4.7: Body Image, Eating Disorders, and Low Body Weight

Body Image

When you look in the mirror, how do you see yourself and feel about your body (e.g., height, shape, and weight)? Your body image is what you think, feel, perceive, and behave regarding your body. Body image is a multidimensional concept that includes^[11]:

• Cognitive: thoughts and beliefs about the body
• Perceptual: how people perceive the size and shape of their body and body parts
• Affective: feelings about the body
• Behavioral: the actions that people perform to check on, tend to, alter, or conceal their body

Factors effecting body image and body image disorders include: BMI, family, social pressures, media, social media, self esteem, chronic illness, depression, and sexual abuse.

A person with a positive body image has a clear and true perception of their body; seeing the various parts of your body as they really are. Body positivity (or body satisfaction) involves feeling comfortable and confident in your body, accepting your natural body shape and size, and recognizing that physical appearance say very little about one’s character and value as a person.

A person with a negative body image or a distorted perception for their body, has feelings of shame, anxiety, and self-consciousness. People who experience high levels of body dissatisfaction feel their bodies are flawed in comparison to others, and they are more likely to suffer from feelings of depression, isolation, low self-esteem, and eating disorders.

Eating Disorders

While there is no single cause of eating disorders, research indicates that body dissatisfaction is the best-known contributor to the development of eating disorders and body dysmorphic disorder. Body dysmorphic disorder (BDD) is a distressing preoccupation or a markedly excessive concern with one or more perceived or slight defects in physical appearance, associated with significant distress and functional impairment.

Eating disorders are serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. They are associated with a wide range of adverse psychological, physical, and social consequences. A person with an eating disorder may start out just eating smaller or larger amounts of food, but at some point, their urge to eat less or more spirals out of control. Severe distress or concern about body weight or shape, or extreme efforts to manage weight or food intake, also may characterize an eating disorder.

Eating disorders are real, treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders. Other symptoms can become life-threatening if a person does not receive treatment, which is reflected by anorexia being associated with the highest mortality rate of any psychiatric disorder.

Anorexia Nervosa

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa also may engage in binge eating followed by extreme dieting, excessive exercise, self-induced vomiting, or misuse of laxatives, diuretics, or enemas.

Symptoms of anorexia nervosa include:

• Extremely low body weight
• Severe food restriction
• Relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image and self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
• Lack of menstruation among girls and women.
• Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.

Other symptoms and medical complications may develop over time, including:

• Thinning of the bones (osteopenia or osteoporosis)
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Mild anemia, muscle wasting, and weakness
• Severe constipation
• Low blood pressure, or slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multi-organ failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility.

Bulimia Nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feel a lack of control over these episodes. This binge eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, desperately want to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge eating and purging cycle can happen anywhere from several times a week to many times a day.

Other symptoms include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel, and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging of fluids
• Electrolyte imbalance—too low or too high levels of sodium, calcium, potassium, and other minerals that can lead to a heart attack or stroke.

Binge-Eating Disorder

People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge eating are not followed by compensatory behaviors like purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They also experience guilt, shame, and distress about their binge eating, which can lead to more binge eating.

Low Body Weight (underweight)

Because more people experience excess body fat, the focus up to this point has been on health concerns related to overweight and obesity. However, fat is an essential component to a healthy body and insufficient fat reserves can cause health issues. It is estimated that 1.6% of U.S. adults aged 20 and over are underweight. Poor nutrition or underlying health conditions can result in adults being underweight. A healthy body fat percentage for men is 10-22% body fat (minimum required is 3-5% fat) and women is 20-32% body fat (minimum required is 8-12%). Using a BMI, if your BMI is less than 18.5, it falls within the underweight range.

Persons who are underweight may experience:

• Osteoporosis
• Skin, hair, and teeth problems
• Immune System disorders (get sick more)
• Low energy (tired or fatigued all the time)
• Reproductive disorders: Irregular menstrual cycle and premature births
• Respiratory disorders
• Slow or impaired growth due to lack of nutrients
• Mental health issues such as Depression
• Increased mortality from external causes like accidents, injuries, and suicide^[12]