Your Relationship with Your Body
Most of us feel dissatisfied with our appearance at one time or another. But individuals with almost anorexia and other officially recognized eating disorders often feel so unhappy with their shape or weight that it distorts not only the way they see their body but their entire life as well. Today, when Jenni looks back at photographs of herself when she was underweight, she can see that she was entirely too thin, her hair was dull, and her eyes looked tired and sad. But back then, she perceived a different image altogether. Wearing “Ed glasses,” as she sometimes says, Jenni noticed just the “fat” body parts that Ed wanted her to see. Only when she finally took off these eating-disordered glasses could she see the truth. Like the ones your doctor might prescribe, Ed glasses come in all strengths and styles. Are you wearing a pair? Is your loved one?
Tell me the truth—do I look fat in this?… I should really work out more…. Ugh—she really shouldn’t be wearing that. This is fat talk. We’ve all heard it, and most of us have engaged in it at one time or another. Anthropologist Mimi Nichter coined the term “fat talk” in her 2001 book of the same name.1 Sadly, people often connect around the language of fat. A memorable scene from the teen comedy Mean Girls2 involves three girls standing in front of a mirror critiquing themselves: the first pokes at her “huge” hips, the second “hates” her calves, and the third laments her “man shoulders.” When they finally turn to the fourth girl, who is at a loss for body criticism, the original three roll their eyes in disbelief. Contemporary body image ideals are so unattainable—for women and men alike—that those who don’t take part in social self-deprecation are often considered abnormal.
We all know that society’s ideal woman—from Barbie dolls to supermodels—is typically represented as tall, thin, toned, tan, young, and blond. And with such a dizzying array of methods to enhance female appearance—plastic surgery, Botox, anti-aging products, and makeup—there’s always an opportunity for something to look wrong. It’s no wonder, then, that in one study, 50 percent of girls ages three to six said that they “sometimes” or “almost always” worried about being fat.3 And although there is less pressure on ethnic minority women, such as African Americans and Latinas, to be extremely thin,4 societal expectations for them to have an hourglass figure with round breasts and buttocks—à la singer Jennifer Lopez—can be just as oppressive.
Men, too, are under increasing pressure to go from Clark Kent to Superman, ditching “scrawny arms,” “pot bellies,” or “man boobs” for six-pack abs and chiseled biceps. Even young boys’ action figures sport supersized bodies—with waists and biceps of the same size—that could not be obtained in real life without steroids. Distinctive body ideals for males may help explain why some men with almost anorexia are terrified of being too big, while others are terrified of being too small.5 Some even struggle with muscle dysmorphia—a preoccupation with being insufficiently lean and muscular, leading to a diet or workout schedule that interferes with psychosocial functioning.6 Though not technically an eating disorder, muscle dysmorphia is a subtype of body dysmorphic disorder that affects both males and females and often co-occurs with eating disorders. Individuals with body dysmorphic disorder worry excessively about aspects of their appearance broader than just shape or weight (from receding hairlines to crooked noses) but share the crippling self-perception of imagined ugliness that plagues those with almost anorexia.7
In The Adonis Complex, psychiatrist Harrison Pope and colleagues have discussed how body image problems can be even more insidious in males because worrying about appearance and discussing feelings have historically been considered female concerns. This leaves men “trapped between impossible ideals on the one side and taboos against feeling and talking on the other.”8 And it might be even worse for some subgroups. Research suggests that gay men are even more likely to be dissatisfied with their bodies than their heterosexual counterparts.9 Licensed marriage and family therapist Brad Kennington, who specializes in treating males with eating disorders, told us, “Gay men are under the same pressures that straight women are to achieve the so-called perfect body. After all, they are both trying to attract men as potential mates. Having the ideal body (toned, fit, youthful looking) in the gay community provides gay men with power, status, and prestige.”10
Supermodel Cindy Crawford famously told Redbook, “Even I don’t wake up looking like Cindy Crawford! What people see on magazine covers is one moment that was perfect—the wind, the light, the hair, the makeup. That’s a two-hour process.”11 We don’t know about you, but we certainly don’t wake up with a team of professionals around us. Increasingly, however, not even the wind, light, hair, and makeup that Crawford describes is sufficient to make models look like models. Today, society’s perfect 10 is simply not attainable without photo manipulation software like Photoshop.
