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Social Dimension of Eating Disorders Pt. 2


Fall 2004, Volume 3, Issue 4

American Culture and the Production of Eating Disorders

Body Image: A Biblical Perspective

Body Image Treatment: A Biblical Framework

The Fall 2004 issue of The Remuda Review continues to explore the social aspects of the bio-psycho-social-spiritual model of eating disorders. In previous issues, we discussed family contributions to eating disorders and the social influences that occur as children grow—peers, school, intimacy, dating, and marriage. In the current issue, we round out our discussion of the social dimension by offering articles on the relationship of eating disorders to culture, media, and body image.

Editorial Staff

American Culture and the Production of Eating Disorders

Edward J. Cumella, PhD
Department of Research and Education
Remuda Ranch at The Meadows Programs for Anorexia and Bulimia

Entrepreneurs made millions exploiting her… the merchants of the earth grew rich from … articles of every kind … and bodies and souls of men (Revelation 18:3, 12-13; The Message and New International Version)

Because of their Biblical commitment, Christians have historically supported freedoms for individuals and groups, including groups formed for economic pursuits. Simultaneously, Christians promulgate the Biblical values of truth, justice, morality, resource and planetary stewardship, and Christ’s perfect, all-encompassing commandment to “love your neighbor as yourself” (Matthew 22:39). Economic interests that fail to incorporate these essential Biblical values depart from the will of God and have the capacity to distort cultures and do violence to people and God’s earth. Well-respected Christian and secular leaders have lamented the immoral and destructive influences that certain untempered economic interests are having on American culture (e.g., Burkett, 1996; Kilbourne, 1999; Lucado, 2001; Pipher, 1994; Swenson, 1992). In this article, we will briefly explore these problematic influences on American culture and the manner in which they may promote the debilitating symptoms of eating disorders.

Culture and Advertising

When patients in Remuda’s body image groups watch the film, The Ad and the Ego, they often walk out angry—angry that they have apparently been deceived by subtle messages in advertising. As one teenager wrote of this situation:

“Messages about our bodies not being good enough … [are] heard and seen on radios, TVs, billboards, news, articles, movies, fashion runways, and magazines everywhere. The result so far of the bombardment of ‘If you don’t look like this you don’t belong’ is nothing but low self-confidence and self-worth…and in some death.” (Fuller, 1999)

Dr. Jean Kilbourne has devoted her life to studying the insidious effects of advertising on people’s identities and emotions. Her critique of American culture resounds when she calls our nation “the United States of Advertising” (Kilbourne, 1999). What she captures so succinctly in this phrase is the following sequence of events, chronicled by multiple scholars (e.g., Ewen, 1988; Jacobson & Mazur, 1995; Jhally, 1991).

By the 1950s, more than enough products were being inexpensively mass produced in the US to meet most essential human material needs

Therefore, producers could no longer assume that there would be markets for new products

To address this economic shift, advertising began to focus on creating consumers for new, less essential products and services

The creation of markets for less essential products has typically involved three factors: 1) Making people feel discontent, doubt, and anxi¬ety about everyday human experiences, bodily needs, and their appearance 2) Encouraging people to compare themselves to other people, to feel as though they are in compe¬tition with others for acceptance and self-esteem 3) Suggesting that particular products can offer deliverance from this discontent and anxiety, bringing acceptance and self-esteem

A women’s advertisement that perfectly exemplifies this phenomenon runs as follows: “Your breasts may be too big, too saggy, too pert, too flat, too full, too far apart, but at least you can have your hair the way you want it.” This ad clearly sug¬gests to women that they can never be comfortable with their bodies; it creates discontent and anxiety where none should be present. The ad further suggests that if women buy a particular product to groom their hair, their physical deficiencies will be less noticeable and they will fare well in comparison to other women. The product in question offers deliverance from artificially fomented discontent and anxiety about one’s body. There is no native, necessary market for this product; the market has been fabricated by assaulting women’s self-esteem regarding something as intimate and personal as their breasts. Messages of this kind are a far cry from the Biblical exhortation: “Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen” (Ephesians 4:29). Rather, messages of this kind suggest that, at least for some, “their hearts are greedy for unjust gain” (Ezekiel 33:31).

