Dr. Gaudet: Getting a Healthy Body Image

Anne, a 24-year-old patient who had come to me for a routine exam, worked out regularly and was an ideal weight. Nonetheless, during the course of our appointment she rattled off a dozen things she "hated about her body." She thought she was proportioned all wrong, with breasts too small and hips too big. She refused to go to the beach with her friends because she felt so self-conscious.

As a physician, I interface with women and their bodies every day. Although some of my patients have a healthy body image, many don't. I see women of all ages who are lightning quick to point out their so-called problem areas. Hips, stomach, thighs, breasts, lips -- there's not an inch that escapes scrutiny. The degree of criticism, even loathing, can be alarming. Pointing to her arms, a patient of mine in her 50s asked, "Have you ever seen something so ugly?" These women would never speak of anyone else so harshly. But about themselves, there's often no-holds-barred judgment.

These judgments aren't based on logic. Our bodies are concrete, physical. But there's frequently a distortion between what they are and how we perceive them. When women criticize their bodies, it's as if they're talking about something separate from themselves. In my view, this is possible because most of us "live in our head" much of the time, disconnected from the flesh and blood that carries us around every day. When you feel separate from something, you can look upon it as an outsider. And if you're playing the role of the critic, you don't have to look far to find the ideal against which to measure yourself: Images of "the perfect body" are everywhere. Whether yesterday's waifs or today's sculpted, washboard-abs models, it's an impossible standard.

None of this is news, but people aren't aware of how far-reaching the consequences are. Women internalize these images, often from an early age, and then begin to objectify and criticize their own bodies -- as if it's their body's job to be perfect. When it fails to meet these standards, which is inevitable, women punish their bodies in some obvious and less-than-obvious ways. In my experience, for many women who overeat or under eat, are sedentary or work out obsessively, smoke or drink too much, or have unhealthy sexual relationships, the root cause is often a distorted body image.

So how do you forge a healthier relationship with your body? Simply spending more time "in" it helps. For those who don't exercise, taking daily walks with your attention turned to your body (noticing how it moves, how it feels) can be a great start. For those who do, instead of tuning out with magazines or focusing on burning calories, simply feeling the sensations -- your muscles working, your feet hitting the ground -- can begin to reconnect you to your body. And, although it might sound paradoxical, one of the most powerful tools for healing body image is guided imagery. Done with a practitioner or by yourself, imagery can help us understand and integrate parts of ourselves from which we've become disconnected.

A few years ago I began working with a woman named Shelley who had come to me with chronic weight issues. She was obese, and her blood pressure had slowly been rising. "I know why I need to lose weight," she said, "and I know what I need to do. I just can't seem to do it."

During our first session, I asked her to let an image representing her body come to mind. Within a few moments, she saw a straight jacket. After she took time to notice everything about the straight jacket, I asked her to start a conversation with it. (To the intellectual mind, this can sound crazy. It helps to think about it as you would a dream, in which images have a life of their own.) Shelley noticed that in her image, she could move her fingers and her toes, but nothing else. Even her breathing was restricted and uncomfortable. She asked the straight jacket if she could step out of it. It replied, "No." She asked, "Why not?" It replied, "Because I define you."

I suggested that Shelley ask the straight jacket whether there's anything it wants or needs. "To be loved and cared for," it responded. She opened her eyes and looked genuinely shocked. "I have never thought of my body as something that needed love; I've spent most of my time hating it." This exchange marked the beginning of Shelley's ongoing conversations with her body image, and a changing relationship with her body. As she became more connected to her body, she began to enjoy going to the gym, and she started sticking to the Weight Watchers program. I'll never forget the picture she gave me of the first 10K that she walked. She was glowing, and 56 pounds lighter.

Shelley's experience points to a universal truth: We take care of the things we love and feel connected to, and we neglect or try to destroy the things we don't. It's that simple.

It's important to note that many women have experiences that drive them even further away from their bodies. Sexual abuse, physical abuse, or trauma can alter one's relationship with one's body profoundly. Subtler damage is even more pervasive -- in addition to the media barrage, many women remember a parent's harsh or judging comments about their body.

I encourage women who have experienced any kind of trauma to explore it with a health professional. Wherever we start from with body image work, we experience a fundamental shift when we understand that the body that we were blessed with is ours, with all of its uniqueness. Once this shift happens, women begin to view their "imperfections" with compassion. They often stop seeing imperfections at all, in fact. They simply see what it is, and greet it with tenderness. When Anne, the 24-year-old who avoided trips to the beach, did imagery, she saw a baby chick, all slick and yellow and adorable. At first the chick kept trying to hide from her.

When Anne asked why, the chick said, "You are always so mean to me." Anne felt horrible; this creature was precious and defenseless. And suddenly Anne got it -- she was harsh, even cruel, to herself at times. Slowly, her relationship with her body changed. She started appreciating how fit and strong she was and seeing her proportions as "just her." Anne taped a picture of a fuzzy chick to her bathroom mirror to remind herself of this message.

We can keep our hearts and souls tucked away, but our bodies are, by nature, on display, and therefore vulnerable. Body-image work is work, but the rewards ripple outward, affecting your health and your life. As you consciously connect with your body, your motivation to take care of it comes not from the pursuit of perfection, or from discontent or loathing, but from a place of love. As with most things in life, out of love can come amazing results.

Text by Dr. Tracy Gaudet.

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