Digital artist Roy A. Cui has retouched covers for fashion, entertainment, and lifestyle magazines. Cui told us that, when a retoucher receives an image from a photographer, there is an “unspoken” preliminary list of perceived flaws to correct. This list includes
But it’s still not over. Cui continued, “Then the photographer will usually request additional changes and forward the files to their client (magazine editor, art director) for final approval. There might even be more changes from their client after that.”12
To see an example of how retouching, makeup, hair, and wind are used together to transform someone into a glamorous billboard model, check out the seventy-five-second “Dove Evolution” video, which went viral on YouTube in 2006. And for a real-life story: New York model Sara Ziff, who has been the face of advertising campaigns for Tommy Hilfiger and Kenneth Cole, told us that once her own mother did not recognize her on the face of a billboard just blocks away from her childhood home.13
Furthermore, some magazine editors have recently admitted to engaging in “reverse retouching”—reshaping certain painfully thin models to look healthier by filling in gaunt cheeks and erasing jutting collar bones, while still preserving their slender silhouettes. According to former British Cosmopolitan editor Leah Hardy, “Thanks to retouching, our readers—and those of Vogue, Self, and Healthy magazine—never saw the horrible, hungry downside of skinny. That these underweight girls don’t look glamorous in the flesh. Their skeletal bodies, dull, thinning hair, spots and dark circles under their eyes were magicked away by technology, leaving only the allure of coltish limbs and Bambi eyes. A vision of perfection that simply didn’t exist.”14 Tragically, this unreal image can kill. Both Brazilian model Ana Carolina Reston and French model Isabelle Caro died of complications related to anorexia nervosa in 2006 and 2010, respectively. More recently, in 2012, British model Bethaney Wallace died of anorexia.15
And the potentially negative impact of reverse retouching on readers’ own body images isn’t lost on Hardy, who has since admitted to feeling guilty about the practice: “No wonder women yearn to be super-thin when they never see how ugly thin can be,” she said.16 Of course, we are not implying that all thin people look bad. What we are saying is that forcing your body to be unnaturally thin for your size is obviously not going to be your best look. We truly look best when we are healthy and happy. If a voice in your head is disagreeing with that last sentence, consider that it just might be Societal Ed talking. (Too bad we can’t just ask Roy Cui to Photoshop Ed’s mouth shut.)
The ability to analyze and evaluate the media messages that we receive is crucial to developing a positive body image. Even if you know that images have been altered, it’s helpful to remind yourself of this fact—and frequently. The human condition is one of forgetfulness. In one study, adding a label that said “Warning: These images have been digitally altered” prevented women from becoming dissatisfied with their own bodies after viewing a twelve-page fashion spread, compared to a no-label control condition which produced the predictable bump in body dissatisfaction.17 Dr. Thomas tries to give patients a visual reminder of such altering in her body image group. She invites them to flick through fashion magazines, ripping out and crumpling up any pages featuring extremely underweight or drastically retouched models. They are inevitably surprised to see the heaping pile of crinkled images in the middle of the room at the end of the task. The magazines themselves have almost nothing left inside. Try it yourself.