Additional developments occurring in the past 20 years have intensified Americans’ experience of discontent in their own skin. First and foremost, advertising has become so ubiquitous that it occupies almost every space in which Americans commonly find themselves. Advertisers have aggressively pursued the idea that saturation and repetition lead to product recognition and sales. Advertisements are appearing in more and more places that were long considered out of reach for marketing—including public schools and children’s textbooks. Advertising has so invaded the crevices of everyday life that it has become our primary environment—something, like air, that we often do not even see or experience consciously, but which nevertheless dominates our senses.

Kilbourne and others suggest that the pervasive, repeated messages of advertising have become a system of public education. The average American comes in contact with more than 3,000 advertisements per day and spends two years of life watching television ads. The average American child spends more time watching television than in school. One can argue that advertising has therefore become the dominant channel through which messages about normal life are offered and digested.

Evidently, advertising is effective in creating markets and consumers for a multiplicity of products. The fact that corporations spend $250 billion a year on advertising suggests its efficacy. America’s economic success also testifies to this. But what does this have to do with eating disorders? According to Ewen (1988), the human images seen in advertisements have become increasingly extreme. Images of an idealized, super-tall, super-thin female body with elegant hair, large eyes, high cheekbones, large mouth, white, straight teeth, plump lips, and per¬fectly proportioned arms, legs, and abs are constantly paired with images of wealth, pleasure, friendship, flourishing sexuality, self-confidence, and success. The message communicated through this constant associa¬tion is that, to fulfill these intrinsic human desires, one must have an absolutely flawless body. Increasingly in recent years, images of idealized male bodies are being presented and associated with the same expressions of human fulfillment. Not surprisingly, some experts believe that there is a concomitant increase in eating disorders among men in the US (Cumella, 2003).

It is worth noting that the kind of super-tall, super-thin idealized female body consistently portrayed in advertising exists in less than 2% of the US population (Smolak, 1996). The remaining 98% of women, because of their genetics, cannot obtain this unusual look. Hence, the female models portrayed in advertising are very poor role models indeed. They may even be considered “anti-models,” since they represent an image that is virtually impossible for most women to achieve. Furthermore, most of the images are pure fiction. They are computer-enhanced composites of multiple women’s body parts. The beautiful woman on the magazine cover does not even exist. Celebrity role models routinely have multiple body doubles, whose inclusion in film and print media reinforces the illusion that the super-thin, super-tall body is not only attainable but an ordinary ingredient of success—a patent falsehood.

When girls and women are repeatedly exposed to these unattainable and frankly alien images of female beauty, the result is a powerful experience of self-criticism and discontent for the 98% who cannot achieve the vaunted look. Producing discontent in 98% of the population may create huge markets for products purporting deliverance from this discontent. But it also leads to wide scale body-hatred. America is sadly a nation in which the large majority of women suffer body image dissatisfaction. Some pursue extreme measures, such as eating disorders, to contort their bodies into an unnatural, idealized shape, in the desperate quest for self-esteem and acceptance. The body hatred starts early, with advertising targeting ever younger audiences. To wit: 80% of fourth grade girls and 91% of college women in the US are dieting (Kurth et al., 1995).

Although reliable data are difficult to obtain, eating disorders appear to have risen steadily in the US during the past 40 years. This increase coincides with the changes in advertising detailed above. The etiology of eating disorders is obviously a complex bio-psycho-social-spiritual phenomenon (Cumella, 2002). But since the human genome has scarcely changed in the past 40 years, cultural changes are likely to be a driving force behind this increase in eating disorders. The sophisticated critiques of advertising’s omnipresent impact on American’s identities may indeed be correct. Recent controlled experimental studies support this conclusion. In one study (Hawkins et al., 2004), women exposed to magazine images of thin models evidenced increased body dissatisfaction, negative moods, and eating disorder symptoms, and decreased self-esteem, when compared with women exposed to neutral images. In another study (Tiggemann & Slater, 2003), women who viewed music videos featuring thin female bodies experienced increased body dissatisfaction and compared themselves more to others than those exposed to neutral music videos. Research is moving beyond qualitative anthropological surveys to quantitative experimental science and finding confirmatory results regarding the impact of culture on eating disorder symptoms.

