South China Morning Post. Monday September 12, 2005
Psychologist Sandra Comer looks at the emotional health risks of striving for the perfect body.

How do you feel when you step out of the shower and see your reflection in the mirror? Where do your eyes gravitate? Many women go straight to the body part they most despise - perhaps their stomach, thighs, or less-than-firm buttocks.

Imagine how different they'd feel if they focused on their best features?

Body image is influenced by many factors including culture, mood and personality. It involves much more just weight and body shape. For some people it's what they focus all of their negative emotions on.

Rather than deal with the more difficult issues, many convince themselves that all their problems would be solved if only they were thinner. Woman often get caught in a vicious cycle where emotional distress can lead to a loathing of their body, which in turn, can heighten their distress. "When I get on the scale each morning" says one of my clients, "the number dictates what kind of day I'm going to have". Another says she weighs herself every day. "If the scales hit 50kg, I start to worry and then spend the next couple of days watching everything I eat, even missing meals, to get back to my 'ideal' weight, which, by most standards, is underweight."

"I'm not as bad as I used to be, but sometimes I wonder what it would be like to be 'normal' because this is how I've been for such a long time." Obsessing about your body gives you a false sense that you can control something - that is, body weight and shape. This belief is validated by society and is expressed not only in the media but also in many interpersonal encounters.

Studies in the US consistently show that over 80 per cent of women are dissatisfied with their bodies. The average American woman weighs 63.5 kg. Their desired weight is 56.7 kg. A poll conducted in Psychology Today found that 87 per cent of women want to lose weight and 56 per cent are dissatisfied with their overall appearance.

Men, although representing a much smaller proportion of the sample size (only 14 per cent), were less dissatisfied with their overall appearance (43 per cent). When they were dissatisfied it was directed toward their stomachs (63 per cent), weight (52 per cent), muscle tone (45 per cent), and chest (38 per cent). The importance of achieving their weight goals was so important that 15 per cent of women and 11 per cent of men would sacrifice five years of their life to do so.

According market research group ACNielsen the average weight among Hong Kong women is 52kg, but the desired weight is 50kg. This may not sound like a huge difference but they also wanted to be 5cm taller (165 cm rather than 160. The resulting body mass index for this desired height and weight would put them in the underweight category. Although more than one in five regarded themselves as "too fat", they were underweight according to international standards.

A study conducted in 2003 by the University of Hong Kong investigated the association between body image and eating attitudes in a sample of 358 adolescent Chinese girls in Hong Kong. Although only 5% of the girls were overweight, 85% desired to lose weight. In Hong Kong, there are 25 times as many patients with eating disorders as there were 15 years ago, according to Sing Lee, a senior lecturer in psychiatry at the Chinese University of Hong Kong and Director of the Hong Kong Eating Disorders Centre.

Experts continue to debate whether these problems are caused by western influences on their cultures through the globalized media or are more the result of affluence, modernization and the conflicting demands now placed on young women.

Either way, the effects are clearly the same: an unhealthy preoccupation with food, body weight, and body image. A study conducted through Chinese University in 2000 examined this modernization theory by comparing body image perception in Shenzhen and Hong Kong. Women in rural China preferred slightly larger body types on average and they dieted less despite being slightly heavier. Hong Kong women weighed less, dieted more and strove to be thinner. The study concluded that modernization equates success with "young, slender, more glamorous women."

It shouldn't be too difficult to figure out where children learn that fat is bad and thin is good. In August 2000 US-based magazine Fairlady tested how children see themselves and others, and how a mother's own body image can affect that of her child's. A group of children, aged from four to six, were shown pictures and asked which one of three girls they liked best and who they'd most like to play with. Extremely weight-conscious mothers influenced their children to judge others and choose those that they would want to be friends with, based on weight and shape. Health experts agree that a long-term approach to weight control combined with exercise is the only way to go. We also need to accept the fact that we are not entirely responsible for the way our bodies look. Weight maintenance is a complicated process and one that researchers are still learning about. According to Rudolph Leibel, an obesity expert at the Columbia Presbyterian Medical Center in New York, there is overwhelming evidence that people inherit a range of weights that their body can comfortably maintain. Heredity may account for as much as 70 per cent of what we weigh.

So what do we do when standing on the scales first thing in the morning ruins our day? First of all, get rid of the scales and judge by the fit of your clothes. Scales do not indicate whether a weight gain is just, for example, water retention. If you must weigh yourself, do so once a month, at the same time.

Appreciate the fact that healthy bodies come in all shapes and sizes. Give up 'weightism' and try to find attractive things in every woman you see. Think of individuals you admire and what traits (that have nothing to do with physical appearance) you most admire in them. Try to identify what it is that triggers negative feelings about your body. It could be an argument with your husband or feeling ignored by friends. According to Carolynn Hillman, author of Love Your Looks: How to Stop Criticising and Start Appreciating Your Appearance, no amount of 'thinness' makes you feel thin if you have deeper unresolved issues. Fat - as in "I feel so fat" - can become the buzzword for all your negative emotions, rather than confronting the issue that is really bothering you. As cliched as it sounds, try saying positive things to yourself when you look in the mirror. If this is difficult try thinking of compliments that others have given to you. Parents should ensure that their children know that many fashion and beauty advertisements are unrealistic. They need to be taught about healthy eating, the importance of engaging in moderate exercise, and the dangers of dieting. And they need to be praised for things that have nothing to do with physical appearance.

Imagine the time you would save if you stopped obsessing about your body and got on with more productive endeavors.

Sandra Comer, Ph.D., is a Hong Kong-based psychologist, specializing in eating disorders.