Q: I am seeing a lot of teen girls in my school counseling office not liking their appearance, bodies and so on. Where to start with this? Psychoeducation on social media? If so, do you have a great resource?

I want to give every one of these girls The Body Image Book for Girls ! They are probably a bit older than the target age for the book, but there’s so much I cover in this book – from basic nutrition to media literacy – that I want all teens to know! A body image group with a focus on empowerment could be a great idea! There are psychoeducational resources available. I’d check out Be Real ( berealusa.org ) and The Body Positive Institute ( thebodypositive.org ) to start with. You don’t need to reinvent the wheel; these groups have activities, videos, and other resources that are great! You are welcome to reach out to me directly at my email to discuss any of this – chmarkey@camden.rutgers.edu

Question 1

How do you support someone who says they’re overweight in their culture, but seems to be a healthy weight based on North American standards?

Charlotte Markey · Accepted Answer

Our weight is just a number! People can be relatively small or relatively big and still be healthy. It’s a lot easier to modify our behaviors -- such as trying to engage in some sort of physical activity we enjoy regularly – than it is to change our body size and shape, which is influenced so much by our genes. The appearance ideals we are all bombarded with are unrealistic and often underweight. Many people believe that they are overweight or dislike their bodies because they want to resemble these appearance ideals. It’s important to keep in mind that the celebrities and influencers that seem to look ‘perfect’ often devote A LOT of their life to looking that way. It can be a maladaptive commitment to appearance, and it doesn’t always leave time for much else! Most of us want more mental space and time to devote to the people in our lives, our education and career, and causes that are meaningful to us.

Question 2

What are important guidelines we can give parents for promoting a healthy body relationship in their child?

Charlotte Markey · Accepted Answer

The first thing parents can do is to work on any of their own body image and eating issues. Our kids learn a lot from watching us and we don’t want to pass on our own insecurities and disorders to them. We also want to be careful how we talk about our own and others’ bodies. People naturally come in different shapes and sizes and we want our kids to understand this and accept and appreciate their own and others’ bodies. Most of us are not going to have the bodies of celebrities and influencers and we want to make sure that our kids appreciate that those bodies do not represent an appearance ideal that we should all be striving for. Parents can also help their kids develop a healthy relationship with food by not restricting their food choices (NOT restricting; I know this may seem counterintuitive). Relevant interviews, videos, and articles can be found on my web pages www.TheBodyImageBookforGirls.com and www.TheBodyImageBookforBoys.com

Question 3

Would you encourage intuitive eating for a teen with body image concerns? Are there specific resources you might recommend, and can you provide guidance on when to recognize and how to intervene if the situation progresses beyond concerns and into eating disorders or body dysmorphic disorder?

Charlotte Markey · Accepted Answer

Yes! Intuitive eating is a great way for anyone to get more in touch with their physical needs and focus on enjoying food. Intuitive eating doesn’t prescribe food restriction and many with disordered eating or an eating disorder find it to be a helpful part of their recovery (although, importantly, intuitive eating is not always appropriate in early stages of recovery when weight restoration and physical stability are urgent goals.) There are a number of great books that may be of help, including the 4th edition of Intuitive Eating by Tribole and Resch and I also really like Intuitive Eating for Everyday by Tribole (for a shorter, simpler overview of intuitive eating). My next book, Adultish: The Body Image Book for Life, which will be out in 2024, has an entire chapter on intuitive eating.

Question 4

I am seeing a lot of teen girls in my school counseling office not liking their appearance, bodies and so on. Where to start with this? Psychoeducation on social media? If so, do you have a great resource?

Charlotte Markey · Accepted Answer

I want to give every one of these girls The Body Image Book for Girls! They are probably a bit older than the target age for the book, but there’s so much I cover in this book – from basic nutrition to media literacy – that I want all teens to know! A body image group with a focus on empowerment could be a great idea! There are psychoeducational resources available. I’d check out Be Real (berealusa.org) and The Body Positive Institute (thebodypositive.org) to start with. You don’t need to reinvent the wheel; these groups have activities, videos, and other resources that are great!

You are welcome to reach out to me directly at my email to discuss any of this – chmarkey@camden.rutgers.edu

Question 5

What is your advice for a school counselor who meets young people with body image concerns and who have just started restricted eating?

Charlotte Markey · Accepted Answer

I’d start by asking what the young people are eating. I’d ask them about why and if their eating habits have changed. I’d ask as many relevant questions as I could to try to get the students to admit that they are hungry, tired, and/or concerned about their body image. It’s important for young people to appreciate that this aspect of their life is not going well and they would benefit from help.

