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How do you feel about your body? And how is that perspective working for you?

Body weight and body image are among the most challenging and perplexing health and wellness issues we face. You may have noticed the tension between these two familiar messages:

• Being underweight, overweight, or obese may be problematic for our health.
• Controlling our weight is difficult and may be stressful. Our efforts may backfire and increase our risk of anxiety and depression, disordered eating, obsessive behaviors, and other health problems.

Why weight and health are difficult to navigate

In part, it’s because of the negative judgment attached to some body types. Some health experts say the medical focus on body mass index (BMI)—a person’s weight measurement divided by their height measurement—plays into this stigma. “Weight dissatisfaction” makes people less able to adopt healthy behaviors, according to a 2015 study in Current Obesity Reports.

How body image affects our health

On college campuses, these risks are evident. “There is this cultural belief that people have to be dissatisfied with themselves in order to make behavioral changes to improve their health,” says Sara Stahlman, marketing and communication coordinator of Campus Health Services at the University of North Carolina at Chapel Hill. “In fact, the opposite has been shown; people take better care of their bodies when they hold their bodies in high regard.” Many health care professionals agree. Stigmatizing body size makes people “sicker, poorer, lonelier, and less secure,” says Dr. Deb Burgard, a psychologist in California who specializes in body image, weight, and health issues.

How weight is (and isn’t) relevant

Some experts say we should take weight out of health advice altogether. Others say that is unrealistic because weight is related to health. The evidence seems to come down to this:

• Can body weight and size negatively affect our health? Yes, but it’s complicated. Body type/weight is one of many factors that influence our well-being. Someone of “normal” weight is not necessarily healthier than an overweight person.
• Is weight change a useful and effective goal? In practice, probably not, since focusing on weight may introduce other health-related risks. Other benefits of self-care—such as improved energy, stress relief, and pleasure—can be more consistently and positively motivating.

“We can reduce the likelihood of disease without ever talking about weight or BMI,” says Stahlman. This approach, she says, “gives everyone permission to feel good about themselves and good about their process of becoming healthier, even if their weight never changes. And when people focus on the process toward health—the behaviors they have control over—their risk of disease goes down.”

How can I care for my own health and support others?

“Those looking to improve any aspect of their health need a squad. A proper squad should include a medical and/or fitness pro; a friend to relax and have fun with; another friend who’ll throw shade if you let go of what’s been working for you; and, finally, an everlasting cheerleader.”
—Roslyn Mays (Roz the Diva), a fitness trainer and pole-dancing instructor, New York (to SH101)

Does being overweight or obese increase my risk of disease?

“Weight is not a behavior, or a choice; it’s an outcome, and not entirely under our control. Genes exert an effect, as does the microbiome [micro-organisms in the body]. So there are problems with a focus on it, but there are problems ignoring it as well, as it does correlate with health risk.”
—Dr. David Katz, founding director of the Yale-Griffin Prevention Research Center at Yale University and president of the American College of Lifestyle Medicine (to SH101)

Why is body mass index (BMI) controversial?

“Science supports trying to control weight in general but it doesn’t support forcing every individual into the same mold of an ideal BMI range of 20–25. Fitness may be as important [to health] as fatness.”
—Dr. Harriet Hall (“The SkepDoc”), a family physician writing at Science-Based Medicine

What’s the risk in focusing on my BMI and weight?

“The stigma of [being] overweight—in the media, society as a whole and even the medical profession—can hold people back from getting help. The over-focus on shape and size can lead to unhealthy practices and even a sense of helplessness and hopelessness.”
—Dr. Ramani Durvasula, clinical psychologist and professor of psychology at California State University, Los Angeles (to SH101)

Is there a more effective way to set health goals?