The body hatred cultivated by advertising may also be intensified by other trends in our culture. Modern America appears to be obsessed with youth and thinness (Maine, 2000). Because maturing bodies naturally widen, Americans may feel compelled by our culture to fight the inevitabilities of biology—a fight that cannot be won. American culture also exhibits obvi¬ous weightism—a prejudice against those who are overweight. Large people are routinely subjected to ridicule, derision, and even violence (Koppleman, 2003). America’s youth and weight obsessions co-exist with super sized eating options—an abundance of rich desserts, large restaurant portions, and fast foods with enormous numbers of calories. Barraged by quantities of high calorie foods, yet obsessed with a youthfully thin body, Americans find themselves in an irresolvable contradiction. This contradiction can be circumvented primarily through disordered eating behaviors such as serial dieting, compulsive exercise, self-starvation, bingeing, purging, cosmetic surgery, and so on. Some analyses (Jhally, 2000) even suggest that advertising deliberately promulgates these eating disorder behaviors as a normal and desirable resolution to this contradiction.

Finally, it is important to recognize the role of sexism in advertising, and hence in our cultural milieu. Because these issues are explored elsewhere in depth (e.g., Buchwald, Fletcher, & Roth, 1993; Jhally, 2000; Maine, 2000), we will describe them only briefly here. Again and again, women are offered extreme thinness as the ideal of feminine beauty. Some authorities have suggested that by offering an impossibly thin ideal of feminine beauty, women are literally being cut down to size—made to believe that their mature bodies are unacceptable and relegated to a diminished, waif-like presence in the world. In addition, women’s body parts—rather than images of complete female bodies—are routinely displayed in advertisements, promoting an objectification of the female body and, perhaps unconsciously, a disrespect for and normalization of violence toward women’s bodies. Images of women in advertising are often nearly naked, essentially pornographic. Exposure to such images would appear to promote continued dehumanization and objectification of the female body. Collectively, these trends may intensify women’s disconnection from their own bodies and experiences of body loathing. It is self-evident that sexism, violence, and dehumanization of women depart from the fundamental Biblical imperative: “Show respect for everyone” (1 Peter 2:17; The Living Bible).

Ethnicity, Subculture, and Assimilation

Inconsistent research results regarding the relationship between ethnicity and eating disorders have led most researchers to posit that there is no clear relationship between the two. One conclusion often repeated is that the more ethnic minorities assimilate into mainstream American culture, the more similar their risk of eating disorders to White Americans. This supports the notion that cultural influences indeed have a significant impact on eating disorder development.

Inconsistent research results have also occurred when examining eating disorders in relation to socioeconomic status and sexual orientation. Once again, the influences of the predominant US culture on eating disorder development may be stronger than many subcultural factors.

International studies also suggest that the more American culture influences a foreign culture, the greater the risk of eating disorders in the foreign population. Ann Becker’s well-known Fiji studies are telling in this regard (Becker, et al., 2002). During the 1990s, American television was widely introduced into Fiji. Within a few short years, a 500% increase was observed in girls’ vomiting to control weight, along with enormous increases in girls’ dieting and feeling fat. Ancient Fijian culture, which had long valued robust women’s body types, appears to have been overwhelmed by images portrayed in American television shows and advertising.

Forces for Cultural Change

Many organizations and individuals are working to offer Americans healthier and more realistic messages about body image. They include organizations that promote public awareness of eating disorders, offering such services as school-based prevention curricula and congressional lobbying. Organizations of this kind include the National Eating Disorders Association (NEDA) and the National Women’s Health Information Center. Many organizations are devoted to media literacy education, such as the Center for Media Literacy, About-Face, Media Watch, and The Media Foundation. Some media have also accepted that the human images they display affect women’s and girl’s self-concepts, and now endeavor to portray “plus-sized” models. The popular magazine for teenage girls, YM, is an example of this phenomenon. New Moon is an advertising-free magazine edited by and for girls ages 8-14. Teen Voices is similar, but targets 13 to 20 year-olds. YSB addresses African-American youth. Brio is a Christian magazine for teenage girls that encourages a healthy, Biblically based self-concept. MODE is a magazine for adult women, emphasizing body esteem regardless of weight.

