Body Image and Eating Disorders

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Editors: Brenda Wilmoth Lerner and K. Lee Lerner
Date: 2016
Worldmark Global Health and Medicine Issues
Publisher: Gale, a Cengage Company
Document Type: Topic overview
Pages: 7
Content Level: (Level 5)
Lexile Measure: 1340L

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Body Image and Eating Disorders

Introduction

Body image is the way a person perceives how his or her own body looks. It may or may not be an accurate perception, and it can affect and change the way one feels about one's body and the way the person behaves. Body image discussions are increasingly frequent in the health profession, social sciences, and feminist theory, as well as around the role of ethical advertising.

Positive body image builds self-worth, promotes physical health, and protects the person from developing eating disorders, whereas a negative body image can cause a person to suffer from low self-esteem, and can affect social, mental, and physical health. In addition to leading to the development of eating disorders, a poor body image can contribute to depression, anxiety, problems in relationships, and the development of substance use disorders. Consequently, this can cause various health problems. People can be internally influenced by their family, friends, teachers, and the media to feel negatively about the way their bodies look, and this feeling can be exacerbated if they receive negative feedback from individuals that they hold in high esteem. It is important that role models such as parents promote positive and realistic beauty ideals.

How you see your own body is called your “perceptual body image,” whereas how you feel about that perception is called your “affective body image.” How people feel about their own bodies can change their way of thinking about themselves as a whole, in a positive or a negative way, and influence behaviors. If an individual thinks that he or she is overweight, regardless of the factual accuracy, that person might choose to change eating habits or dress differently to fit what feels appropriate. The ways that perceptual body image and affective body image make people think about their bodies is called cognitive body image. The changes in actions that people would not otherwise make were it not for feelings about their body are called behavioral body image.

The media can be a constant source of external contribution to a negative body image because of its constant presence in 21st-century society. Television, movies, and the Internet are able to create images and edit them in a way that obscures the actual images. People's bodies are edited in ways that create “perfect” bodies that are unobtainable. People who feel they need to compare themselves to persons they see in media can experience deep psychological and physical harm. Since the mid-1960s, body consciousness has increased internationally, affecting people from every age group. This is concerning because it reflects a movement toward defining one's self-worth as dependent upon attaining an unattainable physical ideal.

Negative body issues can affect anyone, but certain factors can increase the likelihood that some individuals develop dissatisfied feelings about their bodies more than others. Having close relationships with people such as family and friends who express their own feelings of negativity about themselves can pass on the negativity to the people who consider them role models. Long-term body image is shaped most frequently during late childhood and adolescence, and the impressions that are developed early can persist long into adulthood. This is especially true for girls, and most prevalently teenage girls, although negative body image issues in boys is increasing rapidly to almost the same rate. If a person is bullied, has a larger body type, or has otherwise “perfectionist” standards, these factors all increase the likelihood of a person internalizing common beauty ideals and developing a negative body image.

A person who has a negative body image is more likely to diet, get plastic surgery, or develop eating disorders. There are ways to prevent and treat negative body image, including positive thinking, setting health-focused rather than weight-focused goals, and remembering that those persons featured by the media are the physical minority and may have been artificially enhanced or perfected using computer editing techniques.

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Historical Background

All societies in the world throughout history have prized physical appearance, but the standard for the ideal body is drastically different across cultures and changes constantly over time. Beauty includes weight but also ritual, and voluntary body modification such as body piercing or plastic surgery. The standards for women fluctuate frequently and are markedly more pervasive than those for men across every culture. This is not to say that standards for male beauty do not, or have not existed; however, society holds women to a more rigid standard more frequently for a variety of reasons.

The most drastic of changes has been the concentration the 21st century has put specifically on weight. In the 1500s, standards existed for women to be “pear-shaped,” with a large lower half emphasized by an enormous bell skirt and a tiny waist and flat chest, an almost complete opposite from that of the 21st century, in which the word Rubenesque is a polite but slightly derogatory term for a woman who is heavy or overweight. However, the term derives from the style of the painter Peter Paul Rubens (1577–1640), whose paintings often contained representations of large, voluptuous, and usually nude women who were the feminine ideal during his lifetime. Until the early 1900s, for a person to have extra weight on the body and look voluptuous was a sign of good health and wealth. The only people able to eat well and frequently, and refrain from performing physical labor, were the wealthy. In the 21st century the balance is inverted: healthful food is increasingly more expensive, and having the spare time and money for physical activity has become a luxury.

