Redefining Beauty and Health of Women

Redefining Beauty and Health of Women Patricia Natalie Master of Arts in Social Design Maryland Institute College of Art

“Why do we let our standards of beauty get in the way of our health?”

Katharyn Dowell, video interview

About Me As my eating disorders hit rock bottom in my last year of high school, I hit the lowest point of my life. My academics, relationships, as well as physical and mental health, suffered.

Exhausted from being engulfed in secrecy, lies, guilt, shame, and fear, I made a promise to myself to rebuild my relationship with my body.

Curiosity, among many other things, pushed me through recovery. I began to learn more about myself as a Psychobiology major at UCLA with a research focus in eating disorders. Over time, as I continued to find answers through informational sessions, discussion panels, and workshops, I started to believe that I would be able to eat normally again.

The road to recovery was and is long, winding, and never linear.

However, this is exactly why I hope to help other women in my position, or even prevent them from going down the same path that I took. The Social Design program at MICA has allowed me to perfectly combine my skills in research and design with my passion in body image to make positive social change.

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ABOUT | ME

About Social Design When we think about the word ‘design’, visual and aesthetics are usually the first things that come to mind.

Design-thinking, however, draws upon empathy to deeply understand the needs of the end user, as well as creativity to address the problem in an innovative yet feasible way.

Social Design utilizes designthinking at its core to address a particular social problem.

This Master’s program at MICA equips its candidates with practical and valuable skills such as design research, social literacy, teaming and collaboration, facilitation, storytelling, and intervention design. Working with a

variety of external partners, we learned to apply designthinking to a wide range of disciplines, from the medical field to social justice issues.

The 2017 cohort consists of 12 students from all walks of life around the world. Though different, all of us have the same goal of using design to create positive social change in whichever area we are passionate in.

ABOUT | SOCIAL DESIGN

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Table of Contents

08

The Problem

18

Research

40

Opportunities for Change

58

Reflection and Next Steps

60

Acknowledgement

09 12

19 23

42 50

61 64

Problem Definition Problem Analysis

Interviews Insights

Current Initiatives Prototypes

References Thank You

The Problem

Problem Definition Body dissatisfaction, especially in women, is a social epidemic that has yet to receive the attention it deserves. Dissatisfaction with one’s body affects most people to some degree, but it is not seen as a problem until it puts one’s health and life in danger, as in the case of eating disorders.

Twenty million women in the United States suffer from eating disorders.1 On average, one of them dies every 62 minutes.2 The lives of these women are critically at stake because unknown to most people, anorexia has the highest mortality rate out of any mental illness3.

Understanding the biological, cultural, economic, psychosocial, and environmental factors behind this illness, eating disorders are highly complex and difficult to treat. Ironically, eating disorder prevention receives little attention in the existing literature as well as health initiatives.4 5 Prevention does not mean eliminating the causes of eating disorders, as there is no specific cause to the disorder. It means reducing negative risk factors, which are situations and events that contribute to and might increase one’s risk of developing the disorder. These risk factors include negative body image, low self-esteem, cultural or peer pressure, stress, traumas, dysfunctional family dynamics, and many others.6 Overall, these risk factors bring back the issue of body dissatisfaction, which impacts almost everyone and most importantly, every woman.7

1 2 3 4 5 6 7

National Eating Disorders Association. “Get the Facts on Eating Disorders.”

The Eating Disorders Coalition. “Facts About Eating Disorders: What The Research Shows.”

National Eating Disorders Association, “Get the Facts on Eating Disorders.”

National Eating Disorders Association, “What is Prevention... and Does It Work?”

Bear, Merryl. “Prevention of Eating Disorders.” National Eating Disorder Information Centre.

National Eating Disorders Association. “Risk Factors.”

National Eating Disorders Association. “Factors that may Contribute to Eating Disorders.”

PROBLEM | DEFINITION

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54% of women would rather be hit by a truck than be fat 8

80%

91%

of women say that just looking in the mirror makes them feel bad 9

of women are simply unhappy with their bodies and resort to dieting 10

Body dissatisfaction is real and widespread because these statistics are frighteningly relatable. Struggling with what we see in the mirror is something we all wrestle with, and saying awful things to ourselves has become normalized in our society.

The desire to be physically attractive is normal and even has an evolutionary basis. This desire, however, can become problematic when it gets in the way of other meaningful pursuits in life. When we do invest heavily in our appearance, it can be counter-productive to our physical and mental health, ability to connect with others, and sense of self-worth.

Body dissatisfaction, therefore, is not recognized as a problem until it compromises the physical, mental, and emotional health of women.8910

Note: This is not to, in any way, diminish body dissatisfaction amongst men that has been shown to increase over the years.11 This issue, however, is significantly more prevalent and pressing in women, with whom I decided to focus on.

8 9 10 11

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PROBLEM | DEFINITION

Engeln, Renee. “An Epidemic of Beauty Sickness.” TEDxUConn.

Dreisbach, Shaun. “How Do You Feel About Your Body?” Glamour.

DoSomething.org. “11 Facts about Body Image.”

Primus, Mitch. “Body Dissatisfaction and Males: A Conceptual Model.”

Body dissatisfaction is not recognized as a problem until it compromises the physical, mental, and emotional health of women

PROBLEM | DEFINITION

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Problem Analysis

To explore why this social epidemic of body dissatisfaction exists and persists, I utilized two of the many tools from Social Design: 1) Levels of Analysis, which examines how the problem in question manifests on the personal, relational, institutional, national, and societal levels, and 2) Five Whys Method, which repetitively asks the question “Why?� to a particular social problem, as each answer forms the basis of the next question.

