Body Image -- Wendy Oliver-Platt, MD

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Your Body Image -- Wendy Oliver-Platt, MD -- 4/29/03

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What do you see when you look in the mirror? What do you want to see? What is healthy for you? Wendy Oliver-Pyatt, MD, joined us to discuss how you can develop a healthy body image.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Hello Dr. Oliver-Pyatt. Thank you for joining us today. Where do most of us get our ideas about body image?

Oliver-Pyatt: Most of us get our ideas from the people and culture that surrounds us. In our society, things are quite different because of the degree to which we are exposed to media. We are not simply surrounded by our family and friends and neighbors. We are surrounded by television and magazines, cartoon characters, and Disney movies from the time of our earliest memories. These images become the standard by which we judge ourselves.

Moderator: And what kind of messages are we getting?

Oliver-Pyatt: We are getting messages that the genetically based and biologically based shape and size that our body is predetermined to become does not fit the bill. We exist within a society where we confront a double bind on a day-to-day basis. On the one hand our body size is expected to meet standards that do not make biological sense, and on the other hand, we are inundated with sugar and fat-laden foods and don't know how to manage our impulses with the foods.

Our impulses with the foods are confused by the ideas we have about dieting. We have a vicious cycle. On one hand we have the culture-bound belief that our body and shape should be something that doesn't make biological sense, and on the other hand we have the false belief that dieting is the path to this body. What happens is that the dieter inevitably breaks the dietary restraints because dietary restraint is temporary. This leads the person to view himself or herself as a person who cannot be trusted with food. This causes them to develop compulsivity with food. As they start to binge and gain weight, and at the same time they see themselves as a person who cannot be trusted with food, they are led to believe they must follow a diet, thus completing a vicious cycle. The byproduct of the cycle is weight cycling, obesity, and eating disorders.

Member: I want to feel good about my body before I lose weight, yet I think of myself as so fat. How can I start to really like my body before I start a fitness plan?

Oliver-Pyatt: I feel that one of the most difficult aspects in helping a person dealing with these problems is the issue that these individuals experience their self-esteem as directly linked to their body size and shape. Ironically, this lack of self-acceptance hinders the person's efforts to obtain fitness of both mind and body. It is essential that people begin to explore themselves on a deeper plane than their weight. Rather than viewing self-love as a feeling, which may or not pass through the person, we need to make an active decision to love ourselves in the present moment and to view self-love as an option, an action, and a choice. Any and every act we partake in on a day-to-day basis can be viewed as gentle and self-loving or not. As M. Scott Peck says in The Road Less Traveled, "Genuine love is volitional rather than emotional. The person who truly loves, does so because of a decision to love. This person has made a commitment to loving, whether or not the loving feeling is present." While M. Scott Peck describes love in this way as applying to a couple, this idea can be applied to how we feel about ourselves, as well.

What this means is that you must begin to treat yourself today with dignity and as a delicate and special being. You must forgive yourself for your imperfections and be as kind to yourself as you are to others. It also means you must accept responsibility for caring for your own needs. Responsibility implies "being responsive." This may mean many things in actions you can take. It may mean buying yourself clothes TODAY that you feel good about TODAY. It may mean saving up for a vacation. It means we are willing to live in the present moment.

As we begin to respond to ourselves and take ourselves seriously, we become less desperate, and in becoming less desperate, we also become less compulsive. On of my most joyous moments as a therapist recently was when a young mother, who is also bulimic, took her young boy to a swimming pool while simultaneously wearing a bathing suit and eating an ice cream cone. This is part of the path to fitness of mind, body and, spirit. All must go together, all must go hand in hand.

Member: Do you think most people diet or begin a fitness program for the wrong reasons, meaning to look good rather than to be healthy? How does that affect success rates and how important is it to change that basic motivation from image to health?

