Body Image and Healthy Misconceptions

Why is our relationship to our own physical appearance so complicated? In this episode of The Savvy Patient, co-hosts Erin Stein and Gillian Goddard dive into the multi-layered and deeply emotional topic of body image. We break down how societal expectations and objectification distort our relationship with our physical selves from a young age and challenge deep-seated misconceptions appearance. We unpack the true complexities of what it means to be a “healthy” body size versus chasing a manufactured illusion of physical perfection. The conversation addresses the modern pressures of social media and the frustrating realities of navigating weight bias and body image when dealing with medical professionals. Blending clinical insight with candid reflection, this episode provides listeners with a roadmap to understand, question, and ultimately heal their relationship with their bodies and mental health.

Resources:

If you are struggling with mental health, call or text 988 for free, confidential mental health and suicide prevention support. 

For bullying help, text 741741 or visit www.crisistextline.org/topics/bullying/

For an eating disorders helpline call 1-888-375-7767 or visit anad.org

Notes:

Erin mentions the book I’m Glad My Mom Died by Jennette McCurdy, and the documentary film Super Size Me, directed by Morgan Spurlock.

She also recommends the journal review “Body Perceptions and Psychological Well-Being: A Review of the Impact of Social Media and Physical Measurements on Self-Esteem and Mental Health with a Focus on Body Image Satisfaction and Its Relationship with Cultural and Gender Factors” by Merino et al. (2024), published in Healthcare (Basel). https://pmc.ncbi.nlm.nih.gov/articles/PMC11276240/#sec11-healthcare-12-01396

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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Visit www.thesavvypatient.com/podcast for episode transcripts.

Watch full podcast episodes @TheSavvyPatient on Youtube.com.

Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.

This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

00:00 Intro

00:33 Understanding Body Image

03:32 The Impact of Societal Norms

08:33 The Role of Objectification

13:50 Health and Body Size Misconceptions

19:12 The Complexity of Health and Wellness

25:44 Vanity and the Illusion of Perfection

30:18 Parenting, Kids and Social Media Impacts

36:13 Dealing with Doctors

40:04 Addressing Mental Health and Body Image Issues

Erin Stein: Hello, everyone, and welcome to the Savvy Patient.

Gillian Goddard: Hello everyone.

Erin Stein: We feel like we both need to greet you every time.

Gillian Goddard: We maybe don't.

Erin Stein: I don't know, it's weird. Talking to you in the future, our listeners. Today we're gonna talk about body image, which is a pretty wide-ranging topic, so we'll see where it takes us. We have a lot of feelings and thoughts.

Gillian Goddard: I have feelings and thoughts.

Erin Stein: I'm gonna start with a definition of body image, which I think is helpful whenever we have conversations like this. And in psychology, this is what we do. Body image refers to an individual's perception, feelings, and emotions around their own physical appearance.

Gillian Goddard: Mm-hmm.

Erin Stein: And you're like, feelings and emotions are the same thing, except they're not. Emotions are a physical response we have and can be measured. And feelings are how we describe them and how we talk about them and how we socially interpret them. Body image is how you see yourself, how you think about yourself, and how you think other people perceive yourself. And, in general, in human society I would say it's f*cked.

Gillian Goddard: It's a mess. It's a mess.

Erin Stein: We thought about calling this episode, Shut Up, Already! because everyone comments on everyone else's body.

Gillian Goddard: Why is that? Why do people think that they can just say something to you about…you lost weight, you gained weight, you are too this, too that, too tall, too short, too skinny, too fat. You must be having twins.

Erin Stein: I never assume anyone's pregnant.

Gillian Goddard: Never ever assume that anyone is pregnant. Never.

Erin Stein: If you are on the subway in New York City and you see a woman and she looks like she could really use a seat, then you can offer it to her, but don't say it's because you think she's pregnant.

Gillian Goddard: That's correct.