Some organizations are taking a more combative rather than purely educational approach, countering weightism directly with messages and social action intended to bring about greater weight acceptance. The Healthy at any Weight journal, the International Size Acceptance Association, the National Association to Advance Fat Acceptance, The Council on Size & Weight Discrimination, Body Peace, and Body Positive are examples of this latter trend. Organizations listed here are by no means alone in their efforts to reshape US culture. Many others exist. As yet the impact of such organizations on American culture and advertising may be small because the rates of eating disorders are continuing to rise. Many experts believe that eating disorders are also becoming more common among pre-teen girls, middle-age women, elderly women and men, and young men. This increase in eating disorders throughout our society would suggest that greater and more visible efforts are needed to wrest our culture away from its obsession with thinness and to transform America into a society that promotes health, self-respect, and acceptance for all its citizens. As the Bible commands: “You shall love your neighbor as yourself. Love does no wrong to a neighbor; therefore love is the fulfillment of the law” (Romans 13:8-10; New American Standard Bible). Or even more succinctly, “encourage one another and build each other up…” (1 Thessalonians 5:11).


Becker, A.E., Burwell, R.A., Gilman, S.E., Herzog, D.B., & Hamburg, P. (2002). Eating behaviors and attitudes following prolonged exposure to television among ethnic Fijian adoles¬cent girls. British Journal of Psychiatry, 180, 509-14.

Buchwald, E., Fletcher, P., & Roth, M. (1993). Transforming a rape culture. Minneapolis: Milkwood Editions.

Burkett, L. (1996). The complete guide to managing your money. New York: Inspirational Press.

Cumella, E. (2002). Bio-psycho-social-spiritual: Completing the model. The Remuda Review: The Christian Journal of Eating Disorders, 1, 1-5.

Cumella, E. (2003). Examining eating disorders in males. Behavioral Health Management, 23, 38-41.

Ewen, S. (1988). All consuming images. New York: Basic Books.

Fuller, D. (1999). Figuratively speaking. In S. Torres (Ed.), That body image thing: Young women speak out (pp. 31-33). Ottawa, ON: Canadian Research Institute for the Advancement of Women.

Hawkins, N., Richards, P.S., Granley, H.M., & Stein, D.M. (2004). The impact of exposure to the thin-ideal media image on women. Eating Disorders: The Journal of Treatment and Prevention, 12, 35-50.

The Holy Bible (New American Standard Version). (1977). La Habra, CA: The Lockman Foundation.

The Holy Bible (The Living Bible). (1971). Wheaton, IL: Tyndale.

Jacobson, M.F. & Mazur, L.A. (1995). Marketing madness: A survival guide for a consumer society. Boulder, CO: Westview Press.

Jhally, S. (1991). The codes of advertising: Fetishism and the political economy of meaning in the consumer society. New York: Routledge.

Jhally, S. (Director/Producer). (2000). Killing us softly 3: Advertising’s image of women [Motion picture]. United States: Media Education Foundation.

Kilbourne, J. (1999). Can’t buy my love. New York: Touchstone. Koppleman, S. (2003). The strange history of Suzanne LaFleshe and other stories of women and fatness. New York: Feminist Press.

Kurth, C.L., Krahn, D.D., Nairn, K., & Drewnowski, A. (1995). The severity of dieting and bingeing behaviors in college women: Interview validation of survey data. Journal of Psychiatric Research, 29, 211-25.

Lucado, M. (2001). Traveling light. Nashville: Thomas Nelson. Maine, M. (2000). Body wars: Making peace with women’s bodies. Carlsbad, CA: Gurze Books.

Peterson, E.H. (2002). The message: The Bible in contemporary language. Colorado Springs: Navpress.

Pipher, M. (1994). Reviving Ophelia: Saving the selves of adolescent girls. New York: Ballantine Books.

Smolak L. (1996). Next door neighbors: Eating disorders awareness and prevention puppet guide book. Seattle: National Eating Disorders Association.

Swenson, R.A. (1992). Margin: Restoring emotional, physical, financial, and time reserves to overloaded lives. Colorado Springs: NavPress.

Tiggemann, M. & Slater, A. (2003). Thin ideals in music television: A source of social comparison and body dissatisfaction. International Journal of Eating Disorders, 35, 48-58.

Body Image: A Biblical Perspective

Marian Eberly, RN, MSW, LCSW, DAPA
Division of Patient Care Services
Remuda Ranch at The Meadows Programs for Anorexia and Bulimia

Don’t be concerned about the outward beauty... Be beautiful inside, in your hearts… (1 Peter 3:3-4; The Living Bible)

Body image is sometimes defined as “an inner view of one’s outer self” (Freedman, 1989; Thompson, 1996). This definition indicates that body dissatisfaction lies primarily in how we think about ourselves. Some might say that the problem is “from the neck up”.