“Healthy at any weight means an evaluation of one’s overall self and body, instead of just reducing oneself to a number. If a person feels that, at any weight, their choices promote their overall health and well-being (rather than engaging in unhealthy practices to ‘get the number down’), they can establish lifelong health habits.”
—Dr. Durvasula (to SH101)

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In how many ways can eating be disordered? Anorexia and bulimia are familiar terms, and you might have heard of binge eating disorder. What about orthorexia, rumination disorder, muscle dysphoria, drunkorexia, or night eating disorder? Some are clinical diagnostic terms; some have been coined in the community. These and other terms reflect the broadening recognition that disordered eating, eating disorders, and body image issues can manifest in many different ways—including out-of-control eating, obsessive weight-training, cutting out food groups, abusing certain medicines, skipping meals before drinking alcohol, and more. Often, these behaviors both reflect and reinforce emotional health challenges.

How self-criticism can harm us

In many cases (but not all), disordered eating is related to an urge to more closely resemble a popular physical type. “People often feel that peace with your body is conditional: ‘I’ll accept my body when I lose weight or when I exercise more often,’” says Dr. Megan Jones, clinical assistant professor at Stanford University and chief science officer at Lantern, an evidence-based program for improving body image and reducing disordered eating behaviors.

“However, research shows that when you are less self-critical and improve your body image, you’re actually more likely to do the things necessary to optimize your emotional and physical well-being.”

What do many people with eating disorders have in common?

Body image & shame

Negative body image
Thoughts and behaviors might include:

• Body-checking: Obsessively checking the mirror, scrutinizing parts of the body, or holding/pinching skin folds
• Self-scrutiny: Criticizing your own body, in your head or out loud
• Constant comparison: Comparing one’s own shape and size to that of others

Shame and guilt
Shame and guilt often follow the act of eating. People with eating disorders may feel unworthy of food as a source of nourishment, pleasure, or recovery.

• Shame is a feeling of being inherently flawed: “I am bad/wrong.”
• Guilt is feeling regretful about an action or behavior: “I did something bad/wrong.”

Black & white thoughts

Cognitive distortion: Black-&-white thinking
Cognitive distortions are destructive beliefs and self-judgments; these can reinforce eating disorder behaviors. Often, these are learned early in life.

Black-and-white (polarized thinking) is an “all or nothing” mentality that leaves no room for middle ground.

• Food choices are categorized as “good” or “bad”, “safe” or “unsafe”.
• Black-and-white thinkers tend to alternate between extreme behaviors specific to food and exercise (all or nothing).
• Typical thought: “I already blew it by eating that cookie with lunch… Now I’m just going to eat whatever I want for the rest of the day and start over again tomorrow…”

Cognitive distortions

Personalization, mind-reading, and blaming

Personalization

• Constantly measuring one’s worth by comparing oneself to others
• Typical thought: “I’m the biggest person in this room.”

Mind-reading

• Making assumptions about what others think of us without substantial evidence
• Typical thought: “I hate grocery shopping because when I have lots food in my shopping cart, everybody around me is thinking I’m a fat pig, and I can’t handle that.”

Blaming

• Taking the victim role: e.g., “They made me feel bad about my body so now I don’t care; I’m just going to binge on whatever I want.”
• Blaming ourselves: e.g., “My ex broke up with me because I’m not good-looking enough.”

Cognitive distortions

Over-generalization and catastrophic thinking

Over-generalization

• Taking a small piece of evidence or a one-time event and jumping to conclusions about “always” or “never”
• Typical thought: “I gained weight this weekend… I will keep gaining weight every weekend for the rest of my life.”

Catastrophic thinking

• Worrying about worst-case scenarios
  on a regular basis
• Typical thought: “What if I lose control around food? If I’m alone then it’s possible, and since I will be alone later then it will definitely happen to me…”

Rigidity & isolation

Extreme rigidity

• Calorie-counting and setting a daily
  calorie allowance
• Strictly measured portions
• Food rules: cutting out certain types of food
• Limited variety; lack of flexibility: eating the same foods or food combinations every day

Social isolation

• Avoiding social situations centered around food, such as restaurants, birthday celebrations, and holiday parties
• Stems from fear of being judged or feeling pressured to eat a food that makes them anxious

Student story
“When people [manipulate] the natural way their bodies function with [eating disorder behaviors], it changes their personality, values, and attitude.”
—Randi P., fourth-year undergraduate at Pittsburg State University, Pennsylvania

Official eating disorders & related diagnoses: old & new

In 2013, the American Psychiatric Association updated its categories of eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new diagnostic criteria are intended to support more individualized treatment approaches and achieve better outcomes.