Using these two techniques in tandem, I first looked at how body dissatisfaction manifests on the personal level, that is, within the individuals themselves. I asked what is happening at the relational level that might explain what happens on the personal level, and then made my way up the levels.

This analysis is visualized on page 14 and 15, where I also examined body dissatisfaction in terms of two big categories: beauty and health.

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PROBLEM | ANALYSIS

Our definition of beauty influences our body image on the personal level where the constant need and desire to enhance looks cause us to turn to food and exercise to look a certain way.

This concern about body shapes and sizes start as early as 5-7 years old, resorting to dieting to improve their appearance.12

representation of body diversity also accentuates one type of beauty, which is the ‘thin ideal’.

On the relational level, the idea that appearance is all there is to beauty might come from the fact that someone’s looks is usually something we comment or compliment on the first time we meet them, which is only expected since looks is the first thing we see on someone, in addition to the evidence that humans are highly sensitive to visual stimuli. Moreover, there is also the desire to attract potential partners because we believe that appearance is highly correlated to attractiveness.

Unsurprisingly, models in the US are currently 23% thinner than an average American woman, compared to 8% in 1968.13 Ralph Lauren model Filippa Hamilton was fired for “being too fat” as defined by the New York Better Business Bureau, as it requires models to be “5’9” to 6”, 110 to 130 pounds, with eyes widely spaced”.14 Our very own president also constantly shamed women’s bodies such as Rosie O’Donnell’s and Alicia Machado’s, making us question our dignity and values as a country. In addition, the recording of his “locker-room talk” serve as a reflection of how degrading and harsh comments on women’s bodies could be, which further intensifies the objectification and sexualization of women.

On the institutional level, media, advertisements, as well as fashion and fitness industries are to blame for this emphasized importance on looks. With digitally altered size-zero models, they portray an unattainable and unrealistic standard of beauty for consumers to strive for. The lack of

On the societal level, the fact that 96% of sexually-objectifying media images are females15 shows the position or role women play in society as sex objects. This perpetuates the root cause of the problem, which is that women are valued more for their looks and bodies than what they say, do, or believe in.

12 Hayes, Sharon, and Stacey Tantleff‐Dunn. “Am I Too Fat to be a Princess? Examining the Effects of Popular Children’s Media on Young Girls’ Body Image.” British Journal of Developmental Psychology.

13 Lovett, Edward. “Most Models Meet Criteria for Anorexia, Size 6 Is Plus Size: Magazine.” ABC News.

14 Better Business Bureau. “Modeling & Talent.”

15 Heldman, Caroline. “The Sexy Lie.” TEDxYouth@SanDiego.

PROBLEM | ANALYSIS

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Beauty

Dissatisfaction with one’s body may arise from the perception that one is not beautiful enough.

How does body dissatisfaction present itself on each of these levels? Starting with the bottom level, what might be happening on the level above that might explain it?

Societal

• Obsession with outer beauty • Objectification of women

National

• Model requirements • Photoshop bans • President Trump’s bodyshaming comments

Institutional

Lack of representation of body diversity in: • Media • Advertising • Fashion industries • Consumer products (i.e., Barbie® dolls, children’s books and video games)

Relational

• Body-shaming conversations • Desire to attract partners • Family and peer pressure

Personal

• Body awareness • Seemingly harmless attempt and desire to enhance looks

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PROBLEM | ANALYSIS

Health

Dissatisfaction with one’s body may arise from the perception that one is not healthy enough.

How does body dissatisfaction present itself on each of these levels? Starting with the bottom level, what might be happening on the level above that might explain it?

Societal

• Overreliance on BMI • Oversimplification and victimblaming of obesity • Incomplete definition of health

National

• Increasing rates of obesity • Affordable Care Act: higher insurance premiums to “offset” the cost of obesity

Institutional

Definition of health as influenced by: • Weight loss industries • Fitness industries • Health initiatives • Media

Relational

• Dieting as social bonding • Effort to “help” others • Family and peer pressure

Personal

• Normalization of dieting • Seemingly harmless attempt and desire to be more “healthy”

PROBLEM | ANALYSIS

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Our definition of health influences many of our daily actions and behaviors. Since food intake contributes to our body weight paired with the assumption that smaller body size equates to better health, dieting is perceived as “always healthy.” Losing weight, eating “clean”, and restricting our food intake are examples of our “goals” or “new year’s resolutions” to improve our health. There is nothing inherently wrong with having these goals, but when one starts to count calories obsessively, develop fears of eating certain food, constantly have compensatory behaviors (i.e., If I eat this brownie I must run 2000 miles tonight), and other actions that see food as the enemy, one risks compromising their mental health in the pursuit of physical health or simply to “look healthy” by society’s standards.

These personal decisions and actions might also be influenced by what’s happening at the relational level. Families and close relatives might think that they’re helping others to make better decisions by commenting on looks and its relation to health, but those comments often come across as body-shaming. Dieting can be seen as a platform for social bonding in that there might be peer pressure to diet together or to follow the latest trends of ‘clean’ food, created by the food and weight-loss industries at the institutional level.

Body-shaming also happens in the healthcare sectors where providers or nurses make patients who are overweight feel terrible, or when insurance companies charge higher premiums for overweight people to ‘offset’ the cost of their health problems.

On the national level, the Affordable Care Act requires insurance companies to help obese patients by covering weight-loss programs, and penalizes heavier employees in that they would have to pay 30% more of their total health benefit coverage. These policies may be in place because the US has one of the highest rates of obesity in the world that has doubled over the past 30 years16, with 70% adults being overweight or obese.17 Overall, society’s strong correlation between weight and health might be the driving force behind what’s happening on all of these levels. The overreliance on BMI as measures of health might prevent us from considering other aspects of health besides physical health.