Twenty-first-century standards, particularly in Western countries, are focused primarily on thinness. The waif-like figure, which came to popularity most notably with the supermodel Twiggy (1949– ) in the United States during the 1970s, is particularly detrimental to the women who try to achieve this standard. This was the first time in history that a woman who was objectively underweight for her height became an ideal beauty standard. A person who is underweight has a body weight that is too low to be considered healthy, as determined by the body mass index, or BMI. Lifetime prevalence of eating disorders has been found to be consistently 1.75 to 3 times as high among women as men.

Many women struggle with the difference between how their bodies look as compared to these standards. Eating disorders, dieting, plastic surgery, and diet aids often are the “answer” chosen to try to modify their bodies to meet the standards of society's “ideal.” Dieting and weight-loss efforts are common and often unsuccessful ways to try to combat a negative body image when people feel they do not have the perfect body. Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating are extreme behaviors that are the result of people being unable to control the way they think, feel, and act as a result of their own negative body image. However much someone may try, the actions taken to create the perfect body when suffering from one of these disorders will never make a person feel better about his or her body image.

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BODY MASS INDEX

Body mass index (BMI) is a number calculated from a person's weight and height. In metric units the formula is: BMI = weight in kilograms / [height in meters]2. In the United States, or Imperial measurements, the formula is: BMI = weight in pounds / [height in inches]2 × 703.

According to the U.S. Centers for Disease Control and Prevention (CDC), BMI provides a dependable gauge of body fatness for most people and is used to screen for weight categories that may lead to health problems. It does not measure body fat directly, and is not a diagnostic tool but a good standardizing measure of comparison, especially between persons of the same age. According to the CDC, “for adults 20 years old and older, BMI is interpreted using standard weight status categories that are the same for all ages and for both men and women. For children and teens, on the other hand, the interpretation of BMI is both age- and sex-specific.” BMI calculation is inexpensive and easy to use for clinicians and for the general public, as it requires only height and weight. It also allows individuals to make a comparison between their own weight and that of the general population.

Once measurements have been added to the BMI equation, the number falls within a range between 18.5 and 40. Any number between 16 and 18.5 is considered underweight, and anything below 16 is considered severely underweight. People suffering from anorexia nervosa have a BMI under 18.5. A normal weight is considered between 18.5 and 24.9. Persons who are overweight have a number between 25 and 29.9, whereas any number higher than 30 classifies as obesity.

There are limitations to using BMI as an indicator of health. A person may have a high BMI and still be within a healthy range, and it especially overestimates body fat in athletes and other people who have a muscular build. Muscle is denser and weighs more than fat, so BMI is unreliable for persons with a large amount of muscle mass. Also, people lose muscle mass as they age, and BMI does not take this into account. Therefore it is possible that BMI underestimates how much body fat has replaced muscle mass in an older person. The CDC notes that more accurate assessments to pinpoint body fat percentage, and whether weight is detrimental, might include skinfold thickness measurements and evaluations of diet, physical activity, and family history, as well as other appropriate health screenings.

Not maintaining a body weight within the 18.5–24.9 normal range can cause detrimental health effects. People who are underweight can be at risk of bone loss and osteoporosis, as well as become anemic. Also, it is difficult for their bodies to heal from sickness and even minor cuts and scrapes. Women can miss months of menstruation at a time or stop completely. Finally, being severely underweight can cause heart palpitations, heart attack, and heart failure. People who are overweight are at risk of heart disease because excess plaque in the arteries builds up, reducing blood flow to the heart muscle. Being overweight or obese additionally can cause high blood pressure, stroke, and type 2 diabetes.

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After seeing pictures of herself, Lauren Brudenell became anorexic. She lost more than half her body weight, dropping from over 230 pounds (105 kilograms) to a life-threatening 84 pounds (38 kilograms). She later recovered and weighed a healthy 112 pounds (50 kilograms).