Unfortunately, we are not the only ones who criticize our bodies. Increasingly, we live in a world that watches our weight. Melbourne’s Herald Sun dubbed Australian swimmer Leisel Jones too fat to compete just days before she earned a silver medal for her country at the 2012 Olympic games.18 New York City ballerina Jenifer Ringer, who has been open about her history of anorexia, appeared on the Today show to respond to a dance critic who accused her of having eaten “one sugarplum too many” before performing in The Nutcracker.19 And British singer Adele didn’t sit idly by when designer Karl Lagerfeld called her fat: “I’ve never wanted to look like models on the cover of magazines,” she told People. “I represent the majority of women and I’m very proud of that.”20
Today’s world continuously looks at our bodies and judges. Most of us don’t get to fire back in People after receiving a bad body review. This is especially true for children. Throughout their school years, kids who are larger are sometimes bullied, and children who are naturally skinny get teased too. Anyone who doesn’t fit neatly into the middle—or closer to the thin side—can easily be on the receiving end of a negative comment. Indeed, regardless of BMI, weight-related teasing in childhood predicts the onset of disordered-eating behaviors in adolescence.21 Unfortunately, this mentality stays the same as we grow older. Both teenagers and adults, for instance, can feel pressured to look “just right” to get a date or attract a mate. When Jenni signed up for an online dating site, she was surprised when it encouraged her to include at least one full-body photograph in her profile and required her to check a single box describing her body type as “athletic and toned,” “about average,” “curvy,” or “heavyset.” We are waiting for the media to coin the term Matchorexia for people who go on rigid weight-loss programs in the aftermath of creating an online dating profile. As an eating disorder therapist, Dr. Thomas also receives unsolicited feedback about her average-size body. A patient recently told her, “I feel like I can accept body image advice from you, because you are obviously comfortable carrying a few extra pounds.” Another said, “You’ll never understand what it’s like to be me, because you are so thin.” As a young clinician, Dr. Thomas once believed that her BMI needed to land exactly in the middle of the normal range to work with patients who have eating disorders (who tend to take particular note of their treatment provider’s shape, as indicated). But Dr. Thomas soon realized that she would be most effective as a therapist not at a particular weight, but instead when she was taking best care of herself.
With the Internet constantly at our fingertips on smart-phones, laptops, and tablets, body bashing has grown to a whole new level. Making snide, witty comments about another person’s body—known as bodysnarking—is commonplace and seemingly accepted. Blogs, Facebook, and other social media sites give all of us an avenue to comment publicly about not only celebrities but also the person we ran into at last night’s party. Digital cameras on mobile phones turn most of us into potential paparazzi. With one click, a picture can be uploaded to Facebook for all to see. And this, in fact, seems to be fueling a “camera ready” mentality among ordinary people. In one study, 44 percent of Facebook users ages sixteen to forty said that when attending social events, they are always conscious that photos of them might get posted.22 But while most of us are able to bounce back from bodysnarking or surreptitiously “de-tag” ourselves from unflattering photos (that is, remove the picture from our online profile), those with almost anorexia and other officially recognized eating disorders may perceive almost any comment about their bodies as utterly crushing to their overall self-esteem. Unfortunately, that was true for Dante.
A bead of sweat dripped onto Dante’s copy of Men’s Health magazine. He looked at his watch. Just twenty more seconds before my next bench press set. He shook the damp arm of his sweatshirt. Though he felt overheated in his baggy tracksuit, he was too embarrassed to wear a sleeveless shirt in front of the more muscular lifters. When I lose enough body fat, he promised himself.
On the walk to the locker room after his punishing two-hour workout, Dante gazed intently at his shape in the floor-to-ceiling gym mirror. Am I getting bigger? he wondered. The mental measurements he took every morning suggested that he was indeed adding inches, but Dante often worried that he was gaining fat, not muscle. No matter how carefully he watched his diet—which now consisted mainly of shakes, gels, and powders—he was never sure he’d perfected his carb-to-protein ratio. He made a mental note to pick up more creatine and fat-burning pills at the health food store later.
Spending less than a minute in the locker room, Dante grabbed his gym bag and avoided making eye contact with anyone before quietly slipping out. His wife, Joanna, wrinkled her nose when Dante hopped into the car. “You smell like a dirty sock,” she teased. “Why don’t you ever shower after working out those big muscles of yours?” Dante laughed, relieved that she was in a good mood after he had chosen to lift weights rather than accompanying her to a friend’s party—yet again. He never showered or changed at the gym, for fear the other men would judge him as too flabby. And although Joanna was always complimenting his cut and toned body, Dante knew she was just being nice. She has to say that, he thought. She’s my wife.