Many researchers recognize three primary influences on body image disturbance:

Developmental - effects of maturation and peer/family experiences

Sociocultural – influence of Western cultural ideals, gender roles, and mass media

Perceptual - cortical deficits, adaptive failure, and perceptual artifact theories

The last is typically an issue for chronically ill patients with anorexia. The first two—developmental and sociocultural factors—affect the entire population. Developmentally, puberty is a critical milestone in the shaping of body image. It is marked by numerous physical and psychological changes for both genders. Nevertheless, sociocultural factors account for the majority of body image disturbance in Western societies. In an important research investigation, Stormer and Thompson (1996) found that the majority of variance in body image is accounted for by the tendency to make social comparisons and to be aware of and internalize sociocultural norms regarding thinness and attractiveness.

Of course, there is not a one-to-one relationship between sociocultural influences and body image disturbance. Research has concluded that individuals exposed to the same ideals of thinness fall on a continuum of dissatisfaction, with some reporting very little disturbance and others developing eating disorder behavior (Waller, Hamilton, & Shaw, 1992). More study is needed to explore how some individuals manage to refute societal mes¬sages of thinness and escape body image disturbance (Heinburg, 1996). Perhaps some individuals challenge societal messages because their self-understanding is faith-based. Indeed, acquiring a Biblically-based awareness of one’s identity may enhance resilience against powerful societal messages (Newman, 2002).

Children have a great capacity to love, accept, socialize, and play well together. However, from early adolescence onward, they generally do not have a high tolerance for difference. Fear of rejection begins to dominate the psyche in a powerful way; the worst fear is being unacceptable to peers. Beginning in early adolescence, teens learn to conform to the socially approved images they see and to believe the messages they hear about what kind of appearance is valued and expected of them. Certain interests spend a great deal of money offering these “approved” images. For example, the 50 billion dollar a year diet industry profits from those who are afraid of being rejected because they appear different from the approved images. For more details on economic interests and body image, see the companion article, “American Culture and the Production of Eating Disorders”, in the current issue of The Remuda Review.

A central message, continually reinforced in the media, is the need to obtain a beautiful outward appearance at any cost, with “beautiful” defined narrowly by a repetition of similar images. One of the symptoms of narcissistic personality disorder is “…being preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love” (American Psychiatric Association, 1994). Our culture appears to be suffering from narcissism, because we are preoccupied with these issues, perhaps beauty or physical attractiveness above all others.

The socio-cultural standard of beauty, as we know it today, is confusing at best. Being beautiful is touted as the road to happiness. This is a lie we are encouraged to believe as propagated by all forms of media and crafty marketing (e.g., Kilbourne, 1999). If beauty equates to happiness, contentment, peace, and joy, then why are so many of the physically beautiful people we see on magazine covers suffering so much? We need only open the magazines to read that many are beset with the heartaches of broken relationships, addiction, spiraling depression, and thoughts of suicide. Lives are falling apart, and the beautiful outward appearances stand impotent to prevent the tragedy.

We have long known that humans have an innate tendency to derive information about themselves through social comparison (Festinger, 1954). More recent research indicates that a tendency to compare one’s physical appearance to others is strongly related to body dissatisfaction (Heinburg & Thompson, 1992; Striegel-Moore, McAvay, & Rodin, 1986; Thompson, Coovert, & Stormer, 1999). The media and culture as a whole foster this often envious and shame-producing social comparison. Computer enhanced super-models are held up as the standard of comparison for women. This can create a profound narcissistic wound, i.e., a wound to the sense of self.

Self-demeaning social comparison has been an age-old problem. It was Gideon’s problem thousands of years ago (Judges 6). His inferiority complex left him hiding in the bottom of a winepress, fearful and afraid. Gideon had to be small in stature to fit into the bottom of a winepress. His physical appearance evidently had a great influence on how he viewed himself. But the Bible tells us that God spoke to Gideon about God’s plans for him, addressing him as a “mighty warrior”. Gideon basically responded by saying, “You must be kidding! Don’t you know that I’m the least of my clan?” Gideon had beliefs about himself that he had to overcome to accomplish God’s plans for him. He began this process by placing his trust in God at a time when everything else seemed hopeless.

