7/19/19

Exercise and Weight, Part II

I need to clarify that, overall, exercise is beneficial for one’s body and health. The human body is designed to work better with regular exercise in terms of managing cardiovascular health and well being. This fact is undeniable and important.

However, the other messages about exercise that have become pervasive and, for many, apparent facts that are more problematic and untrue.

The association of exercise and weight loss, equating exercise as a form of burning calories to be matched by food intake and the need for increased fitness and exercise as a sign of improvement of health all are either falsehoods or exaggerations not based on fact.

The food, diet and exercise industries benefit from making these statements appear true.

If exercise is associated with weight loss, the imperative and pressure to exercise falls on the individual. The pervasive guilt when people don’t exercise pushes them to sign up for classes, join gyms and participate in a part of life they may or may not want to but feel compelled to. But the purpose of this collective obsession is to maintain or lose weight when the overwhelming data proves otherwise.

If eating food can only be justified by exercise, people will need to rack up a certain amount of calories burned in order to feel able to eat their meals, even though the calories burned statistics on machines and various devices is not based on any biological science. Instead, people feel tethered to inaccuracies as the reason they can or cannot eat.

And with the constant personal urgency to be “healthy,” exercise is often the foundation of that philosophy. Yes moderate exercise is connected with improvement on health, but excessive exercise has no bearing on health. The connection between health and exercise is such a strong reality that people are shocked to know that only moderate exercise shows true health improvement.

These pressures around exercise, based on a series of inaccurate statements, drive a significant amount of behaviors and thought processes for many who don’t have eating disorders. The growing exercise industry benefits from an urgency people feel to exercise, and the diet and food industries also benefit from the growing obsession to seek improved health by focusing on these falsehoods. 

Without sufficient public health and medical establishment response, these falsehoods remain the only “truths” people know. Too many doctors have been brainwashed into believing the propaganda and public health campaigns are more focused on increased weight to realize the larger picture.


As long as our society is so obsessed with thinness, people are trapped in this conundrum. The real freedom is to see exercise as a part of life and to see food more clearly as a necessity to sustain life.

7/11/19

Exercise and Weight, Part I

The societal messages about exercise are incredibly confusing. As with nutrition, most doctors know little about the connection between exercise and health and rely on media misinformation rather than any true data. Minimally knowledgeable writers and a powerful exercise industry instead dominate our collective thoughts.

There is plenty of evidence that moderate exercise on a regular basis is better for overall cardiovascular health. Being completely sedentary worsens health and well-being.

Increased exercise or fitness does not correlate with commensurate improvement in health. It only confers improved athletic abilities.

However, the underlying message about exercise relates implicitly or explicitly to weight. No matter how people discuss exercise, they always imply that exercise is necessary to remain or get to a low weight. And by and large, these conversations lead to shame, guilt or conversely smugness.

The overall data is conclusive: exercise doesn’t lead to weight loss. For a sedentary person, exercise often leads to short-term amounts of weight loss that returns within six months. Exercise often leads to increased hunger to compensate for increased activity. Time and again, research proves that exercise does not change one’s weight.

This fact is irrefutable, yet it seems to shock anyone who hears it. Almost everyone told this information can’t believe it’s true. Instead, most people exercise out of guilt and shame and many people only feel able to eat if they compensate with regular exercise.


How has the falsehood around exercise and weight become so pervasive? What keeps people from learning the basic facts about exercise and the body’s response? I’ll talk more about it in the next post.

6/13/19

Body and Shame, Part III

The message that needs promotion in our culture is that girls’ and women’s self-esteem cannot be connected to body and weight. If image and looks are the most important elements of a woman and if thinness continues to be glorified, then dieting will still be a rite of passage for adolescent girls and eating disorders will continue to be an intractable problem. 

Despite the sentiment that girls are capable of choosing any profession—that they can have it all—they continue to be burdened by anachronistic mores about appearance. The two cannot exist together without severe consequences. In fact, the drive for thinness only weakens the growth of a girl or woman because the energy consumed by dieting and weight detracts from attention needed to build a full life. 

By and large, men don’t have this problem. Some men do have eating disorders and body image issues that largely revolve around the fat phobia pervasive in our society, also a pressing and important issue. But they aren’t trapped behind sexist expectations that a woman prioritize image over everything else. 

The media has created an ideal for women in recent decades of extreme thinness and a photoshopped perfect body. In other words, not only is thinness a goal, but the objective is unattainable. The drive for thinness is inevitably a setup for failure. So the result of focusing on weight is shame and failure. And that is how a significant number of women experience themselves day in day out. 

There is a growing chorus of angry women’s voices expressing outrage about the shackles of thinness and weight. From the body positive movement to the concept of intuitive eating to the food coaching movement, younger people are listening to influencers who making a difference. These voices need to penetrate communities where dieting is a part of every 13 year old girl’s development and be sure the overwrought fears of obesity don’t scare people away.

These voices need to make clear the risks of spending a lifetime suffering in shame. These voices need to make clear that all body shapes are healthy and ok. These voices need to remind everyone what is truly valuable in life.

6/6/19

The Root Cause of Body Image Distortion

These last two posts outlined some of the causes of body image distortion and how one’s mind can latch onto these self-images. The power of negative body image feels like a truth, a rite of passage passed down from mothers to daughters or within communities.

Because this component of eating disorders is a culturally accepted norm, changing the root of the distortion is exponentially more difficult. The outside world continues to state that thinness is a virtue, if not an accomplishment. Among women, telling one another “you look like you’ve lost weight” is still the ultimate compliment.