That evening, Dante and Joanna shared a relaxing dinner. Well, Joanna did at least. Dante didn’t find meals particularly enjoyable; he much preferred just sticking to his shakes and supplements. In fact, Dante rarely ate actual meals except with Joanna, who always begged him to sit down at the table with her, especially on the nights before he went out of town for sales meetings.
“Water, no ice,” he said to the flight attendant on the early morning flight. He needed some more water to mix with his breakfast shake to make it just right. The man sitting next to him, who was in his early thirties—around Dante’s age—noticed and said, “Is that how you stay in such good shape?” Dante smiled, thinking, Maybe my hard work is paying off. “Nutrition and working out,” Dante said. The man continued, “Would you mind sharing your workout routine with me? My girlfriend has been begging me to get fit—but not too buff—like you. She doesn’t like really big muscles.”
Dante felt like he’d been kicked in the stomach. I knew it. Joanna has been lying. He mumbled a response, then immediately put on his headphones, opened his laptop, and didn’t talk for the rest of the flight. Although Dante usually prepared for sales presentations during flights, this time he decided to connect to the onboard Wi-Fi to try to figure out what he might be doing wrong at the gym. With just a few clicks on the Internet, he got his answer: steroids. Why hadn’t I thought of that before? Dante believed that if he could just get bigger, everything would be okay. His newfound obsession with studying up on steroids and trying to figure out where to buy them interfered with his presentation that afternoon. Dante was originally hired for his energetic speaking style, but now his boss, Robert, couldn’t help but notice his change in demeanor. This particular sales pitch was so bad that Robert planned to discuss it after all of their clients had cleared the room.
“Are things all right?” Robert asked. “Is everything okay with you and Joanna?” Dante responded, “Sure. I just don’t see her that much. I’m so busy with work.” And working out, Dante thought. Noticing Dante’s blank stare, Robert could see that he wasn’t going to get anywhere with this conversation and made a mental note to speak with the human resources department when they returned to the office. He knew that something wasn’t right.
Walking back to his hotel room, Dante stewed over Robert’s questioning. He had always prided himself on being a stellar employee. But recognizing that his presentation hadn’t gone over well and that his last few talks hadn’t been up to par, Dante wondered why he might be losing his edge. He thought about it all the way up the ten flights of stairs he ran to reach his top-floor suite. His in-flight magazine had indicated that stair stepping is helpful for building up calf muscles. Upon entering his room, he mindlessly flipped on the television just as an entertainment news show was mentioning a young female celebrity’s suspected battle with anorexia. I just don’t understand. How can girls do that to themselves? he wondered. I take such great care of my body.
Dante did not have anorexia, but he did have an unspecified feeding and eating disorder that was interfering with both work and relationships. If almost all of us are exposed to an unattainable body image ideal, then why do only some, like Dante, develop almost anorexia? The answer lies, in part, in the relative importance of shape and weight to our self-esteem.
