Body image: more than meets the eye

Dr. Theresia B. R. Kiberu. MD, DRCOG (Dublin), DFFP,
Member Obesity Management Association.
Consultant, Northern Slimming Clinic, Stockton-on-Tees, England.

Introduction

Body image is a basic ingredient of an individual's personality and is part of more general concept, which we call "self image". Price defines "self image" as the evaluation of our value that consists of ideas we have about who we are and ideas on how worthy we are to other people. Self-image is important for our confidence, our motivation and our sense of achievement (1).

Terms and definitions

Schilder coined the term "body image" in 1935. He defined body image as the way we see ourselves, this involving not only the physicality of the body, the head and body alignment, but also the psychological awareness of such issues as body unity and integrity (2). Other authors like Price defined body image as the way we understand our body, our appearance and the way we think about them (1). He distinguished three basic factors or dimensions of body image: body reality, body presentation, and body ideal.
Body reality - this is the way we understand our body and the way we sense it. This could be described as the actual situation of the body. Since the body constantly changes because of genetic factors, this dimension of body image is constantly being adapted to these gradual changes.
Body representation - this is the way we control our body and the way we present it to the outside world. It includes the manner of our dressing, how we move or pose and generally how we understand that others accept our appearance.
Body ideal - this is the image we have of the ideal bodily characteristics. It is that which we use as an internal criterion to compare and judge both our body reality and our body representation. The body ideal begins to take shape at a very early age and is deeply influenced by the family, and society. Western society has developed a body ideal based on youthfulness, health, splendour and mobility (1,3). Price goes on to say that if at any given point one of the factors of body image changes, adjustments will be made in the other factors so that there is a compromised new image. The body ideal rarely coincides with body reality and as a result, people are rarely content with their body image (1,4). According to Winchell (5), body image includes having four limbs and other external objects a person associates with oneself such as clothes, the car a person drives, the house or neighbourhood a person lives etc. It is not static, changing with age, current fashions, how a person feels about himself/herself, state of health. It also includes how the family and others see the person in the society at large. The society places a lot of importance on a person having an attractive physique (5).

Express yourself

Changes in body image are most visible in teenagers as they pass from childhood into adulthood and it can sometimes be a crisis! The body undergoes rapid physical changes and almost as quickly, interest in the opposite sex manifests itself. The struggle to acquire the desired body image leads them to experiment with fashions, make-ups and join or associate with groups that best enhance that image. They may dress to shock, rebelling against the expected norm. They may find other ways of expressing their individuality by having tattoos or body piercing, much to the annoyance of parents or figures of authority. During this period, pimples (or acne) appear and can spell disaster to the confidence of some teenagers (6)!

Themes on body image

There are several themes on body image. Among these are: that most people are not happy with their body image; the need to conform and be accepted; the influence of the media on what is perceived as ideal body image; cultural and religious influence. Some of these themes are addressed in my own clinic. Although obesity is now a public health emergency worldwide (7), the clients I see consult mainly for reasons of body image.

Case report

In year 2001, I saw a 29 year old lady with a history of inability to lose weight for six months despite adhering to healthy eating and exercise plan. She was sixty-seven inches (5ft 7ins) tall and weighed two hundred and sixty-five pounds. She was grossly obese but otherwise in good health. After the initial consultation, a regime of low calorie diet, regular exercises and appetite suppressant was started. She continued with this regime for twelve months and reached her desired target of one hundred and sixty-one pounds body weight. She was able to fit into her chosen wedding dress! Her joy was recorded in her lovely wedding photographs. She was one of the successes that year. She continues to attend the clinic periodically for support. Although all the clinic staff saw a "young beautiful slim lady" but she was not yet satisfied, she saw that her breasts were too big and this affected her self-esteem. She has since had breast reduction operation. Now whenever she attends the clinic, her radiance, poise and confidence are obvious for everybody to see. She no longer shies away from the beach when she goes on holiday.
Obesity is a hard condition to treat and although there is no cure, it can be controlled. Obesity in men is a problem and is a concern because in men, "being large" is still acceptable or even desired. The health implications of obesity are well known, but facilities, products and self-help programmes to manage obesity tend to be tailored towards women. The imbalance is being addressed by activities such as "Men's Health Week": focus on obesity (7,8).

Acceptance: personal, interpersonal, society

The whole point of body image is to be of value or be accepted by the people with whom a person interacts. Acceptance is at personal, interpersonal and society levels. This is well illustrated by the documentary on a lady called Alison Lapper. A rare chromosomal disorder meant that she was born with no arms and very short legs.

Her childhood was spent in Chailey Heritage School, which was a residential home that specialised in the care of severely disabled children. Well meaning attempts to provide her with functional prosthetics proved impossible and sometimes dangerous. With time she worked out her own way of doing things and got on with her life. I avoid the word "coping", because she is living her life and not trying to live with a disabled body! She is a single mother and has male and female friends. She views her body not as a disable body but a beautiful different type of body. She is an accomplished artist and has been honoured by Her Majesty the Queen for her contribution to art. Her sculpture by Marc Quinn has won a competition to occupy a plinth in Trafalgar Square, London, England (9).

