Your Body Image -- Wendy Oliver-Pyatt, PhD -- 9/25/2003

WebMD Live Events Transcript

What do you see when you look in the mirror? What do you want to see? What is healthy for you? On Sept. 25, 2003, Wendy Oliver-Pyatt, MD, instructor for the WebMD University course "Eating Well Is a Start Towards Healthy Living," 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: Welcome to WebMD University: "Eating Well: A Start Towards Healthy Living." Our instructor today is course leader Wendy Oliver-Pyatt, MD. Today we are talking about having a healthy body image.

Support for this WebMD University course provided by Medical Mutual.

Member Question: I have a terrible body image. I am 53, and find every excuse in the book to not lose all the weight I should. I do feel very hungry when I try to lose weight, and I do give up, eventually. I really hate being fat!! I don't remember what it like being really skinny. Can you help?

Oliver-Pyatt: I certainly hope that I can help you. However, I think what we ought to start out with is observing that much of the language you use to describe yourself seems to be filled with unloving comments and thoughts.

The first thing I would ask you is, what are the ramifications of self-loathing thoughts? One of the things dieting sets us up to do is to feel like a failure. We need to backtrack even further and become curious about where our definition of beauty or having a satisfactory body is derived from. The preoccupation with body size and shape so prevalent in our society negates the many wonderful aspects about ourselves that are often present and yet ignored or not acknowledged.

So I would ask you to start off by noticing how you're thinking about yourself and where this may lead you. I would urge you to consider looking into Step 3, decide you are good enough today to love yourself today to begin to understand how self-love is the most powerful tool for fitness of mind and body

Member Question: I just received a catalog from Lane Bryant, a company that sells clothes to women size 14 and above. The majority of the models in the catalog are stick thin! How can we accept ourselves if the people making clothes for us won't even show us wearing them?

Oliver-Pyatt: You've made such an important point. We do absorb the images that we are bombarded with daily. You've probably seen nearly 2 million television commercials over the course of your life, and 20,000 magazines containing more than a million ads. Swimming in the sea of cultural images does have an impact on us. One study found that 69% of female television characters are unusually thin and only 5% are larger than the average-sized woman.

We have to take seriously the cultural pressures that cause us to pursue a body size and shape that denies our physical needs. This is why I emphasize, in Step 2, reject the cultural myth that makes you diet and gain weight; the impact of culture on self-esteem. We must pull ourselves away from the television and pull our self-esteem from within, taking seriously the many aspects of our being that makes us who we are. We must be very serious in our effort to ward off the impact of the hostile environment we are currently living in.

Member Question: I want to see my belly a lot trimmer. I'm 66 and I'm having a hard time losing more weight. I'm in a plateau and can't get out of it. Can you help me?

Oliver-Pyatt: The human body was not designed to contain no fat. Our abdomens were not meant to be rock hard. There are a small percentage of people who naturally have a rock-solid abdomen, but much more realistically, our body is meant to have curves and bumps. As we age our body changes. Through the course of even a month or year our body goes through natural changes.

I would urge you to consider self-acceptance, which may be a more powerful tool to help you heal your mind and body than the dissection and critique of various aspects of your body. Our weight is a range, not a number, which changes over the course of the months, seasons, and years.

When our body stores some extra fuel in the form of fat, it may be doing its best to help prepare for an unforeseen circumstance, such as ill health or an environmental disaster. Our bodies don't know that we live in an era where there is an abundance of food, and it makes much sense for our bodies to retain some fuel, particularly as we age and become more vulnerable physically.

Member Question: How do you feel about the new BMI charts? If I met their weight expectations I would not be healthy and not at a weight considered healthy by my doctor. I think the BMI charts are just as guilty of promoting bad body image as advertisers.

Member Question: Isn't our overall health and ability to perform more important than our shape?

Oliver-Pyatt: The BMI chart, in my view, is simply the least worst of the various charts that are available. A person's physical and mental health cannot be gauged by a chart, as our bodies are much more individualized than this. I indeed had significant misgivings about including the BMI chart in my book. The one reason I leaned toward including it was because it at least included a range of weights and I hoped that people would derive a broader understanding of the diversity of size and shape from noting this.

For example, I went to a WNBA (Women's National Basketball Association) game. I was startled to find that, just like with men's basketball, the roster included the women's height and weight. Four of the players on the court that night were 5'9". One weighed 130 pounds, another 162 pounds. And the other two were 148 and 150. That's a 32-pound weight difference between these beautiful and amazingly fit women who were all fantastic and in the best possible shape. We need to take this very seriously. Just look at Venus and Serena Williams, both are strong, powerful and very different women. What we see from Venus and Serena is self-love and appreciation. This is the beauty that glows from within them, and we see that we no longer are concerned with the fact that one happens to be slightly stockier than the other.