All of us have a system for judging ourselves. If we meet the standards we set in important life domains—from relationships to school—we feel successful. If not, we feel like we’ve failed. For example, Dr. Thomas’s work is very important to her sense of self, so she is delighted when one of her scientific papers gets accepted for publication but frustrated when a research grant does not get funded. Clinical psychologist Josie Geller developed the pie chart tool that follows to help people work out which arenas of life are most important to them.23
Take a look at Dante’s example in figure 6, and then try the exercise for yourself. We have listed common domains (such as relationships, work, and hobbies), but you should select only those that feel important to you, and feel free to add any additional ones. After you decide which areas are most important for you, assign them each a piece of the pie. (You can do this by writing in figure 7 or in a notebook, or by downloading the exercise at www.almostanorexic.com). The size of each slice should be determined by its relative significance to your self-esteem. Basing your self-esteem mainly (or even exclusively) on shape and weight is often referred to as the “core psychopathology” of eating disorders.24 Indeed, research suggests that allocating a larger slice of the pie to shape and weight goes hand in hand with more severe disordered-eating behaviors and even predicts the onset of new such behaviors.25 People with a healthy body image might not always like what they see in the mirror, but they do not base their entire self-worth on this. Both in our thirties, we don’t particularly like that we still sometimes get pimples, but we don’t base our self-worth on a blemish or two—or three. As you can see, for Dante, the domain most important to his self-esteem is muscularity (that is, a specific aspect of shape and weight). As psychiatrist Christopher Fairburn has pointed out, having a single slice dominate your pie chart is “risky” because “it is like having all your eggs in one basket.”26 In other words, it is great if you feel you are succeeding in that arena, but devastating if you feel you are not. When Dante believes that he is muscular enough, for example, he feels extremely confident, but when he feels flabby or scrawny, he is crushed. Another problem with allocating most of your self-esteem to weight and shape is that it makes other previously valued domains (like relationships or other talents) start to feel less important. This was certainly true for Dante, who rarely dined with his wife and started having difficulties at work.
Now think about your own life. Which domains of your life have to be going well for you to feel good about yourself? Consider these:
Using these domains, draw a pie chart so that the size of each slice is proportional to its importance to your self-esteem. Domains with larger slices are more important; those with smaller slices are less so.
Basing much of your self-esteem on shape and weight causes you to view the world through Ed glasses. Eye-tracking research suggests that when individuals with almost anorexia and other officially recognized eating disorders look at photos of themselves, they tend to spend more time looking at body parts that they think are “ugly” than parts they think are “beautiful.”27 Hyperfocusing on perceived flaws, they tend to formulate an overall judgment of themselves that is both harsh and critical, and they later recall and ruminate about these imperfections. Once they have developed this critical view of their bodies, it can be difficult to change.
To illustrate this concept, take a look at the ambiguous picture created for this book by artist Emily Wierenga in figure 8. (You can also download this figure at www.almostanorexic.com.) Do you see a thin or a large woman? The figure is designed to be either one. If at first you see the larger woman whose body is positioned sideways facing to the right, it may be difficult for you to change your perspective and to see the thin woman whose body is facing forward with her head tilted up toward the left. To help you distinguish between the two, note that the thin woman’s nose is raised higher, more smugly, and is actually the ear of the larger woman, who appears melancholy with her arms folded across her chest. The feather hat on the upper left belongs to the thin woman and also serves as a ponytail for the large woman. Wierenga, who herself recovered from anorexia nervosa and coauthored the body image book Mom in the Mirror,28 designed the thin woman’s regal robe to represent the large woman’s layers of flesh. She told us, “In a society that equates thin with beauty and beauty with love, we long to be thin, and so we hide. Beneath layers of guilt and shame, not seeing ourselves for the royalty that we are.”29
Created by Emily Wierenga
Available at www.almostanorexic.com
Just like the thin/large woman, our own bodies can be ambiguous figures—one day looking slim and svelte, the next day covered in rolls of fat. Unfortunately, it is all too easy to let this image dictate whether we should feel pride (like the thin woman) or shame (like the large woman). You may have found that, once you started seeing the ambiguous picture one way (that is, as either thin or fat), it was difficult for you to change perspectives. Just as you can get locked in to viewing the ambiguous figure one way, individuals with almost anorexia get locked in to viewing themselves as “fat.” Their perception can be difficult to change, mainly because they begin to engage in behaviors that serve to maintain their negative self-view. As in a game of hide-and-seek, those with almost anorexia often alternate between avoidance, which is a desperate attempt to hide perceived flaws, and body checking, which is near-constant vigilance for any weight and shape changes.