Oliver-Pyatt: This is an interesting question. I do believe many people begin dieting for the purpose of changing their appearance. However, the question implies that dieting does, in fact, lead to health. This is something that is worth questioning; i.e., does dieting result in either a change in your appearance or an improvement in your health status? I would argue that in most cases, or even the vast majority of the time, the outcome is neither improvement in health nor appearance. Most people, as well as most healthcare providers, view dieting as a healthy act. I question this. Dieting, more predictably, leads to weight cycling and weight gain. I will say that dieting is more likely to actually lead to health when it is embarked upon for health reasons rather than self-esteem reasons.

One of the most confusing messages we receive in our society is the message about what is the definition of a diet. You will hear people say, "I'm not dieting; I'm just developing a healthy lifestyle." In the same sentence they will also tell you which foods they are cutting back on or eliminating from their diet. I have seen talk shows where a person says, "I'm not dieting, dieting doesn't work, "and they also say, "I'm cutting carbs out."

Quick GuideDiet for Stress Management: Carbs, Nuts, and Other Stress-Relief Foods

Diet for Stress Management: Carbs, Nuts, and Other Stress-Relief Foods

We need to realize that dieting entails replacing internally driven hunger-based eating with externally regulated eating. The harsh reality is that externally regulated eating tends to spin us out of control. The answer lies within; the answer lies within becoming being responsive to our needs, both physiological and emotional. This includes our becoming responsive to our need, which is biologically driven, to experience satisfaction from the act of eating. What I mean is that I could eat three cantaloupes for breakfast and become very full, while never feeling satisfied. Or, I could eat a bagel with cream cheese with breakfast and experience a satisfying feeling and have no need to eat for many more hours. If I ate the cantaloupe, I would argue that when I went to work and saw the cookies in the staff lounge I might feel the need to graze on them. We need to become particular about the foods that we eat, noting very seriously what food it is that we will experience as satisfying. Freedom and responsibility are therefore intertwined. We have the freedom to choose those foods that we will find satisfying and the responsibility to eat when we are hungry and to stop eating at the point that we are satisfied. This is how internally regulated eating evolves.

Member: I know that my perception of myself is warped. When I buy clothes I think I should wear the size I wore 10 years ago even though I'm much larger than that now. How can I "get real" about my body?

Oliver-Pyatt: We must become fed up. We must begin to recognize that with our imperfections we are perfect. We must begin to view weight not as a number but as a range. Our weight will range over the course of a month, a season, and a life span. We must recognize that there is excitement in our differences. For example, while at a WNBA basketball game, there was a roster which included three players all of them 5'9". Their weights ranged by over 30 pounds. This is not because there was something wrong with any of them; rather, it was because of their biologically based differences. We must take our biology seriously. This includes the changes that are biologically driven which occur over our life span.

Member: What about men? Generally they have issues with hair loss as well as weight gain -- do you recommend any different approaches to men, than women?

Oliver-Pyatt: I feel that more and more men are succumbing to the effects of dieting. Dieting will work no better for men than it will work for women, particularly if their low self-esteem is the basis for which they're embarking on the diet. We all need to take ourselves more seriously and discover that who we are is far more based on what's inside than the shape of our body or the amount of hair on our head.

Member: Now that I'm past 40 my body seems like a stranger to me. It seems almost like it's betrayed me! How can I accept physical changes with grace?

Oliver-Pyatt: You have already taken the first step. In that you are exploring these feelings. It is no wonder that you may feel these unkind feelings toward your body. You may need to consider the source of these feelings. Is the source significant others who are overly rigid in what they expect of your body size and shape? Is it a society that tells you your body is bad as it evolves? I would urge you to consider the source of these emotions and to judge yourself in the same way that you would judge another who has walked in your path.

Member: Doctor, when I am stressed, I eat. How do I stop doing that and still deal with the stress?