Member Question: Do you think body image is related to our race?

Oliver-Pyatt: I think body image is related, in our society, to our race in some ways. Unfortunately, it appears that our society's emphasis on size and shape may be spreading into other cultures; particularly immigrants to the United States have a much higher incidence of developing eating disorders than those who remain in their country of origin.

Additionally, in Fiji, after western television was introduced we saw a tremendous surge in the rates of food and body preoccupation and eating disorders. So it does appear that there are many cultural factors that affect our tendency to diet, weight cycle, and develop eating disorders.

Member Question: So essentially you are saying that if we are within an acceptable weight range, per our doctor's instruction, and have no complications/limitations due to weight, that we should give ourselves permission to be there?

Member Question: Are you saying that if we still are over our weight limit, but have a healthy feeling about us and feel good, we should not worry about the scale weight?

Oliver-Pyatt: Yes, I would concur if your physician feels that your weight is not affecting your health detrimentally, and you're comfortable with your body size and shape, I would see no reason for being tortured over this. I would encourage you to consider what are the risks and benefits of dieting.

However, that does not mean that exploring your relationship with food may not be worthwhile. Learning how to engage in hunger-based eating and developing a relaxed relationship with food can and does lead to fitness of mind and body, which should go together. Many people in our society eat for reasons other than physiological hunger, and have a tense relationship with food.

One of my purposes is to help people to appreciate and respect the presence of food in their life, as well as to learn how to engage in hunger-based eating. We tend to eat when we are lonely, bored, angry, depressed, or anxious. Exploring our nonhunger-based eating is a far more powerful tool for weight loss than dieting.

Oliver-Pyatt: How do I get past negative comments that were made earlier in my life, such as, 'I love you, but you're getting fat' or 'You have a beautiful face, but you're getting fat?' They're all I can remember when I look at myself in the mirror.

Member Question: I'm so deeply pained when I hear these stories. These are stories of intrusion into yourself. This intrusion does have a significant impact on ourselves as we develop into adulthood. Unfortunately, the road to hell can be paved with good intentions. I would urge you, when you're looking at the mirror and flashing to these harmful comments to take some time to sit down and be with yourself and notice the many aspects of who you are that are noteworthy and important.

Sometimes well-intentioned family members and friends can cause great harm. One thing this can lead to is what I call retaliatory eating. You may find yourself fighting off this intrusion through eating when you're not necessarily physically hungry. This makes a lot of sense and I would urge you to not condemn yourself if this is the case.

I would also urge you to begin to notice if this is happening, and to notice the negative stream of thoughts that may be going on in your mind. I would ask you to be deeply honest with yourself about who you are and to define yourself on those values that are truly meaningful in the course of human existence. This may be a painful process, but I would urge you to be gentle and kind to yourself at every moment.

Member Question: How do our self-body images as mothers affect what we teach our sons?

Oliver-Pyatt: That is a very interesting question. One thing a mother's focus on body size and shape may do to her son is to cause him to pay more attention to his own body size and shape, just as it would to her daughter. Another possible outcome is that a son might begin to have expectations from the other females in his life that they should also place emphasis on this.

Isn't it exhausting for all of us to derive so much of our feeling of value and self-worth on this one particular outcome?

One study shows that liposuction in men went up between 1992 and 1997 from 6,000 per year to 20,000 per year. That's a change of 14,000 surgeries in 5 years. Another study indicating men's growing insecurity with their bodies is that 6% of males try steroids by the time they're 18.

It is misguided to assume that eating disorders only occur in women or in gay men. This is because more and more men diet, and dieting is a significant risk factor for the development of eating disorders, because dietary restraint very typically leads to binge eating and compulsivity with food. Additionally, dieting is much more likely to lead to weight cycling and obesity than it is to weight loss. Therefore, men and women both fall victim to the impact of dieting and food and body preoccupation.

Member Question: I have suffered from eating disorders for over 8 years. I am now 24 years old, eating healthy, exercising moderately, and learning to live a healthy lifestyle. I am proud to say I am recovering and feel wonderful. However, I still don't think I see what others see when I look in the mirror. I still have body dysmorphic disorder and it saddens me so much. Will I ever see "me" again?

Oliver-Pyatt: I don't know if you'll ever see "you" again. However, it sounds that you've made significant progress in your path to recovery, and in individuals with eating disorders body image distortion is the last symptom to go.

In your situation, I would urge you to read Step 3: Decide that you are good enough to love yourself today, as well as Step 10, regarding redefining your life, to help you on the path to self-acceptance.

Perhaps you could engage in therapy to continue to explore your perceptions about yourself. Oftentimes, individuals with eating disorders hold themselves to unrealistic standards in their pursuit and expectation of perfection. Unfortunately, we often forget that "perfection" is the enemy of good enough. Are you good enough today to love yourself today? I would urge you to continue to behave in a loving manner, regardless of whether loving feelings happen to be present.

