Body Image and Eating Disorders

Reviewed by Paula Edwards-Gayfield, MA, LCMHCS, LPC, NCC, CEDS-C

Body image is defined as the thoughts, perceptions, attitudes, feelings, and behaviors around one’s physical appearance.1 It also includes how one senses and controls their body as they move and how one physically experiences one’s body. Body image is something that all of us develop early in childhood as we start to become aware of our appearance and seek to gain social acceptance first from our caregivers, peers, and the wider society in which we live.2 One’s culture, society, and personal beliefs all contribute to how one experiences and thinks about their body.

A negative body image involves a distorted perception for one’s shape and physical appearance. Negative body image (or body dissatisfaction) involves feelings of shame, anxiety, and self-consciousness. Additionally, body dissatisfaction includes perceptions of one’s skin color, physical features, hair texture and color, ability status, gender identity and expression, and muscularity. People who experience high levels of body dissatisfaction feel their bodies are flawed in comparison to others, and these folks are more likely to suffer from feelings of depression, isolation, low self-esteem, and eating disorders.3 While it is still unknown what exactly causes body dissatisfaction, many researchers believe that body image issues develop when people internalize and compare themselves to society’s unrealistic and unattainable ideals about the body that are often amplified by social media diet culture.4

How do you see yourself and feel about your body (i.e., height, shape, physical features, muscularity)? If you experience negative thoughts, beliefs, and feelings about your physical appearance you’re not alone!

Body image concerns often begin at a young age and endure throughout life. By age 3, children have often internalized stereotypes about body size and children as young as 5 start to express concerns about their own weight or shape.5 For example, studies have found that 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming fat.6 Rates are even higher among LGBTQIA+ youth with up to nine in ten or 87% indicating they are dissatisfied with their body.7 Athletes are also at increased risk for eating disorders and research indicates that 85% of college athletes report maladaptive eating and weight control behaviors such as bingeing, excessive exercise, dieting, vomiting, and abusing weight loss supplements.8

It is important to note that the age of onset differs depending on the individual, and these body image concerns may start younger, later in life, or never come up at all; though they are quite common in the general population.9 As with eating disorders, body image concerns can affect anyone and impact one’s life in a negative way.

Risk Factors


While anyone regardless of age, gender, sexual orientation, size, ethnicity, or culture can experience body image issues, there are different factors that can increase one’s risk of developing negative body image:

Gender: People of all genders experience body image issues, however the prevalence and ways in which they manifest vary. In our Western culture, girls and women often feel pressure to succumb to the societal appearance-ideal (sometimes referred to as the thin-, beauty-, or cultural-ideal), whereas boys and men are often faced with social pressures to be lean and muscular. Indeed, studies have found that 69-84% of women experience body dissatisfaction, desiring to be a lower weight than they currently are, and 10% to 30% of men exhibit body dissatisfaction with the primary concern being a desire to become more muscular. One study even found that 90% of boys in their sample were dissatisfied with their muscularity.10,11 For nonbinary and transgender folks, research has found that a perceived inconsistency between one’s body shape and the body ideals of the gender they identify as increases body dissatisfaction.12 For example, a study of transgender men reported that prior to gender affirming surgery they had higher rates of body dissatisfaction than their cisgender counterparts.13 Experiences of anti-transgender discrimination and internalized stigma were also found to increase body image issues among transgender individuals.14

Sexual Orientation: Gay and bisexual men have higher rates of body image dissatisfaction and a drive for thinness than their heterosexual counterparts.15,16 While some studies have found that lesbian women have lower rates of body dissatisfaction than heterosexual women, most indicate that rates of body image issues are about the same for all women regardless of sexual orientation.14 Learn more about eating disorders in LGBTQIA+ populations here.

Families: Parents’ negative comments about their own bodies, engaging in excessive exercise or restrictive dieting can unintentionally influence their child’s body image. Furthermore, parents’ teasing or commenting about a child’s appearance or pressures to lose weight can directly affect their child’s body image. Comments that highlight differences for people of color may also influence body dissatisfaction. These comments may focus on skin color, hair type, and physical features to name a few. This includes comments, positive or negative, or nicknames that focus on these features that may be problematic for their loved one.17 Studies have found that these negative attitudes and comments around weight can lead to increased body dissatisfaction.8,18

Social Acceptance: Social acceptance and the degree to which a person feels they conform to what society deems desirable plays a significant role in the development of body image. This is especially evident during adolescence when the opinions of peers become increasingly important and influence how they feel about themselves and their bodies. Indeed, research has shown that adolescents who are bullied or teased, particularly about their weight and appearance, experience higher rates of body dissatisfaction.2,8,19

Weight Stigma: Weight stigma, which is discrimination or negative stereotyping based on a person’s weight, has been found to be a core factor in the development of internalized weight bias and body dissatisfaction.20 It is a derivative of diet culture which reinforces values of thinness, appearance, and shape and equates them with health and well-being.