Culture and religion

Cultural and religious influence shape the way one copes with the issues of body image. There was a television documentary in the United Kingdom called "the six stone baby". The baby boy was born to a couple in the UK. His appearance at birth was normal but thereafter he gained excessive amount of weight and by the age of two years, he weighed six stones (84 pounds). He had breathing problems and suffered a heart attack. He has a rare genetic disorder called "Momo syndrome" which is characterised by macrosomia, macrocephaly and ocular abnormalities. The parents of this boy made contact with a Brazilian family who had a child with the same syndrome. At the time of contact, the Brazilian child was a teenage girl. The British parents were devastated by their child's genetic disorder. However, the Brazilian family and their community looked at all children as God's gifts irrespective of their appearance or form. Although the Brazilian girl did not have perfect features, she was accepted by her peers, she appeared well-adjusted and happy (10).

Media influence

The media and fashion influence on body image are blamed for creating unrealistic ideals of body image leaving many people unhappy with the way they look. Fashion models may be genetically tall, long limbed, in most cases beautiful and often 15% below normal body weight. As these images are portrayed right across the media spectrum, there is pressure to comply. People go to great lengths to attain this "ideal" in the hope of enhancing their sex appeal, being loved, and becoming more successful or even happier (11). This is demonstrated in the issue of obesity. Only one per cent of four thousand obese people who took part in a survey was found to be happy with their body shape. They blamed the media and the recent UK government effort to combat obesity. The majority said that they felt like second class citizens. The celebrity shape they aspired to, were Catherine Zeta-Jones for the women and Brad Pitt for the men (12). Gortmarker et al (13) found that people who were overweight as adolescents were less likely to be married when they reach adulthood. The situation was worse for women as they tended to spend less time in school, had lower household incomes and therefore had higher rates of poverty. Puhl and Brownell found that 28% of teachers thought that becoming obese is the worst thing that can happen to a person, 24% of nurses said that they are repulsed by obese people, and that parents provide less college support for their overweight children compared to their thin children (14).

Conclusion

There has always been pressure for the female body to stay attractive and young. The cosmetic industry started making moisturisers, cleansers, and anti-wrinkle creams and so forth in order to try and keep women attractive. The foundation of beauty industries as we see them today were set well before the term "body image" was coined (15). The 1980s marked the change of attitude with more attention directed to the male body. Since then, the number of men having cosmetic surgery just to look good has steadily increased. Exercising to keep muscles toned has become a pre-occupation of both men and women (14). Body image even when not articulated as such has always been around. The society defines the ideal image. The individual measures himself or herself against that ideal. If there is a significant deviation from this ideal, he or she feels insecure and experiences low self -esteem. Most individuals will find ways of adjusting, just as one of my clients, a sun worshipper sunbathing in her garden said to a disapproving onlooker: "if you don't like what you see, look the other way!".

References

1. Price B. Body image: Nursing Concepts and Care. Prentice Hall, New York 1990.
2. Aacovu I. The role of the nurse in the rehabilitation of patients with radical changes in body image due to burn injuries. Annals of burn and fire disasters. ISSN 1592-9566. Mediterranean Council for burns and fires disasters. www.medbc.com
3. Judith Livingstone. Improving body image. International eating disorder referral organisation. www.edreferral.com
4. Cindy Maynard. Body image. International eating disorder referral organisation. www.edreferral.com
5. Ellen Winchell. Body image: Acceptance is step one. Amputee-coalition. www.amputee- coalition.org
6. Helen Hines. Perfect young women talk about image. Published by Livewire Books, The Women's Press Ltd. London. ISBN 0704349833.
7. Banning M. Obesity: patho-physiology and treatment. Journal of the Royal Society for the Promotion of Health 2005; vol.125 (4): 163.
8. Baker P. Men's Health Week: focus on obesity. The journal of the Royal Society for the promotion of Health 2005; vol.125 (3): 112.
9. Alison Lapper: Extraordinary People.
10. The six stone baby: Extraordinary People.
11. Lydia Campbell. Ultimate Legs Burns and Turns. Firm not fat. Published in 1996 by Boxtree Ltd, Broadwall House, 21 Broadwall, London. ISBN 0752205560.
12. British Broadcasting Corporation News/Health: Obese in despair about their size. www.newsvote.bbc.co.uk
13. Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood. New England Journal of Medicine 1993; vol. 329 (14): 1036-7.
14. Puhl R, Brownell KD. Bias, discrimination and obesity. Obesity Research 2001; vol.19 (12): 788-805. www.obesityresearch.org
15. War Paint. "Helena Rubinstein and Elizabeth Arden: their lives, their times and their rivalry" by Lindy Woodhead. Printed by Virago Press. ISBN 860499740.
16. Alicia Potter. Mirror Image. www.infoplease.com

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