Oliver-Pyatt: Emotional eating is a significant contributor to weight gain in our society. Your question is a complex one. First, let's consider the source of the stress. Is there anything you can do to reduce or eliminate some of the stressors you may face? Are you avoiding confrontations with others and thereby eating to keep yourself quiet? Are you saying yes to demands that are excessive? Are you physically exhausted? In what ways are you nurturing yourself and taking yourself seriously?

To combat emotional eating we must become able to distinguish between physical and emotional hunger. We must become able to cope with our emotional hungers. When we are emotionally hungry we can either distract ourselves, tolerate the emotions, or explore further our emotional hunger. These are all methods by which we can tolerate our emotional hunger without following the path of least resistance, which is usually directly to the refrigerator or the pantry. It doesn't mean we're bad or we want too much if we've learned to respond to our emotional hunger by eating. However, we must begin to take emotional eating seriously, and thus ourselves seriously.

Member: I have always had a body image problem, and I don't want to filter that down to my girls. I think they are so beautiful. How can I boost their self-confidence and help them love their bodies?

Oliver-Pyatt: I, too, share your worry and anxiety as a mother of two beautiful girls. I worry about what our society is teaching them about food and about their bodies. I believe our worry is warranted. I would urge you to consider that the first step is in providing unconditional love. Which, it sounds to me, you are doing.

We also need to foster healthy attitudes about food. If we are feeling neurotic or compulsive about food, we must do our best not to discuss this with young children. We must not be making value judgments about food groups or our right to eat. We can also provide for our children order and structure with regard to eating. This is something that has been nearly lost completely in our society. For example, we can turn the television off. Children watch far too much television and not only are they given warped messages about their body from the images they view on television, but when we eat dinner and graze in front of the television, we are encouraging mindless or not hunger-based eating.

We must teach our children that their need and desire to eat is a valid one. And at the same time, provide structure and order with regard to food. This means eating at the kitchen table in a bowl or off of a plate while sitting down.

We need to have a constant dialogue with our children regarding unhealthy cultural messages. We must teach our children to respect all people of different sizes, shapes, and color, regardless of external appearance. We have to have a zero tolerance towards any teasing or bullying of people who don't fit cultural stereotypes.

Also, we must ourselves make a continuous effort to be healthy in our mind and body. When we are content as parents, it provides our children a sense of peace of mind. So taking care of our children implies taking care of ourselves.

Member: My son isn't so concerned about being "skinny" as teen girls are, but he does seem to think that at age 15 he should have six-pack pecs. How can I convince him that this is not realistic?

Oliver-Pyatt: This is a reality that many of us face, i.e., more and more boys also pursuing a body shape that does not make biological sense, however, in this case, becoming larger rather than smaller. I believe the answer lies with providing our children opportunities to develop hobbies, interests, and self-esteem that are separate from the cultural demands that they are bombarded with. For example, helping that child find an interest that validates his sense of self-worth, which is not based on physical size or shape. If your child seems to be only interested in those activities that have to do with their body size and shape, you may want to try exposing them to other choices. However, this is not entirely within your control. You can only do so much. It's a good idea to become creative. I've recently heard of a woman whose daughter transitioned from being obsessed about her shape and feeling fat, to becoming very fascinated and involved with horseback riding. This is a wonderful transition for this young woman. If we can help our children to make these transitions, we are indeed helping them a great deal. I would add that if we, ourselves as parents are able to make these transitions, we are helping them even more.

Quick GuideDiet for Stress Management: Carbs, Nuts, and Other Stress-Relief Foods

Diet for Stress Management: Carbs, Nuts, and Other Stress-Relief Foods

Moderator: Dr. Oliver-Pyatt, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Oliver-Pyatt: If people are interested in finding out my approach to health and fitness, please visit my web site at www.getfedup.com. Also, I'd like to announce that I will be opening a residential treatment program for the treatment of eating disorders in late summer 2003 in Reno, Nevada. For information you can email me at wendy@getfedup.com.

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Reviewed on 10/19/2004 7:52:02 AM

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