I saw a beautiful, curvatious woman in her 30's this week who is contemplating liposuction. I can't imagine where, but I do know why. She has carried around a distorted body image for 20 years, since her freshman year in college, when she gained the freshman 15 and kept it on for one year. She remains petrified of a tiny amount of fat on her belly, sadly. Doesn't she know it's supposed to stick out a little? Of course, she's from a family of perfectionists and is good at everything she does, which plays into her compulsive beauty maintainance.
Most of the time, I see obese people who view themselves as the new normal, fitting in nicely with their overeating family members and friends. They view average size people ( or what used to be average) as thin. They feel sorry for those who restrict their diet.
Occasionally, there's the anorexic or borderline anorexic, exercising her butt off in the gym and eating one apple for lunch. When she comes into the office, there's hope because she's realizing the problem. It's the person who consistently maintains her weight of 85 lbs. over the years, lying to herself about an amazing metabolism or being careful never to gain weight so she never has to lose it, who worries me more. What's she doing to her body over the years and when will she realize that she looks sick and could be enjoying food?
Poor body image develops from our families' attitude towards their and our bodies, from society and as fallout from anxiety, obsessiveness and depression. We can't just approach people randomly and confront them about their bodies, but if they open up, we can be politely and kindly honest about what we see. Too bad, people aren't honest, so afraid to offend that they reinforce the poor body image by agreeing. For example, they say, "Oh, I'm always trying to lose a few, too," to someone who doesn't need to lose weight or "Dieting is too hard," to someone who does. Let's care enough about people to tell them the truth gently. If they hear it enough, it may take.