These descriptions are abbreviated; they do not include information on the frequency and duration of relevant behaviors. Eating disorders should be diagnosed by a health care professional with relevant expertise and qualifications.

• Anorexia Nervosa: Restriction of energy intake (calories) leading to a significantly low body weight, with intense fear of gaining weight and often denial of the seriousness of low body weight; “subthreshold” anorexia nervosa involves similar behaviors with a normal body weight
• Avoidant/Restrictive Food Intake Disorder: Restrictive eating patterns ranging from feeding problems in infancy to restrictive eating in a young adult afraid of choking or vomiting; the causes are psychological but do not involve distorted body image or weight concerns
• Binge Eating Disorder: Binge eating not followed by compensatory behaviors; “subthreshold” binge eating disorder involves similar behaviors with less frequency
• Body Dysmorphic Disorder: Extreme preoccupation with a perceived flaw in appearance, interfering with daily life; not an eating disorder per se, but may accompany one
• Bulimia Nervosa: Binge eating (eating abnormally large amounts of food, past the point of feeling full, and feeling out of control while eating) followed by compensatory behaviors, e.g., self-induced vomiting, abuse of laxatives and diuretics, or excessive exercise; “subthreshold” bulimia nervosa involves similar behaviors with less frequency
• Muscle Dysmorphia: Extreme preoccupation with the desire to have a muscular physique; not an eating disorder per se, but may accompany one
• Night Eating Syndrome: A pattern of eating very late in the evening or in the middle of the night
• Pica: Repeatedly eating non-food substances, e.g., dirt, clay, chalk, or laundry detergent; most often seen in pregnant women or people with iron-deficiency anemia
• Purging Disorder: Compensatory purging behaviors without binge eating
• Rumination Disorder: Regurgitating food, then re-chewing, re-swallowing or spitting it out; may be present with anorexia or bulimia

Eating disorders VS Disordered eating

Eating disorders:

• Eating disorder refers to a serious psychiatric illness involving intrusive thoughts and actions related to food and weight that interfere with physical, social, and emotional health. “People don’t realize how disturbing [eating disorders] can be until there are dire consequences,” says Jen Rego, a licensed psychotherapist in Marlborough, Massachusetts, who specializes in eating disorders. Eating disorders have the highest mortality rate out of any emotional illness, according to the American Journal of Psychiatry (2009). Causes of death include heart failure and suicide.

Eating disorders vary; they tend to involve behaviors like these:

• Restricting food intake
• Binge-eating: consuming large amounts of food in a relatively short time frame, to the point of feeling out of control and uncomfortably full
• Purging: self-induced vomiting, abuse of laxatives, or diuretics
• Use and abuse of diet pills
• Compulsive exercise with the goal of burning calories: More info

Engaging in multiple methods of compensatory behaviors (efforts to purge or offset calories from food) is associated with more severely disordered eating.

Disordered eating:

• Disordered eating is a broader term that describes an unhealthy relationship with food. All eating disorders involve disordered eating. But someone with disordered eating does not necessarily have a full-blown eating disorder.

Signs of disordered eating include:

• Abnormal, quirky behaviors and patterns related to food and eating
• Changes in eating patterns due to temporary stressors, high-pressure events, or an injury or illness
• Obsession and extreme rigidity around food choices
• Anxiety related to eating certain foods or eating in certain situations, e.g., with a large group of people
• Attempts to offset the calories from alcohol consumption (e.g., avoiding food or exercising obsessively)

Screen yourself

What are “orthorexia,” “drunkorexia,” and other unofficial eating disorders?

