Why Body Image Work Hasn’t Worked

You know how some words just start to bug you because they just lose their meaning? I’ve got a laundry list—self-esteem, body image and self-help are among them.

This body image stuff confounds a lot of folks, therapists included. Many clinicians don’t feel well trained in it. They don’t know if what they are doing is helpful. They don’t feel confident they can help people improve body image.

For many people it comes last in the healing process (or not at all). It gets skipped because treatment ends or the eating challenges are improving and people feel a bit better. Sometimes body image work feels like more work and less inspiration. It can be nebulous and separate from what is absolutely needed for feeling better. After all, we live in a world where body dissatisfaction is highly normative. In fact, feeling content in your body is not all that common.

So what’s the problem? There are huge misconceptions about what it means to work on body image. And, some of it just doesn’t fit well into a workbook.  It’s messy. It is counter-cultural. There’s no way around this. Honestly, I think we’ve missed the point about what it is to heal “body image”. In our confusion over this, we’ve kind of collectively thrown up our hands.

Healing body dissatisfaction/loathing is not necessarily about liking the image of your body. It’s not solely about changing the way you see your body.  It is very much about turning toward and unraveling the internalized body loathing, shame and oppression that have turned your body into a thing needing to be altered and improved. This cultural stuff was never yours, though you may feel overrun by it.

During my years as a therapist doing this work, I’ve come to believe that what we call body image work is actually body acceptance work. Unfortunately and inappropriately, body acceptance has been considered political, or is thought to belong more to the fat acceptance movement, or too HAES® for some folks, so it’s considered fringe-y.

It’s not fringe-y. It’s essential. It’s where sustainable healing happens. We’ve been wrong about it. We haven’t been brave enough as a profession to assert this truth.

Why? Body image cannot sustainably improve without addressing the personal and systemic impact of weight bias. The more deeply we are willing to dismantle institutions that monetize weight stigma, the more deeply people will be able to occupy their bodies. Internalized oppression and body shame have to be named, not merely as “thinking errors”, but as the very real experience of having a body that is subject to other-ing and pathologizing.  Maybe this is why body image work has primarily served white, cis-gendered women?

We all have greater opportunities for healing if we move towards an inclusive image of bodies. Encouraging and respecting variation, including size, is normalizing. Non-white, gender non-conforming and fat bodies are not meant to be addressed with a different set of rules, but wholeheartedly included. Body acceptance work can be deep enough to reach into these places.

Body acceptance work is less about helping people improve their esteem for their bodies and is more akin to self-compassion work (with some radical acceptance thrown in on the side). Self-compassion is a well-researched arena. Self-compassion offers a much-needed antidote to self-esteem work, which, although commonplace in our venacular, has not proved all that helpful. Kristin Neff says “In modern Western culture, self-esteem is often based on how much we are different from others, how much we stand out or are special. It is not okay to be average, we have to feel above average to feel good about ourselves.” Our self-esteem is often contingent on our latest success or failure, meaning that our self-esteem fluctuates depending on ever-changing circumstances (enter the dieting paradigm).

Those of us with any power to do so need to work to dismantle body blame not just within individuals but also our systems and institutions. Do not tolerate “body image work” that exclusively places the burden of healing upon the individual alone. Ask for more. Do not support programs that promote weight change as a way to improve body image. Question them. Clinicians, note that your ability to feel comfortable offering body acceptance work will be enhanced by exploring your own body story and process.

Let us question what we really want when we speak of body image work. We want freedom for bodies and we want inclusion. We want systemic change and less body blame. We must turn towards the territory of body acceptance work to make a significant difference.