It does not help that society also puts the responsibility and pressure on the individuals to have a ‘healthy’ weight, blaming their greed, lack of motivation or willpower, and lack of self-control.

16 American Public Health Association. “Public Health Takes on Obesity Infographic.”

17 Centers for Disease Control and Prevention. “Obesity and Overweight.”

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PROBLEM | ANALYSIS

After examining how body dissatisfaction manifests in terms of beauty and health on all Levels of Analysis, it seems that addressing the overarching issues on the upstream levels will be, though challenging, more impactful. It will have significant trickle down effects on other, more proximal issues on the downstream levels. However, structural changes would also be ineffectual without individual-level changes that would work from the bottom up. Therefore, I believe that positive social change will require multilevel interventions that address the issues from all sectors of society.

PROBLEM | ANALYSIS

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Research

Interviews While academic and market research mainly gathers quantitative data from a statistically significant large sample sizes, design research relies on qualitative data based on human experiences and behaviors. Depending on the problem in question, design research usually starts with ethnographic observations and in-depth interviews with the people experiencing the problem.The goal is to use empathy to understand the needs and desire of the end user, in order to gather insights that will inform future design solutions.

In the case of body dissatisfaction, the end user would refer to any woman who struggles with negative body image. Since this is too broad of an audience to target, I decided to reach out to women whose struggle with their bodies compromises their physical and mental health, sense of self-worth, as well as ability to go about their daily lives. By gaining insights into how their relationships with food and their bodies developed over time, I hoped to identify pivot points where we could intervene to prevent body dissatisfaction from either happening or developing into an eating disorder that would put their health and lives at stake.

RESEARCH | INTERVIEWS

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I was fortunate to get in touch again with Jessica Raymond, the founder of Recovery Warriors, an online eating disorder recovery platform I used to work for. It provides free online resources for those in recovery from an eating disorder in the form of podcast, directory of treatment providers, behavioral tracking mobile app, and reading materials.

The company has reached around 750,000 people with eating disorders in 184 countries, but Recovery Warriors was looking to reach a wider audience with general body image issues, beyond the eating disorder population.

Since the bulk of Recovery Warriors’ consumers come from her podcast, Jessica

Jessica Raymond, Founder and CEO of Recovery Warriors

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RESEARCH | INTERVIEWS

saw a huge potential in building an audio educational platform, such as an online course, for body image and health in general. While her podcast centers around eating disorders, the hope for this online course is to attract the general population who is looking to learn more about health, body confidence, and fear or shame in general.

To determine the content of this online course, Jessica and I collaborated in carrying out indepth interviews with the Recovery Warriors community. The aim was to get an insight into their journeys with food and their bodies, in order to determine their needs and the kinds of content that would help them.

We interviewed a total of 45 women who struggled with or have been struggling with eating disorders. Spread across the nation as well as the globe, these women generously shared their time and stories with us through one-on-one online video interviews.

Some of the prompts we asked during the interviews are: • Tell us about the time when you did not have any concern or worry about food or your body.

• How did your relationship with food and your body change after that?

• What do you think could be contributing to it (i.e., family, peer pressure, extracurricular activities, stress, trauma, media)?

• How has your struggle with food and your body prevented you from showing up fully in other things that were/are happening in your life (i.e., school, career, relationships, family, peers, etc)?

• What or who has been the most influential in helping you rebuild your relationship with food and your body?

• Where would you like to go from your current relationship with food and your body?

• If you could change one thing about society or the world that would help women like yourself cultivate a more positive body image, what would it be?

• What would you tell your younger self who was struggling with food and her body?

RESEARCH | INTERVIEWS

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RESEARCH | INTERVIEWS

The interviews generated more than 500 sticky notes, each one containing every single one of their experiences, thoughts, feelings, quotes, concepts, and ideas. For designers, sticky notes are a vital tool in the design process, partly because 1) their limited amount of space constrains each idea to be succinct and focused, and 2) their mobility allows for similar patterns or ideas to be grouped together, which makes up the next part of the design research.

Insights Seeing connections between the sticky notes, I identified some key patterns and clustered those with similar ideas into larger themes. Out of these themes, I crafted what designers call “insights�, which are revelations from individual stories that stand out and communicate overarching concepts.

The most significant insight to emerge was how relationships with food and bodies developed over time. Each story was intricate and unique, but there were key pivot points that recurred in most of their experiences. I have mapped out these pivot points as a journey on the next few page, keeping in mind that it is a largely generalized map that only serves as an overview. Not everyone went through this journey linearly or in sequence, such as those with childhood trauma, dysfunctional family, or sexual abuse, among many others.

The bulk of this section will discuss the journey in detail, using the insights that emerged from their corresponding themes to explain each pivot point.

RESEARCH | INSIGHTS

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Food and body neutrality

As we asked each of the 45 women about the time when they did not worry about food or their bodies, many hesitated, saying that they could not recall the moment or the feeling. For those who did remember, the answer was when they were really young. As a child, these women felt fairly neutral about food and their bodies. They saw food as it is, without the guilt and shame they associated with it today. One of them described it as having “food freedom”, as she was able to focus on other things in her life and not worry or be concerned about food or her body.

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RESEARCH | INSIGHTS

Change in body, identity, or community

At some point, they experienced a change in their body, identity, or community. These women went through puberty without necessarily knowing what was happening with their bodies. The changing of bodies, especially if unanticipated by those who hit puberty earlier than their peers, had an impact on their self-esteem. They started to feel insecure about their bodies and wanted to change it. One said, “As women, as soon as we know we have bodies, we are going to be concerned.”