Orthorexia 
Restricting the type (but not the amount) of food to the point that it negatively affects quality of life: “healthy eating” taken to an extreme. Research suggests “orthorexia” may be related to obsessive-compulsive disorder and may be more prevalent in men than women.

Student story  
“I have seen a lot of people become ‘gluten-sensitive’ as a reason to remove grains from their diet. Many people see food as an enemy and focus on removing it from their life instead of focusing on making good choices that help energize their body.”
—Jessica T., first-year graduate student, Emory University, Georgia

Drunkorexia  
Restricting food or exercising obsessively to compensate for calories from alcohol. Research shows a strong association between heavy drinking, high levels of physical activity, and disordered eating in college students, according to a 2012 study in the Journal of American College Health. “Drunkorexia” is more prevalent among women than men and is motivated by concerns about body weight, according to a 2014 study in the same journal.

Pregnorexia refers to a resistance to gaining weight during pregnancy.

Diabulimia refers to behaviors in people with insulin-dependent (Type 1) diabetes who restrict their insulin to manipulate their weight.

What contributes to disordered eating?

Disordered eating likely reflects a combination of risk factors. Researchers are exploring many of these influences:

• Genetics
• Certain personality traits; e.g., anxiety, perfectionism, competitiveness, hyperactivity, and compulsiveness
• Emotional health issues; e.g., traumatic experiences, addiction, depression, and stress
• Environmental influences:
  • Idealized media images reinforce
    a narrow definition of attractiveness
  • Dieting in early life is related to eating disorders and obesity later
  • Social pressure and judgment (“body shaming”) contribute to eating disorders and obesity
  • Life transitions can increase exposure to possible triggers
  • Performance pressure—e.g., among athletes—can contribute to stress relating to body weight and shape

Helpline, treatment referrals, support groups, and tool kits

How common is this among students?

How to get along better with your body & your food

Here’s how Marci Anderson, MS, CEDRD (Certified Eating Disorder Registered Dietitian) in Cambridge, Massachusetts, breaks it down:

• Mindful eating: using the five senses to fully experience foods
• Self-care: nourishing the body and mind with a range of nutrients
• Self-worth: feeling worthy of food, health, and happiness
• Intuitive eating: being in touch with our hunger and fullness cues
• Flexibility and variety: choosing different foods and meals from day to day, without stress or anxiety

Why body shaming fails and how you can counteract it

Body shaming (criticizing your own looks or someone else’s) can reinforce destructive self-beliefs and drive disordered eating behaviors, according to research. “Body shaming is a huge issue right now. Instead of encouraging people to have the ideal body, we need to encourage the ideal of loving the body you have,” says Sara A., a first-year graduate student at the University of North Texas.

Focus less on weight and body shape in your conversations. You may think you’re complimenting someone by saying, “Have you lost weight?” or “You look like you’ve been working out.” But you’re actually reinforcing the stereotype that thin means beautiful or that muscular means good looking.

Discuss the health and emotional benefits of healthy eating and physical activity, rather than their impact on appearance. For example, ask your friend whether the dance classes are helping him feel stronger or sleep better.

• Resist criticizing your own body. If your friend or family member criticizes theirs, say, “You know I love you, and it hurts me to hear you say that about yourself.”
• Worried about your friend’s disordered eating? Here’s how to talk to them about it.

How and why to tune out some of that media stuff

In a recent CampusWell survey, nearly 70 percent of respondents said the media’s portrayal of unrealistic body images affects the way they feel about their own body. Research has shown benefits from interventions that help people become more aware of the influence of the media on their body image, according to an analysis published in BMC Psychiatry (2013).