Erin Stein: It starts at a very young age that you are experiencing being told things about your body. And a lot of what we say and do around our bodies is related to sex. And this notion that you must pair off and make babies and so you must be sexually attractive to the opposite sex—and yes, I know not everyone is, but our social societal norms strongly stress a heteronormative sexual relationship and so that's what the media is mainly pressuring us all with. Even a little toddler, people are commenting, “she's so pretty” and “he's so handsome.” And “maybe someday they'll get married.”

Gillian Goddard: Mm-hmm. Yeah.

Erin Stein: Why are we talking about toddlers getting married? It's gross. It's not cute. 

Gillian Goddard: I don't know. It's not the Middle Ages, people.

Erin Stein: Don't do it. It's gross, people. But we do it all the time. It's totally socially acceptable. And as girls get a little bit older, even five years old, people comment on their weight, whether they're pretty or not. “It's a shame she got her dad's nose” or whatever. “That one's so skinny and she's gonna have a million boyfriends.” Like, even when they think they're complimenting children…

Gillian Goddard: Even the compliments, when you really dig down and think about it, are really not helpful.

Erin Stein: Not helpful and uncomfortable. Why are we talking about how many boyfriends she's gonna have? But also, boys, “he's so strong.” “He's so handsome.” He's so this. We are women, so we will be talking a lot about how this affects women, in particular, but it equally affects boys and men in different ways, because we have different societal expectations for them, but equally problematic for everyone. It starts at that age and then as you get older and go to school, children learn these behaviors from their parents and then other children at school are complete a**holes and bully other kids and tease them and taunt them because it makes them feel superior.

Gillian Goddard: Children are horrible to one another.

Erin Stein: That is a big problem. And I would say I'll just dive into a little bit of psychological theory because there's literally a theory about how we compare ourselves to others: Social Comparison Theory. We look at other people and rate ourselves and them both upward and downward to assess whether we are superior or inferior to them or whether they are superior or inferior to us. And when you think about it, that makes perfect sense. That's what bullying is, trying to assert some power and superiority, but we base so much of it on body image and appearance, right? I'm gonna lump in skin, acne, hair.

Gillian Goddard: Mm-hmm.

Erin Stein: There's obviously a lot of racism. There's a lot of sexism. All baked into this. But at the core of a lot of it, is skinny and fat. And we talk to kids about it constantly. 

Gillian Goddard: Unfortunately, that is true.

Erin Stein: I grew up very skinny, was teased mercilessly. So, it's not just fat kids who get teased mercilessly. There was another girl in class who also got teased all the time and I would not categorize her as overweight or obese or any of the medical terms, she was just a heavier kid, and I was a skinnier kid.  I was an underweight kid, and so part of it was my mom and my family being like, “you don't eat enough. You need to gain weight.” But every time I went to the doctor, the doctor was like, “she's fine. She's healthy.” And so, my mom would get defensive and say that to other people. Like, “well, the doctor said she's fine.” But everyone was always commenting on my weight. And even just commenting on it makes you suspect there's something bad or wrong about you. And then kids at school tease you. And I had kids assuming I had an eating disorder just because I was skinny.

Gillian Goddard: Yeah. Yeah.

Erin Stein: So, it goes both ways like, “you need to lose weight. you're too fat. You can't wear that. You can't do this.” Heavier people are just as attractive as the rest of us.

Gillian Goddard: People are born with bodies of all different shapes and sizes.

Erin Stein: And that is the whole point of humanity. No single human is exactly the same. Even identical twins are not exactly the same. I mean, they are pretty close but once they're born and they come out their cells are all changing constantly and different all the time so don't start with me on the identical twins! But every human being is unique.

Gillian Goddard: I know. Yeah.

Erin Stein: It would be so boring if we all looked the same and I find groups of people who all look the same, frankly, very creepy. I'm looking at you, sororities. Why does everyone's hair need to look the same? Conformity—we find safety in conformity and so people get uncomfortable. 

Gillian Goddard: My goodness, conformity. Yes, we do.