Discerning the truth about one’s identity is a central theme in preventing and recovering from negative body image. Although the world’s values include such characteristics as beauty and wealth, the Bible tells us that “what is highly valued among men is detestable in God’s sight” (Luke 16:15). The things we treasure can block what God wants to accomplish in our lives. “Do not be tossed around by waves, … by the trickery of men, by the craftiness of deceitful scheming” (Ephesians 4:14). The bait of comparison to others is an enticing one; for those with a negative body image, this measuring rod continually leaves the person feeling exposed and inferior.

Seeing ourselves as God does is key in overcoming insecurities. The Biblical standard of beauty does not generally focus on outward appearance (Elwell & Comfort, 2001). The Hebrew Scriptures speak of God’s creation and nature as beautiful (Genesis 2:9; Job 26:13; Psalm 19:1-6; Jeremiah 3:19). But physical beauty was considered secondary to resourcefulness and traditional piety in women (Proverbs 31:30). The Hebrew concept of beauty had deeper meaning than simply physical attractiveness. It affirmed God’s essential glory: the Lord’s favor is called His “beauty” (Psalm 90:17). The Greek term for beauty, used in the New Testament, refers more to virtue and character—goodness, fairness, gladness, graciousness, and love—than to physical manifestations of beauty. There are many instances of this usage in the New Testament. Christ’s followers are encouraged to “adorn” the teaching of the Savior, making it attractive to nonbelievers by their integrity and honest actions (Titus 2:10). Those who preach the Gospel are referred to as “beautiful” (Romans 10:15). The Apostles Peter and Paul warn women against being satisfied with outward beauty (1 Timothy 2: 9-10). It is apparent then that the majority of women in the Bible are not specifically noted for physical beauty. The New Testament underscores this powerfully because it does not support physical beauty as the measure of a woman’s worth. Scripture encourages us to focus instead on inner qualities, relationships, attitudes, and love for God. This provides a model and perspective from which a woman can build a healthy identity: refusing to measure her worth by the shape of her body.

God does not view us as we view ourselves and others: “God sees not as man sees, for man looks at the outer appearance but God looks at the heart” (1 Samuel 16:7). In contrast to the world, then, Christians must also view beauty from the inside out: a teachable spirit, open to constructive criticism, and capable of learning from mistakes; self control; consideration and wisdom in the timing of speech; not insisting on “my way”; selflessness; willingness to listen to others’ needs/perceptions; not insisting on putting one’s needs first. These qualities are exemplified by at least two women of the Bible: Esther and Ruth. These qualities are necessary components of the portrait of a truly beautiful woman (Kole, 2001).

According to the Bible, our worth and value have nothing to do with being physically beautiful or fit. As Psalm 139:14 says: “I praise you because I am fearfully and wonderfully made: your works are wonderful…” God made us. We are of great value and worth to Him. When we begin to realize that we are valued, cherished, and loved deeply by the Maker of the universe—that He created each person to be unique and different from every other living being on the planet—we may be moved to step back in awe, knowing that we are worthy even to be called his children.

To further drive the point, the Bible reveals that God has chosen to house his Holy Spirit in a place of great worth: within the believing Christian. “For we are the temple of the living God, just as God said: ‘I will dwell in them and walk among them, I will be their God and they will be my people’” (2 Corinthians 6:16; New American Standard Bible).

God has chosen to inhabit our hearts, to dwell among us and in us. It is an awesome and holy thing to consider this truth. And once we grasp it, we begin to realize that this life is not about the appearance of the temple called the body, but about the relationship we have to God and He to us. That He would find each of us of such great value and worth to him to cause his Holy Spirit to dwell in us puts many concerns into perspective. The God of the universe has chosen to live in us with all our issues, flaws, and shortcomings. There is no need for the temple to meet some idealized worldly notion of perfection before He will abide within it. He loves and values us as we are. For those who consider themselves to be “damaged goods”, this truth can bring necessary perspective and healing. God considers us worthy—worthy to pour his life into. As this mystery unfolds in our lives, it brings deepening self-acceptance: “May the Lord bring you into an ever deeper understanding of the love of God...” (2 Thessalonians 3:5).


American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Elwell, W.A. & Comfort, P.W. (2001). Tyndale Bible dictionary. Carol Stream, IL: Tyndale House Publishers.

Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117-140.

Freedman, R. (1989). Bodylove: Learning to like our looks and ourselves, a practical guide for women. New York: Harper and Row Publishers.

Heinburg, L.J. (1996). Theories of body image: Perceptual, developmen¬tal and sociocultural factors. In J.K. Thompson (Ed.), Body image, eating disorders and obesity: An integrative guide to assessment and treatment (pp. 27-48). Washington, DC: American Psychological Association.