In terms of identity and community, this could be the result of moving to a new place, being in a new extracurricular activity (i.e., dance, modeling, cheerleading), or just simply being in a new environment where they felt like they were the odd one out.

Restricting food to fit in

In order to feel belonging or accepted in a environment, most felt the need to change something about themselves. Fueled by the beauty standard that is being portrayed in the media, these women felt that pursuing the “ideal” beauty standards was the only way to fit in. They resorted to what seemed harmless and innocent attempts to work towards the “ideal”, such as restricting their food intake, calorie-counting, ‘clean eating’, exercising more, and so forth. Whether it is to improve physical appearance or simply to bond with peers through fat talk* 18 19, the definitions of beauty and health became skewed: the thinner, the better-looking; the thinner, the healthier.

External validation

These seemingly harmless attempts were the comments and opinions of others. Compliments that they “lost weight” or “looked better” served as a sign of fitting in and acceptance in the community, thus were taken more seriously and valued more highly. When those compliments were not received, they blamed themselves for not putting enough effort or having enough willpower. Over time, these compliments became ‘addictive’ and they would do whatever it took to keep those coming.

* Fat talk is a term coined by two researchers, Nichter and Vuckovic, that describes a way of speaking about one’s body in a negative, self-abasing, oftentimes light-hearted way. Young girls and women sometimes engage in fat talks to elicit validation from others.

18 Britton, Lauren E., et al. “Fat Talk and Self-Presentation of Body Image: Is There a Social Norm for Women to Self-degrade?”

Body Image.

19 Adams, Rebecca. “How ‘Fat Talk’ Became A Social Epidemic — And How You Can Stop It.” The Huffington Post.

RESEARCH | INSIGHTS

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Disordered eating

Control

False sense of security and power

This vicious cycle of seeking for external validation and attempting to improve their bodies allowed for these women to have a very distorted perception of food, eating behaviors, exercising, and women’s health in general. What is now called the disordered eating behaviors turned into an outlet to take control, perhaps as a response to any life’s uncertainty, unpredictability, or instability. Some examples include career instability, the unpredictable family dynamic, and the sense of powerlessness due to sexual abuse or trauma. Food offered an agency to take control of something in their lives, but it provided them with a false sense of security and power. As a result, food ended up controlling many of these women and their lives.

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RESEARCH | INSIGHTS

Eating disorders

These behaviors spiraled into eating disorders, where food and their body were allconsuming. The eating disorder noise tended to be very loud in their head, obscuring other life pursuits such as relationships, family, school, work, and most importantly, their mental and emotional health. Due to the secretive and isolating nature of the disorder, these women felt like they were drowning in their own thoughts and feelings of guilt, shame, and fear, which again created a selfperpetuating cycle.

Fear of letting go

This secretive and isolating nature of the disorder prevented them from opening up to others, partly because they did not want others to take away their “security blanket”.

Moreover, the lack of understanding of mental illness only perpetuates the stigma surrounding it and prevents one from seeking help. Many of these women then continued to suppress and numb their emotions and feelings, and kept the eating disorder to themselves. It was also very difficult for them to let go of the eating disorder, as they often thought that it was “the only thing [they were] good at”. This is why it was so hard to even start the process of recovery, because life was unimaginable without their eating disorder.

RESEARCH | INSIGHTS

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RESEARCH | INSIGHTS

From this deep exploration, it became clear that the issue is not just about the food. Body dissatisfaction and eating disorders are highly complex problems that deal with the following systemic, societal issues: • Body development in adolescence • Body-shaming or weight stigma • Coping with stress and trauma • Dealing with uncertainties • Ideas of femininity and strength • Objectification of women • Capitalization of self-esteem • Skewed definition of health • Lack of understanding of mental health • Shame, guilt, and vulnerability As beauty and health were previously examined in terms of body dissatisfaction, two of the biggest systemic issues that will be discussed further are the objectification of women and society’s skewed definition of health.

RESEARCH | INSIGHTS

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Objectification of Women Deeply-entrenched, centuries-long objectification of women is so rampant that it is invisible and unquestioned.

This occurs most obviously through media.

Corporations use parts of women’s bodies to advertise and captialize on their products, even though women’s bodies might not have anything to do with their products. This might come off as being ‘clever’ advertising, but it perpetuates the conception that women are nothing but the sum of our parts.

The objectification of women also takes the form of constant fixation on appearance, such as catcalls, street harrasments, what our president claims to be “locker-room talk”, and casual banter about women’s bodies with peers. One of the women I spoke with said that whenever she went for a casting, the first thing that the modelling agency did was to look at her up and down before saying hello. “Models are constantly dehumanized and objectified”, she said. When we fixate on women’s physical appearances more on than what they do, say, or feel, we treat them as passive ornaments to constantly be looked at and projects to be improved on.

The objectification of women perpetuates the deep-rooted, underlying beliefs that: 1) being beautiful is the most important thing that a woman can do, as it gives them love, success, and happiness, and 2) only a certain shape, size, and color is considered beautiful or even accepted.

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RESEARCH | INSIGHTS

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This might beg the question: don’t men get objectified in the media too? Shannon Ridgway wrote an article on Everyday Feminism20 that I thought articulated it really well how the objectification of men cannot be equated with that of women: “Even if a man is objectified on occasion, it is not the same thing as living within its oppressive structure day in and day out.

It’s akin to white people saying that reverse racism exists: It just doesn’t — because white people have never experienced systematic, centuries-long oppression like people of color have.

