Sunday, 31 July 2016 22:54

Body Image and the Legislation of Fashion

Written by  Dr. Michael Pertschuk, Brandywine Hospital

Body image—how we see our physical selves and how we judge what we see—is not always an accurate picture of reality. Our perceptions are colored by what others tell us, by experience, by comparisons with those around us and the images society promotes as ideals.

Body image develops over time and adapts to change, but slowly. People who’ve lost or gained a lot of weight are notorious for misperceiving their bodies, because change in perceptions lags behind actual physical change. We all experience a similar feeling with aging, as we tend to see ourselves as younger than we actually are. A classic example is being shocked at how old everyone else looks at a class reunion.

In the U.S. today, as many as 7 million women and 1 million men battle eating disorders including anorexia nervosa, bulimia nervosa and binge eating, according to the National Eating Disorders Association—that’s over 2 in 100 people. With these potentially life-threatening conditions, patients experience a wildly inaccurate self-perception.

How is it possible for someone who otherwise seems in touch with reality to so badly misperceive her (or his) body? How can a 17-year-old girl of average height see her 65-pound body as “obese”? These remain challenging questions with only partial answers.


Role of Mass Media

There’s more to eating disorders than body image problems. Matters as diverse as trauma and family patterns of eating meals also contribute. And although eating disorders existed centuries before the influence of mass media, there’s a strong sense that contemporary media—along with peer pressure and family attitudes toward weight—play a significant role in developing body image.

A striking piece of evidence of mass media’s impact is the increase in eating disorders following a shift in images of beauty from full-figured females to stick figures in the 1960s, as personified by the model Twiggy. At 112 pounds and about 5 feet 8 inches, Twiggy was described as “boyish” and presented a new look from other models.

Unfortunately this unnatural and unhealthy look has become even more extreme. In fact, by current modeling standards, Twiggy would be considered a bit on the heavy side. According to, a desirable weight for a 5-foot-8-inch fashion model today would be about 90 pounds! 

In the 1970s, there was a sudden and marked increase in identified cases of eating disorders. Before then anorexia nervosa was an obscure disorder the average physician never encountered. But by the 1980s, there were enough recognized cases of the disease for treatment centers to open up around the country.

And a whole new eating disorder diagnosis was officially recognized in psychiatry—bulimia nervosa—defined by weight preoccupation and a pattern of binge eating and compensating behavior, most often purging. It’s hard to imagine that the surge of eating disorder cases and the change in beauty standards were entirely coincidental.


The Lose-Lose of the “Ideal” Image

Girls (and boys) in our society are bombarded with images of “ideal” bodies—on TV, online, on our phones, in magazines and elsewhere. There’s a real concern that pre-teens and teenagers exposed to these images will buy into these “ideals.” Unfortunately, if they do, it’s a lose-lose situation.

If they achieve an anorectic weight, they also get all the health and emotional consequences of malnutrition that go with it. If they “fail” to achieve their ideal body, their self-esteem suffers, and they consider themselves “unattractive” or “fat” because they don’t look like fashion models.

Although there’s been ongoing concern about the unhealthy thinness of models, the fashion industry has been strikingly unsuccessful in changing its practices. However, outside the U.S., in France in 2015 and Israel in 2013, laws were passed attempting to eliminate images of unhealthy thinness from the media.

Israel set a minimum Body Mass Index (BMI), for models, and if a model drops below that mark, she can’t work. For example, with a BMI of 18.5, a 5-foot-8-inch model has to weigh at least 122 pounds. The law also requires a model to obtain a certificate of health before a photo shoot and that photographic images that are altered (for example, using Photoshop) must be labeled as manipulated.

We must all remember there’s nothing preordained about having super-thin models represent ideals of feminine beauty, but there is a serious chance that a shift away could save much grief and some lives.


What Parents Can Do

Parents have a significant impact on their teens’ eating habits and body image. Most teens learn more from good examples than parental lectures, so follow healthy eating habits, share family meals, promote physical activity, use positive language—not fat/thin but healthy/unhealthy—and praise achievement not just looks. Counter negative messages that bombard teens from the media and monitor their online and social media use. And talk with your teens both as a family and as a team with your family doctor.


Treatment Options

There’s a wide range of treatment options available—from weekly counseling to acute hospital care—to help teens and adults get back on track with their lives. What’s needed depends on the extent and severity of symptoms, related health issues and availability of family support, among other issues. Initial assessment by an eating disorder specialist can help provide direction on choices and options.

The good news is that following through with treatment leads to improvement in most cases. 


Know the Symptoms

Typical symptoms and behaviors that may indicate body image issues include:

  • Dieting or overeating to excess
  • Eating only certain types and amounts of food
  • Avoiding social situations that include food
  • “Playing” with food, but not eating it
  • Visiting the bathroom immediately after eating
  • Wearing loose clothing to hide weight loss
  • Exercising compulsively
  • Obsessing over weight and weighing oneself compulsively
  • Thinking and talking obsessively about body image and weight
  • Withdrawing from family and friends
  • Being hypersensitive to comments about food, exercise, weight or body appearance
  • Feeling depressed or having great anxiety or low self-esteem

Dr. Michael Pertschuk, Brandywine HospitalMichael Pertschuk, M.D., is a member of the Medical Staff and Medical Director of the Eating Disorders Unit at Brandywine Hospital. He has 20+ years of experience managing inpatient, residential and partial hospital eating disorders treatment programs. He’s authored numerous research articles and appeared on the Dr. Oz Show, Oprah and GMA.