Depending on students’ answers to these questions, I’d likely recommend therapy with a specialist who focuses on body image and eating disorders. Even a few therapy sessions can be so valuable at this juncture – before a full-fledged eating disorder sets in. A school counselor can also check in (weekly?) with young people who are restricting and offer support, encouragement to engage in self-care, and some educational resources (see question no. 5 and 8 below).

Question 6

While doing Motivational Interviewing (sharing our ideas with the young person only with their permission), should we just facilitate their exploration of their feelings and thoughts, or should we also inject suggestions and reframes of their ideas about health, control and so on?

Charlotte Markey · Accepted Answer

I think that there are so many maladaptive messages about our bodies, eating, and health in general in our culture, that it is important to counter some of those messages. It is critically important that we listen to young people’s ideas and avoid offering a lecture. We want to ask a lot of questions and engage with curiosity and sincerity. But sometimes it’s important to interject some evidence-based information. It is harder for young people to differentiate between evidence-based information and compelling personal experiences – or even a TikTok influencer’s advice. We want to help young people develop critical thinking skills in all areas, but especially when it comes to promoting their psychological and physical health.

Question 7

How do you navigate conversations about the importance of exercise for health and mood with teens, while being deliberate in your communication that weight loss isn't the goal or without having them believe that you think they should lose weight?

Charlotte Markey · Accepted Answer

This is a great question! Teens are savvy and will often read between the lines. The suggestion of exercise can easily be interpreted as a criticism of some sort. I think it is valuable to model healthy physical activity habits. Explain that you are active because it feels good, improves your mood, is an opportunity to socialize, and other non-weight-related benefits. I also think it is important to not say too much to teens. If they don’t enjoy exercise or don’t have time to be active, don’t turn it into a chore by forcing it. As we all know, teens seem to dislike anything they’re made to do. As much as we want our kids to develop good, life-long habits, we also want them to maintain a healthy relationship with food, their bodies, and activity. Sometimes saying less is more.

Question 8

How do you encourage someone who has experienced trauma through their physical body to love their physical body?

Charlotte Markey · Accepted Answer

This is really tough, but not impossible! I think that an experienced psychologist is likely needed to help the person work through the trauma. It can be valuable for all of us to remember that our bodies are our vehicles for moving through the world. They allow us to live our lives. Some aspects of our lives may be difficult or even traumatic, but some will be joyous and wonderful. It is the same body that is there for both the good and the bad. We want to try to appreciate our bodies for being there for us and take good care of them so they will continue to be there for us.

Question 9

What led to your interest in body image and eating-related behaviors?

Charlotte Markey · Accepted Answer

Sometimes I think the most honest answer to this question is probably, “I was an extremely self-conscious teenage girl living in a fat phobic, appearance-focused society.” But the answer is more complicated than that. I was a ballet dancer growing up and spending time in the world of ballet definitely heightened my body image concerns. I also lived in a household where the latest trend diet was always being tried. I knew nothing other than the importance of dieting and appearances until I went away to college and started studying psychology. Studying eating behaviors and body image allowed me to intellectualize my own concerns and learn that there were much more adaptive ways to cope with body dissatisfaction and appearance pressures. I think I’ve been trying to help other people come to the same conclusion ever since.

Question 10

Why do you think there has been a rise in body image concerns in boys? Do you think that the prevention and treatment approaches for boys and girls should be the same?

Charlotte Markey · Accepted Answer

Boys have likely always had body image concerns, but researchers weren’t necessarily picking up on them. Boys don’t always have the same concerns as girls. Early research tended to focus on concerns about weight loss, for example, which is less likely to be of concern for boys versus girls. In addition to these methodological problems with body image research in the 1980s-90s, it does seem that boys’ body dissatisfaction has increased. This is likely due, in part, to the omnipresent media culture that barrages boys with increasingly impossible appearance ideals. The focus on leanness and muscularity has become more extreme. Most people have a difficult if not impossible time ‘bulking up’ and ‘slimming down’ at the same time!

There are some aspects of prevention and treatment that are valuable for both boys and girls. For example, media literacy is an important part of rejecting appearance ideals and (at least some) beauty products for both boys and girls. However, boys are much more likely to engage in weightlifting than girls and to increase their protein intake to build muscles (this is not an effective strategy, by the way). So, some of the health lessons may need to be tailored for these concerns that are specific to boys versus girls.

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