After seeing pictures of herself, Lauren Brudenell became anorexic. She lost more than half her body weight, dropping from over 230 pounds (105 kilograms) to a life-threatening 84 pounds (38 kilograms). She later recovered and weighed a healthy 112 pounds (50 kilograms).
© Worldwide Features/Barcroft Media/Getty Images

Impacts and Issues

People with positive body images feel comfortable within their skin and tend to think about their bodies as products of nature, but human bodies are also the product of culture. When one's body does not align with cultural ideals, a person might choose extreme behavioral measures to “correct” it. Body image disorders, bulimia in particular, increased dramatically in the latter half of the 20th century, and research suggests that it continues to be on the rise. There is evidence to suggest that advertising and media play the largest role in this increase. As with most things, the media does not affect everyone in the same way. Cross-cultural studies on body image suggest that consumers' gender, race, and age can affect how strongly they identify with the people in advertising.

Body Dysmorphic Disorder

People with body dysmorphic disorder (BDD) perceive their looks to be different than they actually are and can spend hours each day thinking about, and camouflaging, the perceived imperfections. People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything other than their bodies and can lead to low self-esteem, avoidance of social situations, and problems at work or school. BDD and the body image issues that accompany anorexia and bulimia usually occur together, but BDD can exist independently of weight concerns, instead causing the person to concentrate on things such as the length of the legs, or the shape of the hairline. BDD also is associated with obsessive compulsive disorder, social anxiety, and depression.

Anorexia

The most commonly known eating disorder is anorexia nervosa. People suffering from anorexia are obsessed with being thin and have a severely distorted body image that makes them believe they are fat, regardless of reality. In order to decrease their weight, they severely restrict their food intake and may exercise obsessively. In 1952, anorexia was the first eating disorder to be classified as an illness by the psychological community. However, physicians have been describing the disease for centuries as a “wasting disease,” which at the time was indistinguishable from other physiological conditions that caused extreme weight loss, such as endocrine disorders. In the 1970s, doctors starting seeing an obvious increase in Page 43  |  Top of Articlepatients diagnosed with anorexia, and in 1983 the singer Karen Carpenter (1950–1983) of the Carpenters died as a result of heart failure related to the disease. Her death brought the disorder into the public consciousness, and discussions around body image and anorexia became increasingly frequent.

Someone suffering from anorexia continues to lose weight even after what may be an healthy weight for body height and shape has been attained. The person continues to diet until his or her body weight is far below what is in an ideal range. This can lead to severe health complications that are common with starvation: the hair and nails become brittle, the skin dries out, menstrual periods cease in females, blood pressure lowers, and heart and brain function may be impacted. Death can result if the symptoms are not treated and the underlying causes of the anorexia are not addressed.

Bulimia

Another well-known eating disorder is bulimia nervosa. The symptoms of bulimia are closely related to those of anorexia; however, persons suffering from bulimia binge on food, causing themselves to overeat drastically. Sufferers then compensate by using laxatives, diuretics, or vomiting, also called purging. The disorder first was categorized in 1980 as bulimia, and then the name was modified to bulimia nervosa in 1987 so as to associate it more closely with anorexia. Like anorexia, bulimia has been known for centuries and in some cultures even promoted. In ancient Rome, wealthy patricians would go to a specially designated room called a “vomitorium” after gorging themselves on food to purge so that they could continue eating.

 
Anorexia Affects Your Whole Body An individual with a distorted body image can develop an eating disorder such as anorexia nervosa. Anorexics limit their food intake in order to lose weight. Excessive weight loss seen in anorexics affects the whole body and can cause permanent damage.

Anorexia Affects Your Whole Body An individual with a distorted body image can develop an eating disorder such as anorexia nervosa. Anorexics limit their food intake in order to lose weight. Excessive weight loss seen in anorexics affects the whole body and can cause permanent damage.
SOURCE: “Anorexia affects your whole body,” from Anorexia Nervosa Fact Sheet, Office on Women's Health, U.S. Department of Health and Human Services.

Page 44  |  Top of Article Binge Eating and Eating Disorders Not Otherwise Specified

There are a variety of other eating disorders, such as binge eating (without purging); pica, in which a person regularly consumes nonnutritional substances such as chalk or paper; and rumination disorder in which a person regurgitates food into the mouth to continue chewing it. However, these eating disorders are not related directly to the perception of one's own body image in the same way as anorexia nervosa and bulimia nervosa. According to the National Eating Disorders Association, what all these conditions have in common is “serious emotional and psychological suffering and/or serious problems in areas of work, school, or relationships.”

