February 26, 2020

One Step Closer to Self-Acceptance

National Eating Disorder Awareness Week (#NEDAwareness) is from February 24th to March 1st, and this year's theme is Come as You Are: Hindsight is 20/20. This theme encourages those with eating disorders to reflect on the positive steps they have taken— including those stemming from setbacks or challenges—toward accepting themselves and others.  I have written many blogs on eating disorders and body image problems.  These blogs are usually pretty gloomy. For a change and in keeping with this year's theme, I'm going to focus on a positive movement.

Body image encompasses your thoughts, perceptions, and attitudes about your physical appearance. The question I ask in clinic: How do you feel when you look in the mirror?  Sometimes a teen looks at me awkwardly and says, "I'm fine." But sometimes the patient says, "I hate my thighs and abdomen," or "My friends are so much skinnier than I am," or "I wish I had more muscle," or even "Nobody likes me since I'm not attractive." There are many things that contribute to one's development of body image, including messages from media, family, and peers. Some teens (and adults for that matter) feel like their whole self-worth is tied to their appearance.

Body positivity (or body satisfaction) involves feeling comfortable and confident in your body, accepting your natural body shape and size, and recognizing that physical appearance says very little about one's character and value as a person. People who experience high levels of body dissatisfaction (negative body image) often feel that their bodies are flawed in comparison to others, and these people are more likely to suffer from feelings of depression, isolation, low self-esteem, and eating disorders. While there is no single cause of eating disorders, research indicates that body dissatisfaction is the best-known contributor to the development of anorexia nervosa and bulimia nervosa. By age 6 years, girls especially start to express concerns about their own weight or shape. Of American elementary school girls who read magazines, 69% say that the pictures influence their concept of the ideal body shape. 47% say the pictures make them want to lose weight.

Like I promised, here's the positive: Health at Every Size is a movement with people of all sizes in finding compassionate ways to take care of themselves. It's based on the book Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD. It promotes weight-inclusivity. Components include:

  • Respect

    • Celebrates body diversity

    • Honors differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes

  • Critical Awareness

    • Challenges scientific and cultural assumptions

    • Values body knowledge and lived experiences

  • Compassionate Self-care

    • Finding the joy in moving one's body and being physically active

    • Eating in a flexible and attuned manner that values pleasure and honors internal cues of hunger, satiety, and appetite, while respecting the social conditions that frame eating options

What can we do to help move society towards body positivity?

  • As individuals: Model healthy behaviors for children. Watch your own comments about weight, appearance. Do not talk about diet, needing to lose weight, etc. Kids are listening, and your comments are contributing to how they view their own bodies. Do not label foods as good or bad — instead discuss moderation. Model physical activity as a way to move your body for enjoyment, not to lose weight. Also teach your kids to be critical of images portrayed in media.

  • As a culture: Companies need to stop showing photoshopped models in ads to promote unattainable standards of beauty. As Taylor Swift said in the new documentary : "There's always some standard of beauty you just aren't meeting." Companies and media needs to show diverse group of people in regards to age, shape, size, color.

  • As a member of the medical community: The medical community has some work to do. We need to recognize that weight/BMI is a data point, and often not the most important data point to assess overall health. With the "obesity epidemic," so much emphasis is placed on the number on the scale. Some people's healthy weight is at a higher BMI (and they have medical complications when at a lower body weight, a weight which may be considered "health" according to charts). We should put the emphasis on healthy behaviors, like eating regular meals, decreasing sedentary behavior, getting appropriate amount of exercise (I say appropriate since people can exercise too much as well) and sleep. There are plenty of people who engage in many unhealthy behaviors to be at what may be considered a healthy weight, when their overall health would actually be better at a higher weight.

Accept yourself. Accept your body.

Here are some warning signs for eating disorders: changes in weight, avoiding social situations where food is involved, making excuses to avoid meal times, preoccupied about weight/food/kcal, having food rules or rituals, physical signs (hair loss, loss of periods, always cold, dizzy).  If you are concerned that you or someone you know has an eating disorder, please talk to your health care provider.