And men haven’t experienced the systematic, centuries-long objectification like women have.

Is it possible for men to feel affronted or even demeaned when women comment on their chiseled chest, six-pack abs, or large penis? Of course. Just like it’s possible for a white man to feel offended when a black woman calls him a cracker.

But those instances are not nearly as common, nor do they contribute to a larger system of oppression like sexism or racism. If we refer to those insults as oppressive, then we’re reducing system-wide, institutionalized objectification and racism to petty, interpersonal slights.”

20 Ridgway, Shannon. “Can Men Be Objectified by Women?”

Everyday Feminism.

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RESEARCH | INSIGHTS

There is also an assumption, even within clinicians21, that body image issues and eating disorders are a “rich, white girl problem”.22 As the National Eating Disorders Association described it, “It is sometimes speculated that women from racial and ethnic minority groups are ‘immune’ to developing eating disorders because their cultural identity provides some amount of protection against body image disturbances. For example, it is frequently asserted that African-American culture embraces larger body types than does the dominant culture, thereby making Black women less prone to body dissatisfaction.”23 What I found from talking to Black women, however, is that the Black culture still sexualizes women’s through their hair, lips, or skin tones. Although their standards of beauty are different from the mainstream, there is still the pressure to look a certain way.

Moreover, my own experience in Indonesia and Singapore asserts that body dissatisfaction in Asian women is as prevalent, if not more.

In addition, these have been confirmed by research that shows that Black, Asian, Hispanic, and Native American youth also experienced body dissatisfaction at similar if not higher rates than their Caucasian counterparts.24

21 Gordon, Kathryn H., et al. “The Impact of Client Race on Clinician Detection of Eating Disorders.” Behavior Therapy.

22 Simpson, Stephanie. “Misconceptions about Eating Disorders.”

Eating Disorder Support Network of Alberta.

23 National Eating Disorders Association. “Eating Disorders in Women of Color: Explanations and Implications.”

24 National Eating Disorders Association. “Eating Disorders in Women of Color: Explanations and Implications.”

In the LGBTQIA+ population, although they said that there is a general acceptance of nonnormativity in their community, the pressure to look or dress a certain way still exists. One of them said that although her community is generally more accepting of different body types, the pressure can manifest in the form of gender expression. “There is still judgment when we do not present ourselves as queer enough”, she said.

All in all, the objectification of women does not discriminate. It is an oppressive system for women of all shapes, sizes, race, gender identities, and sexual orientations.

“It is imperative that we re-examine our assumptions about who is susceptible to disordered eating and ensure that our efforts to combat these issues are inclusive of all women.”

National Eating Disorders Association

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Skewed Definition of Health The growing body of research has linked obesity to a plethora of health problems, such as heart disease, type 2 diabetes, high blood pressure, certain cancers, other chronic conditions, and even death.25 The majority of these findings, however, only suggests correlations and explains nothing about causation.

These studies also fail to consider the wide range of social determinants that contribute to obesity such as poverty, food deserts, stress, genetics, and education, among many others. It puts the blame on the individuals for lacking motivation and willpower to be responsible for their own health.

This skewed definition of health is not only held by individuals, but also by the entire healthcare system. The nutrition, fitness, and medical industries that we trust for their expertise are spreading misleading and damaging messages about health.

Doctors and registered dietitians are recommending weightloss programs to patients who are considered to be ‘overweight’ or ‘obese’ according to the Body Mass Index (BMI) scale, which more and more institutions are calling “bogus”.26 As a result, the war on obesity has turned to victimize people with heavier bodies, especially women. Weight bias discrimination, or fat-shaming, has been shown to significantly increase the risk of stress, anxiety, and depression, potentially creating more health problems.27 28 As Susan Greenhalgh, the author of Fat-Talk Nation, puts it, “We hear a great deal about the dangers of fatness to the nation, but little about the dangers of today’s epidemic of fat talk to individuals and society at large. The human trauma caused by the war on fat is disturbing – and it is virtually unknown.”29

25 National Heart, Lung, and Blood Institute. “Why Obesity is a Health Problem.” National Institute of Health.

26 Devlin, Keith. “Top 10 Reasons Why The BMI Is Bogus.” NPR. 27 Puhl, Rebecca. “Stigma and ‘Fat Shaming’ Can Fuel Depression And Increase Obesity.”

WBUR. 28 MacMillan, Amanda. “Fat-shaming Could Raise Health Risks, Study Suggests.” CNN. 29 Greenhalgh, Susan. Fat-Talk Nation: The Human Costs of America’s War on Fat.

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As a woman, my body is scrutinized and policed. As a fat woman, my body is also lampooned, openly reviled, and associated with moral and intellectual failure. My body limits my job prospects, access to medical care, and, supposedly, my ability to be loved.

Lindy WestÂ

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When we simplify health to just weight, we ignore other aspects of wellbeing, as shown by the Eight Dimensions of Wellness model developed by the Substance Abuse and Mental Health Services Administration (SAMHSA).30 30 Substance Abuse and Mental Health Services Administration. “The Eight Dimensions of Wellness.”

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All these themes and insighs serve as a springboard for areas of opportunities where changes can be made. To explore these opportunities, I crafted what we call “How might we..?” questions for each of these insights to frame the problem in a way that opens up a mindset of possibility.

These questions make up a larger, overarching “How might we..?” question that would guide me in the next part of the design process:

How might we redefine beauty to reclaim the physical, mental, and emotional health of women?

RESEARCH | INSIGHTS

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Opportunities for Change

To continue the collaborative process, I invited the same women I interviewed for online, video-conference brainstorming sessions. I held a total of five sessions with 21 women to begin looking for opportunities where changes can be made.

