by Glenn Mackintosh,
Psychologist specialising in eating, movement, weight, & body image

With all the work I do in weight management, body image may be the biggest issue people face today. Almost all of my clients struggle with their relationship with their body in some way: the people who live in the largest bodies, the smallest – and everyone in between. Body image concerns are now so pervasive that psychologists talk about a “normative discontent” – meaning, it’s normal to be unhappy with your appearance, no matter your weight, shape or size.

Seeing the commonness and cost of body issues, it has become a mission of mine to help people towards “body positivity”, and I must  say it’s the most rewarding work for me.

While many of us may seem okay on the outside, as a therapist, I get a unique view into the inner worlds of people struggling to feel  comfortable in their own skin. I see the psychological cost of having a negative body image, and it’s real.

Here are some examples I’ve seen in my practice recently:

• A middle-aged woman, in tears; she’s lonely, but “can’t” see her friends at her current weight.
• A man having trouble sleeping before his school reunion, and avoiding dating, as he worries what other people will think of him.
• A lady telling me she has hated looking in the mirror and has thought about dieting every day for 20 years.


“I finally realised that being grateful to my body was key to giving more love to myself” – Oprah Winfrey


The struggle is beautifully personified in the story of one of my clients, Sarah1.  

“Since I can remember, I’ve always felt uncomfortable in my body and unhappy with my appearance. It’s never been about my features, but always with my size: particularly my legs, arms, hips,  and stomach. When I look at myself in the mirror, or when I ‘check’ my body by pinching the fat on my waist I feel hopeless. I‘m fit and healthy, and even though I have lost around 25kg, I can never seem to get to a size that I am happy with.

 “Well, that‘s not entirely true. A couple of months ago I was at my lowest weight ever; I wasn‘t eating very well (having maybe one coffee and one smoothie a day), and I was also on a new contraceptive pill (which, contrary to most women‘s experiences, seemed to help me lose weight). I weighed 64.5kg, and I remember seeing that number on the scales and seeing my body and for the first time in my entire life, I actually felt content and happy. I‘ve also struggled with restrictive eating, but at this weight, not eating enough didn‘t really bother  me: it meant that I was light, and I felt good and people complimented me on my weight loss. However, I went off the pill because it was making me too emotional, and now my weight is back up at around 66-67kg with eating according to my hunger cues.

“Being at a higher weight than my perceived ‘optimal‘ is frustrating. On one hand, I know that I‘m healthy and fit and that my weight seems to like to sit at this point. On the other hand, although it takes a lot of stress and a lack of food to maintain, being at that lower weight feels fantastic. I felt so good, but also unhealthy and unsustainable. Last week, I went through a lot of stress and decided to forgo meals so that I could get drunk and forget about the stress (something that I have never done before). But I went back down to that size that I was  happy at; my jeans were loose, and my stomach was flat, the rolls of my stomach when I sat down weren’t so big. I was unhappy because of the stress, but at the same time I was incredibly happy with my size. Now, I‘m eating normally, and my size has gone back up, and I feel healthier, but I also feel big and bulky and that I take up too much space, and that I‘m not very nice to look at. Sometimes I feel like  it‘s a choice between being unhealthy and happy with my weight, and healthy and unhappy with my weight. It‘s really frustrating, and I don’t know what to do about it. I think I know, realistically, that size doesn‘t really even matter that much. I know that health and happiness are the most important things. But for me, it‘s different. I feel happy when I‘m slim, so is it a trade-off between health and happiness?

“My body image is at its worst when I‘m in public. Sometimes I have good days, but as soon as I go out and see other people, I feel uncomfortable again. I don‘t know if it‘s me comparing myself to them, or if they just remind me of what I don‘t look like. And I feel so  confused, because I don‘t think size makes you a good or bad person, but when I see girls who are slim I feel so inadequate. Likewise, for when I catch my reflection in windows; I can be feeling great, but as soon as I see my reflection that good feeling comes crashing down and I want to disappear. It seems so illogical, for my happiness to be based on my appearance, but it is, and I can‘t seem to help it.

“I often feel confused with my body image because of what other people say about my appearance. My boyfriend and friends tell me that I look slim and fit, but most of the time I don‘t feel it. Sometimes I wonder if I‘m actually seeing the right reflection in the mirror, if my body actually looks how I see it, or if I‘m seeing something that my brain is making me see. Like, I don‘t know if I actually look like this.

Reference:[1] Name is made up, to protect client confidentiality.

With this story fresh in your minds, here are five actionable ways to help you, as dietitians, discuss body image with your clients.

1. Help clients declutter their social media.

Assist your clients in deleting, unfollowing and unlike-ing pages, blogs and social media  accounts that preoccupy them. Unless they free their brains from being bombarded with these insidiously harmful messages, body  acceptance is a near impossible goal. I have often made this a starting point for my body-image work, and I’m happy to do it in session. How can I hope to be effective in an hour a week, when people are viewing these images for an hour a day?

2. Stop the talk about body size.

Encourage clients to put a stop to discussions about body shape, weight loss, dieting and even appearance in general! Being openly critical of bodies is very likely to result in body dissatisfaction – you get good at picking out flaws in appearance, including your own. But just as harmful as body dissatisfaction is body preoccupation – placing too much importance on appearance. Too much talk about bodies (positive or negative) can eat away at body acceptance. Open talks with clients about making “No body size talk” pacts with their friends,  colleagues, and family – we all have more important things to talk about.

3. Don’t reward weight loss.

Clients, living in a diet culture, tend to be  obsessed with their weight. Of course, they get excited about weight loss (or its siblings, body composition and measurement changes). De-emphasising this excitement and focusing on nonweight benefits (such as improved blood sugar, gut health and mood) helps clients “zoom out” from the scales and see themselves as whole people.

4. Encourage clients to  explore the world of body positivity.

Learning body positivity is like learning a new language. It is a complete paradigm shift away from diet culture’s messages about our  bodies. I always find it helps clients to have many guides to this brave new world. Some of my favourites are the one-and-only Taryn  Brumfitt, amazing  plus-sized trainer Louise Green, and my good mate Lyndi Cohen. Searching hash tags such as #bodypositive  #effyourbeautystandards and #bodyposi is a great start, too.

 5. Refer to a psychologist.

Psychologists are not weirdos, waiting to hear all the juicy details about your past for a couple of hundred bucks an hour, without any real point to it.  Did I miss any clichés? Oh yeah, the men don’t all have beards and pipes, and the women don’t all wear glasses and shawls either. Body image issues are complex.

A trained psychologist can help clients with all of the following,and more:

• Defuse critical body talk stemming from earlier life experiences
• Question the common assumptions society gives us about our bodies
• Help develop a more positive sense of our appearance
• Reframe negative body thinking
• Do more positive body image behaviours and less negative ones
• Help make sure body image improvements translate into healthier habits

Point being, psychologists can really help here.

Learn more here.

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