Heinburg, L.J. & Thompson, J.K. (1992). Social comparison: Gender, target importance ratings, and relation to body image disturbance. Journal of Social Behavior and Personality, 7, 335-344.

The Holy Bible (New American Standard Version). (1998). New York: World Bible Publishing.

The Holy Bible (The Living Bible). (1971). Wheaton, IL: Tyndale.

Kilbourne, J. (1999). Can’t buy my love. New York: Touchstone.

Kole, S. (2001). Seeing yourself through God’s eyes. Artesia, CA: Shannon Publishers.

Newman, D. (2002). Loving your body: Embracing our true beauty in Christ. Wheaton, IL: Tyndale House Publishers.

Stormer, S. & Thompson, J.K. (1996). Explanations of body image distur¬bance: A test of maturational status, negative verbal commentary, social comparison, and sociocultural hypotheses. International Journal of Eating Disorders, 26, 43-51.

Streigel-Moore, R., McAvay, G., & Rodin, J. (1986). Psychological and behavioral correlates of feeling fat in women. International Journal of Eating Disorders, 5, 935-947.

Thompson, J.K. (1996). Body image, eating disorders and obesity: An inte¬grative guide to assessment and treatment. Washington, DC: American Psychological Association.

Thompson, J.K., Coovert, M.D., & Stormer, S.M. (1999). Body image, social comparison, and eating disturbance: A covariance structure model¬ing investigation. International Journal of Eating Disorders, 26, 43-51.

Waller, G., Hamilton, K., & Shaw, J. (1992). Media influences on body size estimation in eating disordered and comparison subjects. British Review of Bulimia and Anorexia Nervosa, 6, 81-87.

Body Image Treatment: A Biblical Framework

Eileen Adams, MS
Body Image Specialist
Remuda Ranch at The Meadows Programs for Anorexia and Bulimia

Body image can be understood simply as one’s relationship with one’s body. In eating disorders, this relationship focuses primarily on appearance. As with any relationship, if one area is emphasized and others ignored, the relationship becomes unhealthy and unbalanced. When conceptualizing a patient’s body image issues, it is helpful to think in terms of relationship. How does the patient need to improve her:

Physical relationship with her body—e.g., self care, clothes, distorted perceptions

Emotional relationship—e.g., alexithymia, feelings skills, self-talk

Cognitive relationship—e.g., ineffective beliefs, identity, comparisons with others

Spiritual relationship—e.g., gratitude, competition with others, priorities

The essence of body image treatment across these four domains is encapsulated in Psalm 139:14. “I will give thanks to you, for I am fearfully and wonderfully made; wonderful are your works…” (Psalm 139:14; New American Standard Bible). Does the patient:

See her body as a good work? ? Physical relationship

Feel awe about the way God made her? ? Emotional relationship

Know about the beauty and love with which and for which she was made? ? Cognitive relationship

Experience gratitude that she was born and made as she is? ? Spiritual relationship

Answers to these questions give direction for continued body image work, helping the patient to build a Biblical foundation for a healthy, right relationship with her body. For many with eating disorders, distorted body perception is the symbolic core of the eating disorder. It often manifests as follows:

The patient literally sees herself as fat, even if her weight is within normal parameters. Because she hates fat, she hates her body and mistreats it. Her physical relationship with her body is damaged.

The patient feels fat—a shorthand way of expressing a variety of complex and difficult emotions, including shame, depression, anxiety, and fear. Her emotional relationship with her body is confusing and troubling.

The patient believes she is fat and that she is therefore unworthy, unlovable, and inferior to others. Her cognitive relationship with her body demeans her.

The patient alienates herself from God and others, competing with others who appear thinner, longing to be someone else. Her spiritual relationship with her body has been pinched off and depleted of joy.

The books below describe specific step-by-step techniques that can be used to assist patients in body image recovery within this Biblical framework.

Cash, T. (1997). The Body Image Workbook. Oakland, CA: New Harbinger Publications.

Hornyak, L.M. & Baker, E.K. (Eds.). (1989). Experiential therapies for eating disorders. New York: The Guilford Press.

Newman, D. (2002). Loving your body: Embracing our true beauty in Christ. Wheaton, IL: Tyndale House Publishers.

Next Issue: Spiritual Dimension of Eating Disorders

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