Body image dissatisfaction, a complex construct, is the negative evaluation of one’s weight and shape. In their developmental contextual theory, Lerner, Skinner, and Sorell (1980) proposed that experience with one’s body is influenced by a variety of factors, including cultural, developmental, biological, and historical. Specifying the relative impact of these contexts on body image satisfaction versus dissatisfaction is complex, and it likely varies by individual (McKinley, 2006). However, body image dissatisfaction impacts a wide range of individuals, both women and men, including those with subclinical levels of disordered eating and those without eating disorders.

Consider these questions: When was the last time you heard an individual remark negatively about his or her body? Was it last year? Last week? Was it today? Was the individual a man or a woman? Have you experienced a judgmental thought about your body today? If you cannot recall the last time you listened to someone negatively judge her body, take a trip to the local mall, grocery store, or gym and conduct your own research study. See how long it takes before you hear a comment related to weight loss, body fat, or changing body shape in some way. Our guess is that it won’t take long. The Western society in which we live offers plenty in terms of food available. However, we also live in a society with a daunting ideal of beauty. That ideal dictates that bodies should not only be increasingly thinner but also have less body fat and more muscle, a reality that, for most people, is impossible to achieve. We face a difficult dichotomy between food that is hard to resist and an ideal body image that is hard, if not impossible, to achieve.

When did we humans begin to evaluate the body, and how did that evaluation acquire so much importance? Why are we so frequently obsessed with appearance? Several sociological and evolutionary theories offer possible answers to these questions, yet a definitive answer eludes us. The topic, however, provides good material for a lively philosophical discussion. In each time period and culture, people adhere to a narrative “truth” about what is beautiful (for example, “You can’t be too rich or too thin” or “Thin is in”). Likewise, within each individual, a certain narrative “truth” reverberates in the mind (for example, “I’ve always been the fat girl,” “I’ll never look good enough,” or “I’ve always been the scrawny guy”). In our minds, we tell ourselves various stories: what we think might happen in the future, why we think something happened in the past, what is beautiful, what is desirable, and so on. Like the thoughts we have on a daily basis, the stories we tell ourselves and others vary in accuracy with respect to our actual experience. When we become attached to thoughts or to a particular story as “truth,” our behaviors may change accordingly. For example, if you’re attached to the thought “Fat is ugly” as truth, your eating behavior may change in order for you to avoid becoming fat. Alternately, if you’re overweight or perceive yourself to be, you may experience negative feelings when you tell yourself the “truth” that “Fat is ugly.”

Just as individuals have personal stories, societies also have stories or myths that are passed down through generations. These are reflected in art, music, and literature, and they become social symbols of what is considered important, timely, and desirable. Today the media, including advertising, television, and movies, powerfully convey the “ideal” body image. The societal idea that thin is beautiful and that physical attractiveness is a valuable asset has roots in antiquity and is reflected in the Greek myth of the judgment of Paris (sixth century BC). In this myth, which appears in classical texts and artwork, three goddesses—Hera, Athena, and Aphrodite—are judged on their beauty by Paris of Troy, a male mortal. The prize for the fairest goddess is a golden apple, which Aphrodite wins with her beauty. She then causes Helen, wife of Menelaus and the most beautiful woman in the world, to fall in love with Paris, who takes Helen home with him to Troy. To avenge the insult to his brother Menelaus, Agamemnon follows with troops. The Trojan War ensues in a quest to bring Helen home.

For centuries, women have waged personal wars with their bodies as they have sought a “winning” appearance and all that is associated with it. The casualties of these wars are the women who lose vitality, time, and energy fighting for the weight, shape, or appearance that is attached to the perception of a prize. Each decade of the twentieth century had its own representation of female attractiveness. Each promoted a new look—the flat-chested, slender figure of the flapper style popularized during the 1920s; the more curvy figure that emerged in the 1930s and 1940s, highlighted with Marilyn’s hourglass figure in the 1950s; Twiggy’s stick figure in the 1960s; and, closer to the end of the century, the emergence of the athletic shape of the 1980s and the waif-thin appearance popularized in the 1990s. The twentieth century evidenced a continued emphasis on physical attractiveness as being associated with success. In the first ten years of the twenty-first century, we’ve observed an increase in advertisements to the public regarding both surgical interventions for weight loss and medical interventions for reducing signs of aging. New dietary strategies for weight loss and over-the-counter products marketed toward weight loss and reduction of the signs of aging are also prominent in television infomercials and magazines. As part of our popular culture, the marketing of these interventions continues to cultivate the message that it is important to remain youthful and thin. Since Greece in the sixth century BC, we’ve seen thousands of variations on Helen of Troy, the woman whose beauty was fought over, sought after, and idealized.

And what about men and body image dissatisfaction? It may seem that marketing for weight loss and beauty products is aimed primarily at women. Given the high rates of eating disorders among women, much of the research on body image concerns and eating disorders has historically focused on women and used women as research subjects. However, body image dissatisfaction is not just a female problem. With rates of obesity increasing across genders and in a culture with plentiful food yet with a high value on thinness, youth, and physical fitness, body image dissatisfaction is a human problem, not only a women’s problem. While body image dissatisfaction may manifest differently in men and women, the relative impact is the same. The treatment presented is for anyone, man or woman, struggling with body image dissatisfaction. Our clinical case examples include both men and women to illustrate issues relevant to both genders.

Excerpt from Acceptance & Commitment Therapy for Body Image Dissatisfaction: A Practitioner’s Guide to Using Mindfulness, Acceptance & Values-Based Behavior Change Strategies by Adria N. Pearson, Ph.D., Michelle Heffner, Ph.D., and Victoria M. Follette, Ph.D.