CONDITIONS & DISORDERS
BODY IMAGE AND EATING BEHAVIOURS Nikki Brierley Specialist Dietitian and CBT Therapist
Nikki has been a HCPC Registered Dietitian for eight years and more recently gained BABCP accreditation as a CBT Therapist. She currently works in a dual role within the Adult Community Eating Disorder Service at Cheshire and Wirral Partnership NHS Foundation Trust.
Body image dissatisfaction can negatively impact on an individual’s health and wellbeing and directly influence eating behaviours. With a reported 50% of the UK population suffering with a negative body image,1 it is clear that this is a subject which needs further discussion and better understanding/ management. The idea of body image (BI) was first developed by neurologists, whilst research was undertaken to understand how the brain interprets information received from different parts of the body. The term BI now refers to how an individual perceives their physical body (i.e. height, shape, weight, size and general appearance) and the thoughts/ feelings that this creates. This results in an internalised sense of what the individual thinks they look like. The subjective appearance may or may not accurately match the objective appearance (i.e. how they appear to others). As such, BI can be described as positive/ healthy or negative/dissatisfied (briefly summarised in Table 1 overleaf), and this can change over time.2 DEVELOPMENT OF BODY IMAGE
The development of BI is understood to be complex and influenced by individual and environmental factors.1 Babies and very young children appear to show little awareness of their own or others’ appearance; however, by the age of around seven, children are able to discriminate between ‘good’ and ‘bad’ appearance. This is reinforced by childhood literature that commonly links goodness with beauty and evil with ugliness.2 Adolescence is a time when the vulnerability to BI concerns increases, as the physical body endures many changes and becomes associated with sexual attractiveness. It is common for teenage girls to worry about their 24
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appearance and strive to the ideal ‘weight and shape’, it is also not uncommon for young males to develop concerns that their appearance differs from the projected ideal of ‘strong and muscular’. This is also a time when the risk of bullying increases and as physical appearance is obvious, any variation form the average is common a target. In addition, mainstream media continues the theme that was commenced in childhood and portrays attractiveness as being linked to success and happiness.2 There can be the assumption that with age, BI concerns reduce and individuals become less concerned with their appearance; however, the very lucrative ‘anti-aging’ market would strongly suggest otherwise. It is also true that if someone’s sense of self-worth has been largely dependent on their appearance, this is unlikely to change with age alone.2 NEGATIVE BODY IMAGE
There is no denying that physical appearance does hold some importance and that first impressions are partly formed due to the judgements made on how someone looks. Indeed, wanting to be attractive makes good sense as it conveys evolutionary and social advantages, with evidence suggesting that attractive children and adults are treated more favourably. However, the way someone feels about their body has a greater influence on the quality of life than how physically attractive they actually are.3