13 Brown Street across from Keeney Quad.
Confidential information and care is available for initial, current or past disordered eating patients.
Psychological Services 401.863-3476
Located on the fifth floor of J. Walter Wilson.
Confidential appointments are available at Psychological Services for students concerned about their eating issues. Guidance is also available for those who are concerned about a friend, roommate, or teammate's eating. Services include crisis intervention, short-term psychotherapy and referrals. Appointments at Psychological Services are free as part of your Health Services fee.
Rhode Island Hospital
The Body Image program at Rhode Island Hospital in Providence is one of the few specialty programs in the country for Body Dysmorphic Disorder. It’s directed by Katharine A. Phillips, MD, Professor of Psychiatry and Human Behavior at Rhode Island Hospital and The Warren Alpert Medical School of Brown University. The website offers an overview of BDD, current treatment options, and other resources for individuals dealing with this condition. Call 401.444-1644 for more information or to participate in a study.
The University of California, Los Angeles has done a great overview of this topic and we are indebted to them, in particular, for content in the section “Why are so many people unhappy with their bodies?”
Body Positive: Boosting Body Image at Any Weight. This is a great website for people wanting tools, articles, and resources for living well in the body they have right now.
Body Image and Your Health
There is some good, brief information for women on body image, with a useful link on the risks of cosmetic surgery. It should be noted that the federal government is not immune to mixed messages around weight and health, and that some of the links to Healthy Eating and Staying Active, may actually reflect a traditional agenda for weight control.
National Eating Disorders Association
Links to research, resources, conferences, and advocacy opportunities, it’s one of the best sources of information on body image and eating disorders. NEDA heads up and promotes National Eating Disorder Awareness Week.
Health At Every Size (HAES)
HAES is a paradigm that says you don’t have to change your weight or size in order to improve your health. It isn’t a health promotion model that we hear much about, but it’s an approach that has been shown to have tremendous psychological and physiological benefits – without the pitfalls associated with traditional weight-focused interventions.
Click here to read about a study that compared HAES with a weight-centered program.
Jon Robison, PhD, is a health educator and HAES specialist who has written some great articles about this new paradigm.
Karin Kratina, PhD, RD, is a nutritionist who has been at the forefront of HAES since the beginning. Her website is a wonderful resource for people interested in research resources and the daily practice of HAES.
* Anderson, A., Cohn, L., & Holbrook, T. (2000). Making weight: Men’s conflicts with food, weight, shape & appearance. Carlsbad: Gurze Books.
Brumberg, J.J. (1997). The body project: An intimate history of American girls. New York: Random House.
Campos , P. (2004). The diet myth: Why America’s obsession with weight is hazardous to your health. New York: Penguin.
* Cash, T. (1997). The body image workbook: An 8-step program for learning to like your looks. Oakland: New Harbinger Publications.
* Hutchinson , M.G. (1985). Transforming Body Image. Freedom: Crossing Press.
Kilbourne, J. (1999). Can’t buy my love: How advertising changes the way we think and feel. New York: Touchstone Books.
* Pope, H.G., Phillips, K.A., & Olivardia, R. (2002). The Adonis complex: The secret crisis of male body image. New York: Touchstone Books.
* Thompson, B.W. (1994). A hunger so wide and so deep: American women speak out on eating problems. Minneapolis: University of Minnesota Press.
These books can be borrowed from the Health Education Library, located on the 3rd Floor of Health Services.
Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.