• Living Well Psychology

Body Image: Mental Health Awareness Week 2019

This year’s theme for the Mental Health Awareness week is Body Image. Whilst this is such an important topic for many people, it is particularly relevant for people who struggle with their weight regardless of actual body size.

We can’t get away from messages about the perfect body, they are everywhere. In some ways though, we can cope with these because we know they are likely to have been digitally enhanced and they are often so far away from what is possible for us, we categorise them differently. What can be much more distressing are messages about ‘unacceptable’ body size. If we feel our body or our BMI is unacceptable we feel self-conscious, unattractive and as if we are not good enough. We feel like we are a failure.

Research tells us that worrying about how we look prevents us from engaging in activities that we enjoy and things that might benefit our health and well-being, which in turn can impact on our mental health. Exercise is a good example. So many people that I have worked with over the years would like to start or get back to exercise but they feel too ashamed of their body to try, “people will stare at my loose skin when I walk from the changing room to the pool”, “I’m going to be the biggest person at the gym”, “I can’t walk outside when it’s hot because people will see me sweating”. We imagine people will be thinking the most critical and judgemental thoughts about us. And so, believing that to be true, we avoid. But as with all slippery slopes, the more we avoid situations the more anxious we become about them, making it harder to try, and worse about our body.

An improvement in health and mobility are often described as reasons to have bariatric surgery but underneath is a desire to feel more body confident; to feel an acceptable size (whatever that really means). But this does not automatically happen with weight loss. Using the BMI as a measure of whether our body is acceptable can lead to dismissing very significant change. One of my clients recently talked of feeling awful about her body because her BMI was 34. She was socially and physically more active than she had been for many years and yet because her BMI placed her within an obese range she dismissed the 9 stone she had lost.

Bariatric surgery can impact on body image in two different ways: forgetting how much your body has changed and the impact of loose skin. For many people weight loss after surgery is so rapid that it takes time to adjust. When I call people from the waiting room into my clinic, I watch how they move because sometimes that highlights how comfortable they are feeling in their body. I remember seeing a man who squeezed himself tight against the wall to allow space between him and the chairs, much more space than he needed. When I mentioned it to him, he told me that he kept forgetting his body shape had changed and when he looked in the mirror he didn’t recognise the person looking back to be him.

We see so many amazing ‘before’ and ‘after’ photos on social media but they only tell part of the story. They show us how a person’s body shape has changed, not how they feel about it. If we take the position that being slimmer is the ‘ideal’ to achieve we might automatically assume that people will be happier in their body in the ‘after’ photo, but we know that is not always the case.

So, what can we do to enhance our body image? Searching Google reveals so many different ‘top tip’ lists: we can focus on the positive aspects of our body, it’s strength and ability and remind ourselves of the journey our body has carried us through life. We can notice self-criticism and replace it with positive thoughts or stop comparing ourselves to others. And the list goes on. But as with many strategies, whilst they make rational sense, we don’t always feel able to apply them. The reality is that after surgery how you feel about your body will change and change again. Some days you will feel fantastic and body confident, then other days you will feel self-conscious. This can dramatically fluctuate for a long while. Like so many other things after surgery, it is a transition, a coming to accept how things are: not always as we might like them to be but good enough, and hopefully better than how we have previously felt.

Sometimes we need help along the way, particularly when how we feel about our body is so overwhelming that it is difficult to hold a broader perspective. Talking to people we trust, to friends within online communities or seeking specialist support can all be helpful. If you would like to talk to Jackie or I we offer face to face meetings and online support. Or if you would to join a workshop with people in a similar position, let us know, it would be great to work with you.

With warm wishes to you all,


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