• Photoshop® and lighting are extensively used to make actors and models appear thin, chiseled, and flawless. Sometimes, they take things too far. For examples, search online for “Photoshop mistakes.”
• Many actors dedicate considerable time and energy to diet and exercise, especially if their roles require a certain body type. That’s their job. It’s probably not yours.
• The media play to our insecurities in order to sell us something—like miracle creams and get-buff-quick products (which don’t work).

“The thing that we have to understand and accept is that those images are unobtainable. Guys will not have flawless bodies with perfect abs, pecs, arms, etc. Similarly, girls will not have thin waists, large busts, larger butts, etc. Eating disorders can happen to anyone… boys too.”
—Michael D., first-year undergraduate, Southwest Minnesota State University

Hang out with people who nourish your self-belief

• If a friend or family member comments on your weight (positive or negative): “Thank you, I care about my health, but I try not to let my weight be a focus.”
• When you’re tempted to compare your own looks to someone else’s, try to think about their—and your—positive traits that aren’t related to appearance. What do you admire about their personality? What might they admire about you?

Student story
“Being a black woman in a predominately white culture has taken a toll on my self-image. I still have my struggles about how I look, but having friends who do not emphasize highly unrealistic standards of beauty, and who embrace themselves, has really helped.”
—Third-year undergraduate, Rollins College, Florida

Student story
“The way to overcome a negative body image is to be around people who support you and make you feel good about your body. Once you are around people who love you no matter what you look like, you can really start to love yourself and love your body.”
—Chaminie D., fourth-year undergraduate, San Diego State University, California

How to disempower your inner critic

• “I like that I can dunk a basketball.” 
• “I’m really good with kids and can’t wait to finish my degree in elementary education.” 
• “I’m a pretty darned good computer programmer, if I do say so myself!” 
• “I’m a supportive and loyal friend.”

“Silencing the inner critic is a key step in the process [of accepting your body]. But it also involves being willing to let go of that critic.”
—Dr. Megan Jones, chief science officer at Lantern, a program for improving body image and eating behaviors

“Make a list of things you like about yourself that aren’t related to what you look like. Everyone has strengths; what are yours?”
—Dr. Rebecca Puhl, deputy director of The Rudd Center for Food Policy and Obesity and professor at the University of Connecticut

“Whenever possible, challenge yourself to think about your body in terms of what it can do instead of in terms of how it looks. For example, if you find yourself feeling bad about how your legs look, remind yourself of all the things those legs do for you. They move you around in the world. They let you dance. Focusing on the functions of your body is a great way to treat your body with more kindness and respect.”
—Dr. Engeln, psychology professor, Northwestern University, Illinois

Get active to help your body and mind support each other

Almost any type of regular physical activity can help people feel better about their bodies, regardless of the effects on their fitness and body shape, according to a 2009 meta-analysis of studies by researchers at the University of Florida.

Student story
“As someone who has struggled with disordered eating and body image since my early teens, I understand the temptation to punish my body. It is very easy to hate yourself in a world that trains you to critique and loathe your body for what it isn’t instead of appreciate it for what it is. Physical exercise forces you to come to terms with the fact that your body is a miracle, and can lead to positive body image and an increased sense of accomplishment and self-worth.”
—Second-year undergraduate, Mount Allison University, New Brunswick

When exercise isn’t working
If you find yourself exercising compulsively or punitively to compensate for what you’ve eaten or drunk, this may be a symptom of disordered eating.

Try a self-guided online intervention

Some internet-based interventions appear successful in preventing and/or treating eating disorders, according to studies. For example, Student Bodies™, an eight-session program developed for college students at risk of eating disorders, is based on cognitive-behavioral therapeutic techniques. Inquire at your campus counseling center about accessing an online (or other) intervention.

Helpline, treatment referrals, support groups, and tool kits

Eating disorders are serious health conditions that require medical attention and personal and professional support. It’s estimated that in the US, 20 million women and 10 million men will have an eating disorder at some point in their life. To increase the chances of recovery, early detection and intervention is key.