With 4-5 people in each session, we used the insights and their corresponding “How might we..?� questions to guide our conversations and generation of ideas. An immense pool of ideas emerged, which I gathered on this mind map below.

Some of the ideas have already existed in the world. These initiatives address the issue from not only the personal and relational levels, but also the institutional, national, and even societal level. For the ideas that we have not seen or encountered in the world, I attempted several prototypes, which are preliminary models that make the ideas more tangible.

ABOUT | SOCIAL DESIGN

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Current Initiatives Puberty Education Programs Organizations like Girls Inc. and Big Brothers Big Sisters offer peer-to-peer puberty education programs to let young girls guide each other through the transitory period of their lives. Moreover, P&G Always also offers this in addition to their well-known campaign, #LikeAGirl.

By relating to peers about the development of their bodies, seeds of confidence and positive body image will hopefully be planted.

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OPPORTUNITIES | CURRENT INITIATIVES

OPPORTUNITIES | CURRENT INITIATIVES

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The Evolution of Barbie® Dolls Mattel’s launch of Petite, Tall, and Curvy Barbie® dolls in 2014 opened up a whole new conversation around the definition of beauty.

Since girls learn about their body image from a very young age, Mattel believes that by ‘evolving’ the dolls (referring to their hashtag #thedollevolves), young girls will be able to learn from young what beauty and body diversity are like.

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OPPORTUNITIES | CURRENT INITIATIVES

Mattel’s evolution of Barbie® dolls has been successful at the institutional level. As a toy company with perhaps the biggest influence on girls’ body image, Mattel has gained a lot of media attention as well as positive feedback, and sparked a whole new perspective and conversations around beauty and body positivity.

Besides Mattel, Lammily has also paved its way towards redefining beauty for young girls. As the first fashion doll with realistic proportions of the human body, Lammily’s aims to “empower children of all shapes and sizes to develop self-esteem, have a positive body image and to be accepting of others.”

OPPORTUNITIES | CURRENT INITIATIVES

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Dove Real Beauty Campaign Dove Real Beauty Campaign is considered one of modern marketing’s most talked-about success stories, with their videos garnering millions of views especially the Real Beauty Sketches which has reached 67 million people.

According to Jean Kilbourne, Dove was — and still is — one of the only mainstream advertisers talking about how we define female beauty. 31 Dove believes that the way beauty is portrayed in the media is harming girls’ and women’s health and self-esteem. With their Real Beauty campaign, Dove hopes to start to change the narrative around beauty for women, in order to improve women’s confidence, self-esteem, as well as health.

31 Bahadur, Nina. “Dove ‘Real Beauty’ Campaign Turns 10: How A Brand Tried To Change The Conversation About Female Beauty.” The Huffington Post.

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OPPORTUNITIES | CURRENT INITIATIVES

Dove targets all levels of analysis: • Personal: In their interviews, they invite mothers, girls, even boys and guys, to experience the transformation themselves (i.e., Dove Beauty Patches, Real Beauty

Sketches) • Relational: Their videos are shared on social media and spark conversations • Institutional: They represent a more diverse body shapes and sizes, and women closer to reality, changing the narrative around beauty in the media

• National: They created a fund in 2004 to partner with organizations like the Girl Scouts, Boys & Girls Clubs of America and Girls Inc. to organize activities including discussions about online bullying and women photography projects • Societal: They represent the fight towards female empowerment and the emphasis on inner over outer beauty

OPPORTUNITIES | CURRENT INITIATIVES

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Women Not Objects Campaign Started by an advertising agency Badgers & Winters, Women Not Objects campaign was the first to successfully address the objectification and sexualization of women in the media. The campaign video features women holding up the ads from companies like Tom Ford, Burger King, and Post-It, calling out their objectifying concepts behind their ads with sarcasm.

The campaign hopes influence the advertising industries by sparking conversations around the objectification of women.

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OPPORTUNITIES | CURRENT INITIATIVES

OPPORTUNITIES | CURRENT INITIATIVES

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Prototypes Mirrors in Bathrooms, Fitting Rooms, and Fitness Centers

Fitting rooms are one of the most triggering places for body dissatisfaction. During the brainstorming sessions, some of the women said that when certain clothes did not fit, they thought that something was wrong with their bodies.

Subtle messages such as, “Wear what’s comfy, not just fancy” will hopefully serve as a reminder to not have to change their bodies just to fit a certain size of clothing.

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OPPORTUNITIES | PROTOTYPES

Caution tapes on bathroom mirrors that say something like, “Your reflection does not define your worth,” or, “You have been manipulated to hate what you see here,” will hopefully remind women to not be so critical of themselves and their bodies.

Messages like, “Work out because you love your body, not because you hate it” at gyms will hopefully shift the attitude of exercising from looking ‘fit’ to feeling good.

OPPORTUNITIES | PROTOTYPES

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Esteem-building Campaigns on Sanitary Pads Since sanitary pads or tampons are one of the first things young girls encounter when they enter puberty, putting body-positive messages and puberty fun facts will hopefully reduce their fears about their changing bodies.

In addition, there is also an opportunity for campaigns such as #PERIOD or #pubertyfacts to both market products and help build young girls’ self-esteem.

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OPPORTUNITIES | PROTOTYPES

OPPORTUNITIES | PROTOTYPES

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Music and Arts Festival Music festivals have always been known to subconsciously put some pressure on its attendees to look a certain way.

