Clinical:Case Study: Body Image

Original materials created in April 2002 by JoDean Nicolette, M.D.

History

LEP is a 34 y/o tax lawyer who states “I want to weigh less. One hundred sixty pounds is too much.” She takes no medications. She has tried “every diet out there,” and lost weight on a few, but always gained it back. She reports eating “salads daily and many low fat foods.” LEP goes to the gym 5x/week, and does “cardio” for 50 minutes and weight-training for 20 minutes. She wonders about using diet pills,over the counter or by prescription. Med Hx and Fam Hx unremarkable Soc Hx: husband, no smoke, one glass of wine daily; TV, and popular magazines for fun

PE

Well, P=60, BP=110/60, HT 5’8”, WT 158#(body mass index=24) Normal exam

Studies

TSH=2.3 (normal) Total cholesterol 200, LDL 98, HDL 84, Triglycerides 100 Discussion: LEP’s level of physical fitness, cardiovascular (CV) health, diet, and lipids are all outstanding. She is not at risk for hypertension, insulin resistance or other obesity related conditions. Her BMI falls within the range of “healthy” as defined by the National Institutes of Health. Her healthy habits deserve congratulations, and reinforcement. LEP’s misperceptions and focus on her weight negatively impact her health status. Unfortunately, she represents far too many of my patients. The media, especially TV and popular magazines are likely at the root. Americans watch an average of 6 hours of television daily. The disproportionate representation of abnormally and unhealthily thin women portrayed in situation comedies, films, and advertising is well documented. Research has suggested that women have a 7% chance of having the thin, yet curvaceous figure of a catwalk model, 2% chance of being an international model, 1% chance of being a super model, 0.5% chance of being a store mannequin, and zero chance of being Barbie (a lethal BMI). Despite the fact that women are unlikely to attain these physical proportions, the sheer volume of media characters of small size implies such body types are normative. Other negative aspects of viewing include laugh tracks played during scenes with “over” (normal) weight women, and consistently negative comments (appearance and non-appearance related) made about women who are larger than size 6. Almost half of advertising during “women’s TV” is directed toward altering appearance, compared with less than 15% during “men’s TV.” Commercials tout products for thickerfuller hair, less hair, moist skin, oil-less skin, and thinner bodies. Women are most often depicted in pursuit of improved appearance rather than in career or hobby focus. Resulting mental health and self-esteem consequences appear in our offices everyday; they are as crucial to elicit and address as other more “physical” complaints.

Plan

LEP is an educated, and insightful woman. She considers herself liberated, and she is—from a financial and vocational standpoint. She needs help with the process of liberating herself the cultural constraints imposed by the media in her life. I simply called this out, and explained that I considered this her paramount health concern. We discussed the following.

1. I asked LEP to assess her “health status. She and I agreed on her suc cess. We discussed the effects of exercise on her CV health, glucose tolerance, bone health, osteoarthri tis, and mood. I also mentioned the accumulating data that suggest ex ercise reduces the risk for certain cancers.

2. I asked LEP why, given her excellent health, she “needs to weigh less?” After minimal discussion she acknowledged that her perceptions of being overweight come from the visual impact of substantial time she spends focused on the popular media. She has often felt she should watch less TV, but has not been motivated to find other activities.

3. I objectively discussed (see Discus sion) popular images of women in the same way that I present data for other health care concerns.

4. To reinforce the unrealistic media portrayal of women, I asked LEP if any of the women she encounters most in her life are less than a size 10.

5. I asked LEP to name several women she admires in her life, and why. She named friends, co-workers, and athletic partners. None of the qualities she admired had to do with appearance or weight. LEP rapidly gained insight and nodded her understanding. We agreed on some small, but important steps to change her self perceptions. LEP agreed:

• to continue her healthy lifestyle, but put her scale in a closet, weighing herself no more than once every two weeks.
• to cut back her television watching one night at a time, and replace the time with other activities, such as a pottery class she had been meaning to take, and the Sue Grafton Mystery Series (A-Z).
• to replace Vogue Magazine with a more issue-oriented publication, such as Ms. or Mother Jones. We agreed Oprah’s Magazine “O” is a good middle of the road choice for now.
• not to criticize her physical appearance in front of the mirror while dressing for work, but rather to plan her schedule, or set personal goals.
• to seek out information to educate and motivate herself in her attempts to change her perceptions and evolve personally. (see References)

I stressed to LEP that changing ingrained habits is a process. We would work together to improve her quality of life and well-being. Follow up was a phone call in two weeks, and a visit in one month. We have maintained a dialogue. LEP’s current self-assessment is “ongoing liberation.”

References

Literature

Orbach, Susie. Fat is a Feminist Issue. New York: Berkley Publishing Group, 1978.

Brunsdon, Charlotte, Julie D’Acci and Lynn Spigel. Feminist Television Criticism: A Reader. Oxford: Clarendon Press, 1997.

Craig, Steven. Men’s Men and Women’s Women: How TV Commercials Protray Gender to Different Audiences. From Issues and Effects of Mass Communication: Other Voices, ed. Robert Kemper. San Diego, CA: Capstone Publishers, 1992.

Steinem, Gloria. Sex, Lies, and Advertising. Ms. Magazine. July/August, 1990.

Film

Dying to be Thin. Nova. View online www.pbs.org/ wgbh/ nova/thin Killing Us Softly. Gail Dines. www.cambridgedocumentaryfilms.org/killing.html

Internet

www.mediaandwomen.org