Symptoms vary according to the type of eating disorder. The signs can include:

• Not eating enough
• Intense fear of weight gain
• Frequent periods of eating large amounts of food (which may or may not be followed by behaviors to stop weight gain, like induced vomiting)
• Feelings of shame or guilt around eating

How to help a friend

If you’re worried a friend might have an eating disorder, here’s what you can do to help:

• Be honest with your friend that you’re concerned. You could say something like, “I’m concerned about you, because you don’t eat breakfast or lunch.”
• Don’t make promises or threats, e.g., “If you don’t get help, I won’t speak to you again”
• Use “I” statements instead of “you” statements (which imply blame). E.g., avoid saying “You just need to eat” or “You are acting irresponsibly”.
• Compliment your friend on their accomplishments and successes.
• Express your support.  Let your friend know you are there to help/talk.
• Ask for help! You’re not expected to have all the answers. If you need advice or help, talk to your school’s health or counseling center.

MORE INFO: National Eating Disorders Association

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Has your dark mood ever driven you to a frenzy of ice-cream madness? Could you use a natural antidepressant without any side effects?

Certain foods can make or break our moods

What we eat can affect our moods for up to two days afterward, research shows. Foods packed with vitamins, minerals, and omega-3 fatty acids—fruits, vegetables, whole grains, fish, and so on—can alleviate anxiety and lift our spirits. That’s not just because we’re feeling smug about eating something that’s good for us. The mood boost appears to come from the properties of the foods themselves. And unhealthy foods high in fat, sugar, calories, or sodium—like cheap hamburgers, candy, and chips—seem to make us miserable.

Messing with food messes with feels

“On the biological front, food is used to alleviate hunger, so it is a basic need and leads to a physiological reward and positive feelings,” says Dr. Carol Landau, clinical professor of psychiatry and human behavior and medicine at Alpert Medical School, Brown University, in Providence, Rhode Island. “The situation becomes more complicated when food additives and fat, sugar, and salt are added.”

Students sacrificed their mood to science

Undergraduates who ate foods high in calories, saturated fat, and sodium reported feeling moody and blah for up to two days afterward, reported Dr. Helen Hendy, a psychologist at Pennsylvania State University, in the journal Appetite (2012).

But students who ate fruits and vegetables felt happier until the following day, even after other influences had been ruled out, according to Many apples a day keep the blues away (2013), a British study. Meaningful improvements in mood were associated with seven to eight servings of fruits and vegetables a day. (In 2007, the CDC moved away from its five-a-day message, in favor of “Fruits and veggies—more matters.”)

As students, our time and money are limited. But we don’t have to settle for processed foods that leave us feeling crummy and tired. Try these mood-boosting, inexpensive snacks. For full-on happy feels, combine them into our Ultimate Easy Happy Salad:

Oranges

Cost $1.00 for a navel orange
Why oranges work Vitamin C boosts energy levels by aiding iron absorption;  Vitamin B6 and B9 (folate) appear to protect us from depression; thiamine is linked to improved mood
Happy bonus Vitamin C protects the immune system (but won’t cure your cold)
How to eat Unpeel, chomp, wipe fingers

Walnuts

Cost $5.49 for 6.5 oz. tub
Why walnuts work Zinc and omega-3 fatty acids promote calm. Vitamin B9 (folate) appears to protect us from depression
Happy bonus Omega-3 fatty acids help decrease inflammation and disease risk
How to eat From the packet—or crack ’em open

Carrots

Cost $1.00 per 16 oz. pack
Why carrots work Vitamin E stimulates dopamine, a neurotransmitter associated with feelings of reward and pleasure
Happy bonus Vitamin A is good for our skin
How to eat Dip in hummus or ranch dressing

Spinach

Cost $2.49 per 8 oz. pack
Why spinach works Vitamins B6, B9, and C, and omega-3s help synthesize mood-boosting brain chemicals like serotonin and dopamine
Happy bonus Antioxidants help us resist disease
How to eat Sauté or use in our Ultimate Easy Happy Salad