Body Modification

Anorexia nervosa and bulimia nervosa are two extreme ways that people try to modify their outward appearance, and both can have devastating effects on the sufferer's health. Body modification, practiced virtually all over the world, also is used to align one's own body image with a cultural ideal. Tanning, piercing, tattooing, and hair dying are relatively innocuous types of body modification popular in Western culture. However, examples of more extreme body modifications from around the world include body building in North America, neck elongation in Thailand and Africa, henna tattooing in Southeast Asia and the Middle East, lip and earlobe stretching in Africa, and foot binding in China. Some of these practices can be highly detrimental to the person's health.

Foot binding, a practice started during infancy on Chinese girls, was practiced up until the middle of the 20th century. After breaking the child's toes, the feet were kept under constant pressure by being wrapped in fabric, resulting in the feet growing only a few inches over the course of their lifetime, sometimes crippling them completely. Similarly, tight corseting that began during a woman's adolescence in Europe and the United States was an attempt to make the waist as small as possible, sometimes as little as 12 inches. Eventually the body grew and adapted to its shape, but at the expense of women being unable to stand for long periods and sometimes fainting. All of these practices are ways in which the body is modified in order to align with the ideals of a particular culture, and accordingly to improve one's own body image.

 
A pedestrian walks past advertisements for plastic surgery clinics at a subway station in Seoul on March 26, 2014. The South Korean capital Seoul is to restrict the use of plastic surgery advertisements on public transport, officials said, after complaints that they were fueling an unhealthy obsession with body image.

A pedestrian walks past advertisements for plastic surgery clinics at a subway station in Seoul on March 26, 2014. The South Korean capital Seoul is to restrict the use of plastic surgery advertisements on public transport, officials said, after complaints that they were fueling an unhealthy obsession with body image.
© Jung Yeon-Je/AFP/Getty Images.

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Reconstructive or plastic surgery procedures, originally developed to restore facial symmetry after combat injuries in World War 1 (1914–1918), have since become among the fastest-growing elective medical procedures. According to the International Society of Aesthetic Plastic Surgery, more than 23 million cosmetic and nonsurgical procedures are performed annually worldwide. Botox injections are the most popular procedure, followed by breast surgery, liposuction, eyelid surgery, lipostructure, and rhinoplasty (nose surgery).

Race, Body Image, and Eating Disorders

When research on body image and eating disorders first began, the studies were concentrated primarily on Caucasian women. Very little research had been conducted on persons of color. However, one study done at a New York City hospital indicated that African American women preferred heavier body types compared with their white counterparts and were less likely to develop eating disorders despite having a higher incidence of obesity.

In 2004, a report indicated that African American and Hispanic women had more positive feelings about their looks compared to white Caucasian women aged 20–65 years. Fifty-nine percent of African Americans and 60 percent of Hispanics liked the way they looked, compared to 51 percent of white women.

This suggests that the role culture plays in body image can be a strong preventive measure in the fight against eating disorders and the prevalence of negative body image, but since those studies that influence has decreased. A study by Savita Bakhshi, “Women's Body Image and the Role of Culture: A Review of the Literature,” indicated that, as with other races/ethnicities, eating disorders among black women are also on the rise as a result of assimilating beauty standards. The study showed that an increasing number of women of different ethnicities reported that they did not like their body shape and had resorted to dieting to change the way they felt about themselves. In India, the prevalence of eating disturbances rarely is reported, perhaps due to the traditional Indian culture that encourages plumpness as a symbol of feminine beauty. However, the effect non-Western cultures previously had in supporting larger, more realistic body ideals continues to decrease. A thinner body ideal has become more standardized across various cultures and ethnicities, leading to increasing body dissatisfaction.

The National Eating Disorders Association notes that researchers, clinicians, and educators should make efforts to increase their awareness of factors affecting minority populations, such as stress triggers in minority communities. Understanding the factors that might make a person more or less susceptible to these disorders such as worldviews, values, and beliefs; patterns of acculturation, assimilation, and immigration; and effects of oppression and ethnic identity will improve the quality of psychological care and success of prevention.

Future Implications

It should be stressed that every human body is different, and internalizing and accepting differences is healthier than internalizing social ideals. Preventing the internalization of ideals projected by society and the media should be systematic and should reduce the factors that contribute to negative body image. There are two main types of ways to prevent negative body image issues and the development of eating disorders: universal prevention and targeted prevention.