The task for the clinician of convincing a patient that the goal of thinness, a central part of society, is somehow false is a tall order. A therapist may be able to work against eating disorder thoughts that tell people to starve or binge and purge, but it’s a much more difficult goal to contradict the belief that women need to focus on weight loss as a sign of success.

This contradiction comes up in recovery very regularly. Even the most educated and supportive families struggle not to question their child’s meal plan and become afraid of too much weight gain. Even after years of watching their family member suffer with an eating disorder, the overall pressure for thinness can often override a person’s general health and wellness.

The drive for thinness leads to dieting, the most significant risk factor for developing an eating disorder, and also makes recovery more difficult because of the pressure not to gain weight, even if that’s necessary to get well. Trapped on both sides, people often feel most stuck because of body image distortion in their recovery. This is the last element of the illness that gets better.


Ultimately, body image distortion will only change when the cultural norm changes, something well beyond the lone clinician’s ability. This focus on weight remains a curse in our lives and especially women’s lives. Nothing will change unless the people most affected find a way to band together and insist on those changes. Life has to be more important than weight.

5/30/19

Body Image in Eating Disorders, Part II

The last post focused on the changes in brain processing which affect body image and the perception of one’s own body differently from others. Another equally important aspect of body image distortion is the emotional connection.

The underlying feeling behind body image thoughts is shame. Thoughts about body always revolve around never being enough: not thin enough, not shapely enough, not attractive enough. The list is endless.

Typically, these thoughts about one’s body starts around puberty when bodies change quickly and suddenly. The development of identity and self-perception occurs at the same time and often in lasting ways.

Adolescents, especially girls, still grow up with the message that their changing bodies are a source of deep shame. That shame may begin in how they are perceived with a developing body, how they dress, how they develop curves or fat in typical places for women or in the deep discomfort others, typically family, have during their development. Sometimes, the shame begins at home and other times from school or peers.

Because of the drive for thinness in our society, many children see dieting, food restriction and weight loss as a concrete way to battle against puberty and attempt to halt the changes in their body. The cultural norm of thinness naturally condones this dangerous behavior and assures teenagers that body shame is a critical part of becoming a woman.

As I have written many times in this blog, dieting is the number one risk factor for developing an eating disorder. Whether or not children become ill, for the most part, they learn about the connection between shame and body image. And the constant negative thoughts associated with their own self-image is quickly ingrained in so many girls and young women.


The new trends of body positivity, varied size models and body acceptance are taking hold. Both for the sake of avoiding eating disorders and for avoiding a lifetime of shame, let’s hope these trends make a dent in the cultural norms of the last fifty years.

5/23/19

Body Image in Eating Disorders: a Brain Malfunction, Part I

People with eating disorders struggle more with body image than with any other part of their illness. Even when eating behaviors have normalized, body image distortion often persists for years afterwards before fading.

The first component of body image thoughts manifests as a brain distortion. The visual image of one’s body is transformed in the brain into something very different from reality. At the most extreme, people who are very underweight see a much larger person on the mirror. Others may only see a body that disgusts them no matter its appearance.

As one’s own reflection is associated with such negative thoughts and feelings, it becomes impossible to disconnect the internal reaction from the way their body actually looks.

I have seen many people have an experience that highlights the power of body image distortions. These patients have told me that they will catch the reflection of their silhouette in a store window and not realize they are seeing themselves. In that moment, they describe having a positive feeling about that body and often a jealous reaction that they wish it was their body. Once they realize it actually is their body, the reaction immediately changes to seeing a body they hate which leads to disgust and hatred.

This moment makes clear how body image symptoms can be seen as a brain malfunction. The brain of someone with an eating disorder can process one’s own image very differently depending on the context. The exact same body can be a source of envy or the locus of disgust depending on whose body it is.


The connection of positive or negative feelings with one’s body grows from years of associations with how one feels about oneself. The core of the negative associations starts at a younger age and coalesces around body and body image through the process of childhood and into an eating disorder. The next post will focus on this process.

5/16/19

The Expanding Influence of Bariatric Surgery

As Bariatric surgery widens its reach in diet and weight loss culture, the psychological risks for many patients increase dramatically.

Originally, these surgeries were meant to be last ditch efforts for people with very high weight and clear and evident medical risks. When weight leads to organ failure and shortened life, it makes sense to consider drastic options. But these circumstances are very rare.

Acceding to the lure of financial gain and a completely new surgical speciality, doctors have increased the type of surgeries and the people eligible for them as well. It’s clear that medicine does not have a clear handle on the long-term anatomical and medical risks associated with these procedures. The siren call of permanent weight loss—without any factual basis to the long-term benefit of surgery—is enough to pull in a multitude of desperate patients.

What these surgical centers lack is a thorough psychological screening for their patients. Having performed several of them and reviewed many others, the centers expect a cursory screening at best. Surgeons and hospitals don’t want to know about latent eating disorders or even more obvious ones. They want to check the necessary boxes and perform more surgeries.

Our culture prays upon people unsure of themselves who have determined that they can manage their own personal limitations by losing weight. Since diets never work, people seek out more desperate measures as time goes on. One increasingly common decision is to research Bariatric surgery.


The surgeons don’t seem to realize they are exploiting cultural vulnerabilities for their own professional gain rather than helping people manage their own health and longevity. Bariatric surgery may have its place in very specific situations, but the overall message of a quick surgical fix to a cultural problem only reinforces the cynical nature of our diet culture.