A negative relationship with your body can be like living in a prison whose rules dictate what you can and cannot do. Don’t let anyone take your photo until you lose weight. Don’t go to that party, because you look horrible in dress clothes. Those with almost anorexia and other officially recognized eating disorders are significantly more likely than healthy individuals to engage in avoidance behaviors, such as refusing to be weighed, averting their eyes as they walk past reflective surfaces, and wearing baggy clothes to disguise their shape.30 Avoidance behaviors can be subtle, such as making yourself sit or stand in a certain way that you think will make you appear thinner—whether in photos or in real life. These behaviors can be incredibly impairing too. Dr. Thomas has worked with patients who dress in the dark, rarely shower, or won’t even get out of bed on “fat” days.
For example, Dante wore oversized sweatshirts at the gym and wouldn’t shower or undress in the locker room, because he was worried that others would judge him negatively. Similarly, when Jenni first gained weight in recovery, she only wore—or hid out in—big, baggy clothes. A waistband pressing against her stomach seemed to scream out, You need to lose some weight, and pants that fit snugly against her hips said, You’re nothing special. A friend once asked, “Are you ever going to wear jeans again?” Jenni responded that she could live her entire life without jeans. And she could have. But when we are slaves to our closets, we are not living a fulfilled life. Gratefully, Jenni kept learning and growing. Today, if you see her give a talk at your local university, you will most likely see her wearing a comfy pair of jeans.
Although seemingly different from body hiding, body checking is actually the opposite side of the same coin—the coin of basing your self-esteem primarily on shape and weight. When Jenni was struggling, she knew exactly how her clothes were “supposed” to fit. She pinched rolls of perceived fat—it was skin—on her stomach. She checked (and double-checked) to make sure that her thighs didn’t touch at the top. During early recovery, she thought that getting rid of her scale might end the obsession with needing to know her exact weight. And it did. Yet her struggle with body checking was nowhere near from over. No longer able to hop on the scale every morning, she began trying on a special pair of jeans, her new metric of thin and fat. The number on the size tag became her new obsession. Body checking behaviors like pinching your upper arms to measure fatness, seeing if your thighs spread when you sit down, and scrutinizing yourself in mirrors (or shop windows, or other people’s sunglasses!) are common among women who struggle with disordered eating.31 Men’s checking behaviors more often revolve around muscularity, such as checking muscle definition in their abs, comparing the size of their chest and shoulders with others’, or flexing their biceps in the mirror.32 Like Dante, some measure their muscles to see how many inches they’ve gained or lost. Both males and females might compare their size and shape to that of other people.
Body checking can even occur outside of conscious awareness. Dr. Thomas once interviewed a patient who adamantly denied body checking, while simultaneously running her fingers along her clavicle, feeling for bone. Indeed, checking is so pervasive among individuals with almost anorexia that Dr. Thomas has even observed it in a blind patient whom she was treating. The patient shared that, “I do all of the checking, but without the eyes.”33 Undeterred by her lack of sight, this young woman repeatedly felt for bony protrusions in her face, ribcage, spine, and hips. During conversations with others, she attempted to estimate their height through voice location and weight through voice pitch, with higher locations indicating taller height and lower pitch indicating greater abdominal girth. Her need to engage in body comparisons—even approximate ones—was that strong! Ultimately, she learned to apply her ingenuity and imagination to a more worthy goal: applying to graduate school.
Although body image disturbance is an extremely common feature of almost anorexia and other officially recognized eating disorders, it is by no means universal. There are some individuals who, despite low body weight, do not endorse a fear of fatness.34 As we mentioned previously, anorexia without fear of weight gain is commonly seen in cultural non-Western societies that feature less pressure to be thin. Even in the United States, Dr. Thomas has worked with many patients who attribute their restrictive eating patterns to uncomfortable feelings of overfullness or a strong need to feel “in control” or “self-disciplined” rather than concerns over shape and weight. Regardless of the rationale for almost anorexic behaviors, their allure can often be difficult to resist.