Embrace is a 3-day music and arts festival that invites its attendees to celebrate all shapes, sizes, and colors of bodies. It provides a safe space for everyone to just enjoy music and arts without any preoccupation of how they look.

By being immersed in body positive music and activities, Embrace hopes for its attendees to leave the festival feeling more deeply connected and compassionate with their own bodies as well as others’.

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OPPORTUNITIES | PROTOTYPES

OPPORTUNITIES | PROTOTYPES

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Health at Every SizeÂŽ Rebrand Health at Every Size (HAES) is a principle, advocacy, and registry that supports the idea that there is more to health than just weight and that everyone can be healthy at any size.

Currently, HAES is not yet widely recognized and has not received the attention it needs.

HAES’ new brand is meant to be more welcoming, convincing, and attentiongrabbing. The bold red color symbolizes courage that its pledgers take to challenge the cultural and scientific assumptions that weight or size is a sole measure of health.

The new HAES marketing materials can be placed on billboards on the street, bus stops, or subway stations. Placing them sequentially side by side is hoped to bring the most attention and hopefully paradigm shift about the definition of health.

HEALTH AT E V E R Y

SIZE

CELEBRATE BODY DIVERSITY TA K E T H E P L E D G E

H A E S C O M M U N I T Y. C O M

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OPPORTUNITIES | PROTOTYPES

TA

HA

HEALTH AT E V E R Y

SIZE

CELEBRATE BODY DIVERSITY

REDEFINE HEALTH

REDEFINE HEALTH

AKE THE PLEDGE

TA KE THE PLEDG

A E S C O M M U N I T Y. C O M

HAESCOMMUNIT

E

Y. CO M

TA KE THE PLEDG HAESCOMMUNIT

E

Y. CO M

OPPORTUNITIES | PROTOTYPES

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Reflection and Next Steps

All in all, I have gained a plethora of valuable skills and delved deeper into the social issue I am passionate about, more than I would ever have had I not been in the Social Design program.

As I hope to continue this work beyond my thesis project, I plan to create more prototypes of the remaining ideas, get feedback from the women I interviewed, reiterate them, and potentially collaborate with external partners to implement them.

Looking back, rebuilding my relationship with food and my body was a tremendous struggle, but I have never been more grateful that it has led me to this point and shaped who I am. As I continue to believe that the world can be a more inclusive, accepting, and compassionate place for women of all bodies, I will continue to ask, “How might we redefine beauty to reclaim the physical, mental, and emotional health of women?�

REFLECTION AND NEXT STEPS

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Acknowledgement

References Adams, Rebecca. “How ‘Fat Talk’ Became A Social Epidemic — And How You Can Stop It.” The Huffington Post, 27 May 2014, http://www.huffingtonpost. com/2014/05/27/fat-talk-women_n_5331507.html. Accessed 30 June 2017.

American Public Health Association. “Public Health Takes on Obesity Infographic.” American Public Health Association, 2014, https://www.apha.org/ news-and-media/multimedia/infographics/obesity-infographic. Accessed 30 June 2017.

Arcelus, Jon, et al. “Mortality Rates in Patients with Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies.” Archives of General Psychiatry, vol. 68, no. 7, 2011, pp. 724-731.

Bahadur, Nina. “Dove ‘Real Beauty’ Campaign Turns 10: How A Brand Tried To Change The Conversation About Female Beauty.” The Huffington Post, 21 Jan. 2014, http://www.huffingtonpost.com/2014/01/21/dove-real-beauty-campaignturns-10_n_4575940.html. Accessed 30 June 2017.

Bear, Merryl. “Prevention of Eating Disorders”. National Eating Disorder Information Centre, 2003. http://nedic.ca/prevention-eating-disorders. Accessed 30 June 2017.

Better Business Bureau. “Modeling & Talent.” Better Business Bureau, https:// www.bbb.org/new-york-city/get-consumer-help/articles/modeling-talent/.

Accessed 30 June 2017.

Britton, Lauren E., et al. “Fat Talk and Self-presentation of Body Image: Is There a Social Norm for Women to Self-degrade?.” Body Image, vol. 3, no. 3, 2006, pp. 247-254.

Centers for Disease Control and Prevention. “Obesity and Overweight.” Centers for Disease Control and Prevention, 2016, 13 June 2016, https://www.cdc.gov/ nchs/fastats/obesity-overweight.htm. Accessed 30 June 2017.

Devlin, Keith. “Top 10 Reasons Why The BMI Is Bogus.” NPR, 4 July 2009, http://www.npr.org/templates/story/story.php?storyId=106268439. Accessed 30 June 2017.

DoSomething.org. “11 Facts about Body Image.” DoSomething.org, https://www. dosomething.org/facts/11-facts-about-body-image. Accessed 30 June 2017.

ACKNOWLEDGEMENT | REFERENCES

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Dreisbach, Shaun. “How Do You Feel About Your Body?” Glamour, 9 Oct. 2014, http://www.glamour.com/story/body-image-how-do-you-feel-aboutyour-body. Accessed 30 June 2017.

Engeln, Renee. “An Epidemic of Beauty Sickness.” TEDxUConn, TED, 21 Sept. 2013, University of Connecticut, Storrs, CT. TEDx Talks.

Gordon, Kathryn H., et al. “The Impact of Client Race on Clinician Detection of Eating Disorders.” Behavior Therapy, vol. 37, no. 4, 2006, pp. 319-325.

Greenhalgh, Susan. Fat-Talk Nation: The Human Costs of America’s War on Fat. Cornell University Press, 2015.

Hayes, Sharon, and Stacey Tantleff‐Dunn. “Am I Too Fat to be a Princess?

