While we tend to associate poor body image with younger women, I remember the first time I heard one of my older clients, in her 70s, mention how she hates parts of her body, particularly her “belly bump.” She longed for her small, youthful waist. 

Having struggled with my own body-image issues, I fearfully thought, please tell me this gets better as we get older.

Turns out, I was wrong.

In fact, a study titled, “Never too old for eating disorders or body dissatisfaction,” took a random, nonclinical sample of 1,000 women, aged 60 to 70 years old, and found that of the 475 participants used for analysis: 

• More than 80% controlled their weight and more than 60% expressed body dissatisfaction 
• Eighteen women met criteria for eating disorders and 21 reported single symptoms of an eating disorder

There are many things that have an effect on an individual’s body image. One review of the literature demonstrated how body image can be affected by factors such as life stage/age, medical conditions and health behaviors. Additionally, numerous studies show how social media also plays a role in how women, in particular, feel about their bodies. 

What exactly is body image? Let’s take a closer look.

Body Image 101

“In simplest terms, body image refers to the way you think and feel about your body,” says Renee Engeln, PhD, director of the Body and Media Lab at Northwestern University and author of Beauty Sick: How the Cultural Obsession with Appearance Hurts Girls and Women. “There is also a behavioral component to body image, which captures the things you do to manage or change your physical appearance.”

According to the National Eating Disorders Association (NEDA), if you have a positive body image (body positivity, body satisfaction), you are “comfortable and confident in your body, accepting your natural body shape and size, and recognizing that physical appearance says very little about one’s character and value as a person.”

On the other hand, according to NEDA, if you have a negative body image (body dissatisfaction), you likely struggle with “feelings of shame, anxiety and self-consciousness. People who experience high levels of body dissatisfaction feel their bodies are flawed in comparison to others, and these folks are more likely to suffer from feelings of depression, isolation, low self-esteem and eating disorders.”

Body dissatisfaction can be considered as a spectrum. On one end, there are people who would just like to lose weight and get into better shape. On the other end of the spectrum are those who experience great shame and equate their body image to their self-worth. 

“Body-shamed clients interpret everything as a measure of their self-worth,” explains Mark B. Constantian, MD, adjunct professor of surgery at the University of Wisconsin, visiting professor at the University of Virginia and author of Childhood Abuse, Body Shame and Addictive Plastic Surgery. “They will ignore instructions or carry them to excess. They may not take appropriate precautions to avoid injury. In men, shame can manifest as ‘muscle dysmorphia,' [which is a] preoccupation with the idea that his body is always insufficiently muscular or lean, or is too small, even when it is highly developed. This is a distortion of reality.”

Both Constantian and Engeln agree that poor body image often takes hold in childhood. “Parents who focus on appearance and weight tend to have children who struggle with body image,” points out Engeln. “Being the target of body-related teasing or bullying from peers can also lead to poor body image, as can having a peer group that is highly invested in appearance norms. Media messages and images that reinforce an unrealistic body ideal or encourage body shame can also contribute to poor body image.”

“What my research has shown is that body shame is directly related to childhood experiences,” explains Constantian, “particularly adverse childhood experiences, like constant verbal criticism, teasing and ridicule, physical or emotional abuse or neglect, excessive dieting or weight loss imposed by parents, or never being taught to live careful, moderated lives. Parents’ attitudes and statements about their children’s appearances and health can create a sense of defectiveness that carries right through to adulthood.”

It is important to note that if you find yourself working with clients who seem to have deep self-worth issues, it is always best to refer them to an appropriate mental health professional.

Helping Your Clients See Themselves in a Positive Light

There is a good chance you’ll have clients who struggle with body image. How can you help? For starters, says Engeln, avoid shaming them into “submission.” 

“There’s a common misperception that shaming people for their current body size or shape is an effective way to motivate change," Engeln explains. “This is categorically false. Those who feel shamed in fitness settings are much less likely to continue with exercise programs.”

Engeln goes on to say that health and exercise professionals should work to eliminate body-shaming language from their vocabulary and avoid focusing on appearance-related goals. “Don't talk to clients about ‘burning fat’ or ‘getting rid of love handles.’ Instead, focus on positive gains in health and strength.”

Engeln and her colleagues’ own research suggests that the language we use with our clients and students has a direct impact on how they feel about themselves.

“Health professionals are all trying to help people improve their health—that’s why we do what we do,” interjects Ashley Wentworth, MS, RD, LD, registered dietician and nutrition therapist. “But sometimes comments or attitudes towards clients’ bodies may be shameful. Behavior that we may believe to be encouraging may actually be weight stigmatizing to clients.”

When my own clients make a self-deprecating comment, I ask them to tell me something they appreciate about their bodies. Engeln concurs. “Talk about bodies with kindness, gratitude and appreciation. If your client disparages how her body looks, help her reframe those negative thoughts by focusing on the gifts her body gives her each day or the ways that her body might be getting stronger. Exercise is a way to care for your body, and it’s always easier to care for something if you think of it with kindness instead of negativity.”

It's also important to avoid using exercise as a punishment and to steer your clients away from “fat talk.” 

“Avoid talking about ‘earning your dinner’ or any suggestions that exercise should be used to atone for previous eating,” adds Engeln. “You often have no idea whether your clients may struggle with eating disorders, so a focus on appreciating what the body can do is preferable to a focus on weight management.”

Wentworth agrees. “Focus on what a client’s body is able to do and how they feel instead of what they look like. Avoid weighing clients and commenting on weight loss or weight gains or on making weight-loss goals. Instead, focus goals on actual health behaviors.

“Focusing on wanting to change a client’s body gives the message that her body, and therefore, the client herself, is not good enough and needs to be changed in order to be valuable,” continues Wentworth. “Concerns and discussions about clients’ size or perceived negative health behaviors are meant to help clients facilitate change, but likely will only cause shame. These are all examples of weight stigma, also known as weight bias or weight discrimination. Risks of weight stigma include depression, poor body image and binge eating.”

Wentworth feels that it’s also important to assess the motivation behind a client’s desire to change, especially if he or she is prioritizing changing appearance over improving health. “Extrinsic motivation, or motivation that is based on external rewards like losing weight to change one’s appearance, does not have long-term success. Intrinsic motivation, or motivation that comes from within the client to change his or her health behaviors for health instead of appearance, is more effective long term. If your clients show signs of extrinsic motivation for their changes, it is important to discuss their reasons for working with you.”  

As a health coach or exercise professional, you can help your clients move their attention away from extrinsic motivators to intrinsic ones by asking them to focus on how much better they feel and what they can do now that they couldn’t do before. For example, consider asking your clients to keep a running list of the benefits of being stronger and feeling healthier as they become more so over time. 

Finally, it’s important to realize that working on these issues with our clients can sometimes trigger our own issues. “Health professionals should assess their own body image before working with clients. Health professionals that have body dissatisfaction are more likely to project these feelings, beliefs and insecurities onto their clients,” says Wentworth.

Take an honest evaluation of your own body-image beliefs, the language you use and how you may be inadvertently perpetuating shame in your clients. By assessing your own beliefs and behavior, you will be even more effective in helping your clients change theirs.