As you make this commitment to self-love in the form of an action, the healing process can continue.

Moderator: The steps Dr. Oliver-Pyatt refer to are in her book, Fed Up!

Member Question: I am 5'2", 120 pounds. What I see is fat, stretch marks, and extra skin. How do I get rid of that? I work at a gym only a couple hours a day. I come home and eat. I hate diets and I work out but not a lot. I want a fast fix. I want something fast easy and manageable.

Oliver-Pyatt: We all want a fast fix, that's why we spend $30 to $50 billion a year in dieting and weight loss products. Rather than focusing on weight loss, why not focus on developing a healthy relationship with food and exploring your relationship with yourself.

Once again, it seems like much of your focus and inner thoughts are of a very condemning nature. Think about what it's like to live with these kinds of thoughts floating throughout your mind during the day. Becoming gentle with our thoughts is a part of the path to fitness of mind and body.

Let us remember that fitness of mind and body must go hand in hand. The focus on dieting and body size and shape causes us to believe there should be a separation. The "just do it" mentality denies the very complicated relationship between food, body and self, and has proven to be an ineffective tool for weight loss. Until we are ready to take very seriously our relationship with ourselves and with food, we cannot achieve fitness of mind and body.

If all you see are stretch marks, extra skin, and fat, I am certain that you are blinded to the most significant aspects of who you are. Try to focus on all the other parts of yourself that really matter.

Member Question: I'm finding attempting to attain a healthy body image for a reason different then most. I'm underweight and attempting to gain, but am surrounded by all the comments in our society about how to lose and achieve "health" through dieting. So when I try to congratulate myself for gaining a pound or two, I have an internal argument telling me it's bad because society says so, even though it's what my body actually needs.

Oliver-Pyatt: Your comments highlight the reality that we are individuals with diverse emotional and physical needs. We do live in a society where it's one body size fits all. In your situation, you'll have to work particularly hard to focus on your individual self and your individual needs.

We have a tendency to absorb what we are bombarded with on a daily basis. It will therefore require work and mental concentration to focus on yourself and what's helpful and important for you. I define work as mental or physical energy directed toward a goal. In this case, your work will be to maintain your focus on yourself with regard to your physical needs.

Member Question: Can you give suggestions about what helps to keep from eating? Are there tricks when you are not really hungry to tell yourself this food isn't what you need right now?

Oliver-Pyatt: I'm glad you asked this important question. In fact, I do have some tips that may be useful:

  • No. 1, sit at the kitchen or dining room table when eating, not in the living room, not in the car, not while standing. This allows you an opportunity to notice and experience the act of eating. When we watch television while we are eating, we are mentally disconnected which leads us to disassociated eating and we often eat far more than we are really hungry for. So it is very important to learn to sit while we're eating and turn off the television when we are eating.
  • I would also advise you not to eat out of bags, but to put your food on a plate or bowl, further enhancing the experience and pleasure of eating.
  • When we are stressed, tired, angry, sad, lonely, or afraid, we do want to be comforted. It is very reasonable that we want to be comforted when we are hurting, but let us notice that we often follow the path of least resistance when it comes to comforting ourselves. That path is often straight to the kitchen, and unless we begin to notice ourselves and to remain conscious of our inner state, we are likely to follow that path of least resistance into the kitchen.
  • I would also urge you to begin engaging in some sort of relaxing activity that you can actually enjoy and look forward to that integrates your mind and body on a regular basis. For example, a facial, massage, yoga, stretching, or meditation.
  • You may benefit from journaling. When you notice yourself stepping foot into the kitchen when you are emotionally, rather than physically, hungry you can make a choice to sit down and write about what's going on in your mind. Also, it can be useful to determine what I call our "trigger times" and "zone out zones." These are places and times where you may have a tendency to eat for nonhunger-based reasons. For many people this can be at the end of the day after they have worked very hard and they are tired and drained.
  • Also, many people who struggle with emotional eating are those who have a tendency to pay close attention to the needs of others and under attention to their own emotional needs. Learning how to set limits and say no is a part of taking your emotional self seriously, which is necessary for fitness of mind and body.

Moderator: We are out of time. Our thanks to Wendy Oliver-Pyatt, MD, for being our instructor today, and thank you class for joining us! Dr. Oliver-Pyatt's book is called Fed Up: The Breakthrough 10-Step No Diet Fitness Plan, and her web site can be found at www.getfedup.com. She has also recently opened a new residential treatment program in Reno, Nev. for eating disorders called Center for Hope of the Sierras. For information you can email her at wendy@centerforhopeofthesierras.com.



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