Universal prevention applies to the general public regardless of whether they have indicators of body issue disorders. An example of universal prevention would be when a major clothing retailer intentionally changes its advertising to show models that have bodies closer to those seen in reality because of the effect that abnormal body representations have on society. Another example would be a public awareness campaign on the prevalence of body image disorders and eating disorders. These actions affect the community as a whole, without directing influence to specific people in the way that targeted prevention does. Targeted prevention is when a person is already exhibiting dissatisfaction with his or her body, and measures are taken to make sure that dissatisfaction does not evolve into an eating disorder. Both targeted and universal prevention have been helpful in leading to positive change.

As has been discussed, body image dissatisfaction and eating disorders have increased drastically since the mid-1960s. However, there has been backlash on the standards of beauty that advertising and media play in this trend, and more people are discussing these issues. A study on advertising used different body types within advertisements to assess whether the body types changed an ad's effectiveness. The first utilized traditional, thin models, and the second employed average-sized models or none at all, yet both were equally effective. The implication of this study is that businesses could choose to use average-sized models without that choice being detrimental to business interests. Further work should be done to universally target the things that influence people's body perceptions to prevent the rise of connected eating disorders and the related health effects.

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BIBLIOGRAPHY

Books

Agras, W. Stewart, ed. The Oxford Handbook of Eating Disorders. Oxford: Oxford University Press, 2010.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM 5. Washington, DC: American Psychiatric Association, 2013.

Cash, Thomas F., ed. Encyclopedia of Body Image and Human Appearance. Amsterdam: Elsevier/Academic Press, 2012.

Cash, Thomas F., and Linda Smolak, eds. Body Image: A Handbook of Science, Practice, and Prevention. New York: Guilford Press, 2011.

Fox-Kales, Emily. Body Shots: Hollywood and the Culture of Eating Disorders. Albany: Excelsior Editions, State University of New York Press, 2011.

Greene, Sophia B., ed. Body Image: Perceptions, Interpretations and Attitudes. New York: Nova Science, 2011.

Latzer, Yael, Joav Merrick, and Daniel Stein, eds. Understanding Eating Disorders: Integrating Culture, Psychology and Biology. New York: Nova Science, 2011.

Periodicals

Bakhshi, Savita. “Women's Body Image and the Role of Culture: A Review of Literature.” Europe's Journal of Psychology 7, no. 2 (December 2010): 374–394. Available online at http://ejop.psychopen.eu/article/download/135/pdf (accessed April 7, 2015).

Hudson, James I., Eva Hiripi, Harrison G. Pope, and Ronald C. Kessler. “The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication.” Biological Psychiatry 61, no. 3 (February 2007): 348–358.

Levinson, Cheri A., et al. “Social Appearance Anxiety, Perfectionism, and Fear of Negative Revaluation: Distinct or Shared Risk Factors for Social Anxiety and Rating Disorders?” Appetite 67, no. 1 (August 2013): 125–133.

Striegel-Moore, Ruth H., et al. “Gender Difference in the Prevalence of Eating Disorder Symptoms.” International Journal of Eating Disorders 42, no. 5 (December 2009): 471–474.

Thomas, Jennifer J., et al. “Do DSM-5 Eating Disorder Criteria Overpathologize Normative Eating Patterns among Individuals with Obesity?” Journal of Obesity 2014, no. 1 (June 2014): 320–328.

Websites

“Body Image.” Office of Women's Health, U.S. Department of Health and Human Services. http://womenshealth.gov/body-image/ (accessed November 16, 2014).

“Diseases and Conditions: Eating Disorders.” Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/definition/con-20033575 (accessed November 16, 2014).

“Healthy Weight, It's not a Diet It's a Lifestyle!” U.S. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html (accessed November 16, 2014).

Mallick, Nadira, Subha Ray, and Susmita Mukhopadhyay. “Eating Behaviours and Body Weight Concerns among Adolescent Girls.” Advances in Public Health 2014 (2014). Available online at http://www.hindawi.com/journals/aph/2014/257396/ (accessed March 31, 2014).

“Media, Body Image, and Eating Disorders.” National Eating Disorders Association. http://www.nationaleatingdisorders.org/media-body-image-and-eating-disorders (accessed November 16, 2014).

“NEDC Fact Sheets and Other Resources.” National Eating Disorders Collaboration. http://www.nedc.com.au/ (accessed November 16, 2014).

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Margaret Loraine Scott

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Gale Document Number: GALE|CX3628100015

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.