Examining the Effects of Popular Children’s Media on Young Girls’ Body Image.” British Journal of Developmental Psychology, vol. 28, no. 2, 2010, pp.

413-426.

Heldman, Caroline. “The Sexy Lie.” TEDxYouth@SanDiego, TED, Jan. 2013, San Diego, CA. TEDx Talks.

Lovett, Edward. “Most Models Meet Criteria for Anorexia, Size 6 Is Plus Size: Magazine.” ABC News, 12 Jan. 2012, http://abcnews.go.com/blogs/ headlines/2012/01/most-models-meet-criteria-for-anorexia-size-6-is-plus-sizemagazine/. Accessed 30 June 2017.

MacMillan, Amanda. “Fat-shaming Could Raise Health Risks, Study Suggests.”

CNN, 7 Feb. 2017, http://www.cnn.com/2017/02/07/health/fat-shaming-sickstudy-partner/. Accessed 30 June 2017.

National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. U.S. Department of Health and Human Services, May 2017, Hyattsville, MD, https://www.cdc.gov/nchs/data/ hus/hus16.pdf#053. Accessed 30 June 2017.

National Eating Disorders Association. “Eating Disorders in Women of Color: Explanations and Implications.” National Eating Disorders Association, 2016, https://www.nationaleatingdisorders.org/eating-disorders-women-colorexplanations-and-implications. Accessed 30 June 2017.

National Eating Disorders Association. “Factors that may Contribute to Eating Disorders”. National Eating Disorders Association, 2016, https://www. nationaleatingdisorders.org/factors-may-contribute-eating-disorders. Accessed 30 June 2017.

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ACKNOWLEDGEMENT | REFERENCES

National Eating Disorders Association. “Get the Facts on Eating Disorders”. National Eating Disorders Association, 2016, https://www. nationaleatingdisorders.org/get-facts-eating-disorders. Accessed 30 June 2017.

National Eating Disorders Association. “Risk Factors”. National Eating Disorders Association, 2016, https://www.nationaleatingdisorders.org/learn/ general-information/risk-factors. Accessed 30 June 2017.

National Eating Disorders Association, “What is Prevention... and Does It Work?” National Eating Disorders Association, 2016, https://www. nationaleatingdisorders.org/what-preventionand-does-it-work. Accessed 30 June 2017.

National Heart, Lung, and Blood Institute. “Why Obesity is a Health Problem.”

National Institute of Health, 13 Feb. 2013, https://www.nhlbi.nih.gov/health/ educational/wecan/healthy-weight-basics/obesity.htm. Accessed 30 June 2017.

Nichter, Mimi, and Nancy Vuckovic. “Fat Talk: Body Image among Adolescent Girls.” Many Mirrors: Body Image and Social Relations. Rutgers University Press, 1994.

Primus, Mitch. “Body Dissatisfaction and Males: A Conceptual Model.”

Scholarly Horizons: University of Minnesota, Morris Undergraduate Journal, vol. 1, no. 1, art. 6, 2014, http://digitalcommons.morris.umn.edu/horizons/vol1/ iss1/6. Accessed 30 June 2017.

Puhl, Rebecca. “Stigma and ‘Fat Shaming’ Can Fuel Depression And Increase Obesity.” WBUR, 11 Dec. 2015, http://www.wbur.org/ hereandnow/2015/12/11/obesity-stigma-fat-shaming. Accessed 30 June 2017.

Ridgway, Shannon. “Can Men Be Objectified by Women?” Everyday Feminism, 30 July 2014, http://everydayfeminism.com/2014/07/men-objectified-bywomen/. Accessed 30 June 2017.

Simpson, Stephanie. “Misconceptions about Eating Disorders.” Eating Disorder Support Network of Alberta, 23 Nov. 2014, http://www. eatingdisordersupportnetworkofalberta.com/guest-blogs/misconceptions-abouteating-disorders. Accessed 30 June 2017.

Substance Abuse and Mental Health Services Administration. “The Eight Dimensions of Wellness.” Substance Abuse and Mental Health Services Administration, 1 July 2016, https://www.samhsa.gov/wellness-initiative/eightdimensions-wellness. Accessed 30 June 2017.

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The Eating Disorders Coalition. “Facts About Eating Disorders: What The Research Shows.” The Eating Disorders Coalition for Research, Policy & Action, 25 Sept. 2014, http://eatingdisorderscoalition.org.s208556.gridserver. com/couch/uploads/file/Eating%20Disorders%20Fact%20Sheet.pdf Wade, Tracey D., Anna Keski‐Rahkonen, and James I. Hudson. “Epidemiology of Eating Disorders.” Textbook of Psychiatric Epidemiology, Third Edition, 2011, pp. 343-360.

Thank You To the women of Recovery Warriors, who have shared their deepest emotions, insightful thoughts, and hopes. You are worthy and you are the reason I will never stop fighting for this change.

To Jessica Raymond, without whom I would not have had the chance to discover all the commendable work that Recovery Warriors has done.

To Mike Weikert, Thomas Gardner, Lee Davis, and the MASD ‘17 cohort for the continual support, advice, joy, and camaraderie.

To Arun Ravendhran, for the countless hours of insightful conversations, discussions, and debates. Your selflessness, thoughtfulness, patience, and jokes have carried me through this Master’s program.

And last but not least, to mom, dad, and my sister, for believing in and allowing me to pursue what I care about the most.

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ACKNOWLEDGEMENT | THANK YOU

“Don’t make my mistake.

Don’t waste a single day of your life being at war with your body.”

Taryn Brumfitt, “Embrace”

Patricia Natalie Maryland Institute College of Art pnatalie@mica.edu