Trauma/Abuse: Trauma, including sexual abuse, physical abuse and child maltreatment are linked to an increased risk of developing body image concerns.21 Additionally, some folks with trauma histories or chronic illnesses describe a sense of their body betraying them leading to frustration, anger, anxiety, and negative body thoughts.22 Learn more about trauma here.

Media/Social Media: Media (i.e. television, movies, advertisements etc.) that promote the thin and muscular ideal and perpetuate weight stigma have been shown to increase the likelihood of experiencing body dissatisfaction and is even greater for those who are already at a higher risk for developing an eating disorder.23 Furthermore, due to the constant availability of social media, research suggests that this form of media may have a greater impact on body image than traditional media.8

Body Image and Eating Disorders


While there is no single cause of eating disorders, research indicates that body dissatisfaction is one of the best-known contributors to the development, maintenance, and relapse of eating disorders like anorexia nervosa and bulimia nervosa.24,25 Although body dissatisfaction is not listed as part of the diagnostic criteria for binge eating disorder (BED), studies have found that body dissatisfaction is higher among those with BED than those without BED.26 Furthermore, those who have experienced weight-based stigmatization report more frequent binge eating behaviors, are at an increased risk for developing an eating disorder, and are more likely to have a diagnosis of BED.27 In addition to BED, Avoidant/Restrictive Food Intake Disorder (ARFID) is another eating disorder that does not include negative body image as part of its diagnostic criteria.28 It is also important to note that while negative body image is prevalent among those suffering with eating disorders, experiences of body image may present in ways we don’t often think about or discuss (i.e. someone with ARFID may not experience negative body image concerns or someone in a larger body may not express a desire to lose weight).

Beyond formal diagnoses for eating disorders, body dissatisfaction can also increase one’s risk for disordered eating and other potentially harmful behaviors to alter appearance such as restrictive dieting, excessive exercise, taking diet pills, and steroid use.29 Since body image issues can be an early sign that someone may develop disordered eating or an eating disorder, it’s important to seek help as soon as possible from a professional and address these concerns before they progress further. Addressing body dissatisfaction is important not just in the prevention of eating disorders but researchers also believe that early intervention for body image concerns could be helpful in the treatment of eating disorders and reduce the risk of relapse once a person is in recovery.22

Learn more risk factors for eating disorders here.

Body Image Movements


The body positive movement first emerged from the fat acceptance movement in the 1960’s and was created by and for folks in marginalized bodies (i.e., fat, queer, and black bodies). Its goal is to promote size diversity, body acceptance, and a healthier body image for all ages, genders, races, abilities, etc. It encourages people to unconditionally accept, embrace, and love their bodies. However, in recent years this term has been commercialized and co-opted leaving out the people the movement was created for, thus contributing to body dissatisfaction. Indeed, research has found that spaces that have presented themselves as aligned with the body positive movement (i.e., social media posts) instead support the thin ideal and dominant cultural standards that the movement originally sought to combat.30,31

As an alternative to body positivity, body neutrality seeks to find a middle ground neither promoting body dissatisfaction nor body love. Instead, this approach highlights the body’s function and achievements, rather than its appearance and views the body through a neutral lens without judgment or forced positivity. It promotes the idea that liking your body is not a requirement for loving yourself and acknowledges body love is not always realistic or attainable.32,33 Body neutrality can be considered a form of body kindness or body respect.

The body liberation or fat liberation movement can be traced to the formation of the National Association to Advance Fat Acceptance (NAAFA) in 1969 and later the creation of the Fat Underground in 1973. These organizations and the fat liberation movement that emerged from them seek to fight systems of oppression, including weight stigma and size discrimination, and address how they intersect with other forms of oppression (i.e., racism, sexism, homophobia, ageism, ableism, classism etc.). They seek to reduce prejudice against people of different body types with the goal to create a safe space for fat bodies to exist and equal rights in all areas of life. The movement goes beyond promoting self-acceptance on the personal level and encourages people to become activists to fight larger systems that marginalize and discriminate against fat bodies in our society. It promotes inclusivity for people (particularly those who have been historically marginalized), body autonomy (the right to make decisions about your body), fat acceptance, size diversity, and the idea that a person’s worth is separate from their body size or appearance.34,35

Sources


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[35] Freespirit, J., & Aldebaran. (1979). Fat Liberation Manifesto. Off Our Backs, 9(4), 18–18. http://www.jstor.org/stable/25773035