Body image is a complex and deeply personal issue for all of us. As clinicians, we are often faced with the challenge of supporting our clients in improving their relationship with their bodies. We might feel intimidated by this endeavor because it’s not something that we’re taught in school, especially if you’re reading this as a dietitian. Keep reading to learn about how clinicians can help their clients on the topic of body image and eating disorders.
Our society puts lots of pressure on individuals to achieve certain body ideals, so body image is a topic that will often be brought up in therapy. Even if you don’t “specialize” in eating disorders. And, if you do specialize with eating disorders, then fine-tuning your body image counseling skills will be critically important.
This blog aims to support clinicians in learning practical ways they can have more extensive conversations about body image with their clients in sessions.
What is Body Image?
First, let’s define body image. Body image refers to the way individuals perceive, think, and feel about their physical appearance. It is influenced by many factors, including cultural norms, media representation, personal experiences, and social interactions. A positive body image is characterized by a realistic and accepting view of one’s body, while a negative body image can lead to various mental health issues, such as eating disorders, depression, and anxiety.
Anti-Fatness and Weight Stigmas in Our Society
We also can’t have a conversation about body image without addressing the anti-fatness and weight stigma that exists in our society. Many people in higher weight bodies have a more difficult time existing in this world because of the stigma that is associated with larger bodies. For example, higher weight individuals might be more hesitant to go to the doctor’s office. Why? Doctors often focus on weight as the sole issue, as opposed to addressing other health concerns, leading their patients to feel shame. Eventually avoiding the doctor altogether. Here is a link to a powerful poem about being fat and going to the doctors – The Fat Joke by Rachel Wiley.
Another example of anti-fatness in our society is that many seating arrangements (train, plane, conferences, movie theaters) are not created by taking larger people into consideration. It is more difficult to develop a positive body image when you are living in a world that isn’t designed for you. That’s not to say that thinner people can’t have body image concerns. Of course any body image concern someone has is so valid! We just need to be mindful of how higher weight individuals experience fat phobia on a more systemic level than thinner individuals.
It’s just to say that higher weight individuals experience that phobia on a more systemic level than thinner individuals. It’s important for clinicians specifically to understand this. Looking at our culture’s fat phobia can support us in having a deeper understanding of what some of our clients experience on a daily basis if they live in a larger body. This helps to put in perspective why body image can be a difficult conversation and improving body image is more than simply learning to like how your body looks.
Helpful Conversations to Explore Body Image with Client Sessions
So, what are some helpful conservations to have with clients to explore body image during session? Let’s take a look!
1. Reframing “body positivity” to “body neutrality”
While the idea of loving your body is great, it might not be possible for everybody. With some clients it can be really helpful to reframe the idea of “body love” or “body positivity” into body neutrality. Making neutrality the new goal.
Body neutrality means that you are able to live your life without your relationship with your body preventing you from doing so. For example, a client wouldn’t cancel dinner with friends if they didn’t like how they looked that particular day. We need to work with clients to give themselves permission to feel neutral about their body and understand that it’s normal to not feel completely positive at all times. You can still have an overall healthy relationship with your body if you are treating it with respect, even if that means you don’t like how your body looks.
This body neutrality idea will support clients in laying groundwork for future body positivity or body love. Check out our blog on 6 Body Image Activities for Eating Disorders for more information on body neutrality and respect.
2. Focus on values
Another body image conversation to bring to session, is to actually step out of having a conversation about body image specifically, and step into a conversation about what the client values. Think about discussing how their relationship with their body prevents them from living their values or brings them closer to their values. This can support clients in seeing that it’s possible to live a full life without having a deep focus on looks. A client might even realize that beauty isn’t one of their top values.
If a client does value beauty, you can discuss why and where that comes from. Perhaps this was something drilled into them at a young age. Perhaps valuing beauty really means they value belonging and acceptance. Perhaps it’s not something that they value but they feel they should.
I would recommend asking your clients to list out five of their top values and discuss each of them in detail. You then can go through each of their values and discuss how their relationship with their body brings them closer to said value and how their relationship with their body brings them further away to said value.
Additionally, a good “homework” assignment would be for a client to select one value and observe the actions they are taking that align with that value throughout the week. And, if they notice they are straying from that value, to journal and observe those actions. Without judgment!
3. Discuss comparison
Comparison is natural for all of us. We compare ourselves to our friends or our family members – both with how we look and with accomplishments. This is something very normal for our clients, and it can impact body image and self esteem. It can be helpful to have a conversation with clients about how comparisons are serving them or hurting them. You can validate that comparison is normal and there’s nothing “wrong with it,” but the goal is to assess how it might be impacting their overall self-esteem.
One first step to reducing comparisons is for our clients to notice when it’s coming up. I would recommend that they keep a log on their phone or in a paper journal and jot down each time they are noticing a comparison.
4. What would you tell a friend?
It can be helpful to encourage clients to show themselves a bit of self compassion by asking “what would you tell a friend?” Oftentimes, clients will say I can give advice to a friend, but I can’t take that advice myself. You can ask a client to list out what they would tell a friend, and encourage them to pick 1-2 things they can practice on themselves.
Final Thoughts on Helping Your Clients with Body Image and Eating Disorder Issues
Body image is a multifaceted and deeply personal issue that clinicians often encounter in their practice. Our society’s pervasive pressure to conform to certain body ideals make this an ever-relevant topic regardless of one’s specialization or experience treating eating disorders. Practical strategies such as promoting body neutrality, focusing on values, discussing comparisons, and encouraging self-compassion can facilitate meaningful conversations about body image. By using these techniques, clinicians can help clients build healthier relationships with their bodies and improve their overall well-being.
Contact Us
Courage to Nourish is a group of eating disorder specialized dietitians. We have in person locations in Alexandria, Virginia, Columbia, Maryland and College Park, Maryland. We offer virtual services across the state of Virginia, Washington DC, Pennsylvania, and Colorado. We offer individual nutrition therapy. As well as support groups. We would love to guide you in building a better relationship with food.
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Alex is the founder and owner of Courage to Nourish. She opened Courage to Nourish to create a practice that aligns with her values in eating disorder recovery. She is a Certified Eating Disorder Dietitian and Approved Supervisor through iaedp. Alex loves working with children, high school and college students as well as athletes. Additionally, Alex is a proud anti-diet dietitian and works with her clients through a Health At Every Size © and intuitive eating framework. Read more about Alex here.