Erin Stein: But we need to be so much more thoughtful about how we talk. Just start with how you talk to little kids. I have a niece and I'm trying very hard not to talk to her about her appearance. I will talk to her about how smart she is and how strong she is and how amazing something is that she made. But I'm trying so hard not to say, “you look so beautiful” or “you look so pretty.” You know, I’ll say, “I love your dress” and “I love the purple,” really trying not to make her feel like her appearance is her value, basically.

Gillian Goddard: Absolutely, absolutely. You know, one of my experiences talking to patients with bigger bodies is they've been hearing negative talk about their bodies a lot of times since they were children and they've really incorporated so much of this judgment—and it is judgment—

Erin Stein: Yes.

Gillian Goddard: One of the real problems with how we think about body size is that we equate people in smaller bodies as being good and people in larger bodies as being bad or unhealthy or that it's somehow a moral failing to have a larger body. Many of the diseases that we think of as diseases that occur more often in people with a larger body. We call them lifestyle diseases, suggesting that if only the person in the larger body were following a healthy lifestyle, they would not have these diseases. So, they are responsible for their own poor health.

Erin Stein: Yeah, they're being blamed.

Gillian Goddard: We blame people in larger bodies for all these bad things that might happen to them. I have seen patients go from doctor to doctor and get told again and again and again that the problem is with their body size when the symptom or the complaint that they're talking about has nothing to do with their body size at all. At all.

Erin Stein: Mm-hmm. A friend just told me about a woman who needed a knee surgery and was told, “you have to lose weight before I'll do this knee surgery for you.

Gillian Goddard: That's common. That's common.

Erin Stein: If that's your size, that's not something you can just do before you get an important surgery that you need. There's an idea in both directions, but I would say far more in direction of bigger bodies that it's their fault they're bigger, that they did something. And so, there's all these negative associations with it. Like, you're ugly and you're not attractive and all that garbage but then there's this element of blame that you must have done this to yourself and are doing it to yourself. And why don't you just “fix it” quote-unquote? And that's actually another interesting element of how psychologically we deal with these things because we're all objectified. Every single person is objectified by other people. That's just how we exist and how our society exists, and all of these elements are part of that objectification. And that makes us self-objectify. So, we're always surveilling ourselves about our own idea of our image and so we have this actual person, like there is me as a physical person objectively, but then there's my ideal version of it that I want to reach. And then there's also this idea of what it ought to be. Like when I see celebrities or people on social media doing the makeup and the diets and the exercise and all of that stuff, it is what we think we ought to be because other people have told us.

Gillian Goddard: Mm-hmm and have told us that those things have value in our society.

Erin Stein: Yes. Women in particular, but men also are we're taught that our value is in our sexual attractiveness. Because that is what it is when we're talking about it, whether we're attractive or not. It's whether we're sexually attractive. It's all based in that. 

Gillian Goddard: Yeah. Yeah.

Erin Stein: And we've now made that literal much more so than we used to because now on social media if people find you attractive enough you make money. You become an influencer and people watch you and you get rewarded for it that makes it even worse, the metrics that we now have on social media. The likes and the views make it so much unhealthier and clinically dangerous to have these measurements that we're tracking, that we're rating our self-worth against. It's bad. It's so bad.

Gillian Goddard: It's not good. It's not good. So, I'd like to think a little bit about body size and where some of our concerns about body size and our reactions to body size, where that comes from. And I like to start with a story about a patient I know who had gone from doctor to doctor trying to get some help and kept being told that her problem was that she was too fat and that she had to lose weight. And she had more than one doctor tell her that the only possible way that she could be the size she was is because she was eating at least 3,600 calories. And she said to me, “I track everything I put in my mouth”—and we can talk about the sadness that is that. But “I track every single thing I put in my mouth, and I rarely eat more than 1500 calories per day.” And I said, “I believe you.” That's all I said. She started bawling because she had never been validated in that way. How did we get here? Like, how did we get to this place? I think that it's really important to understand this.

Erin Stein: Mm-hmm.

Gillian Goddard: Eighty-ish so years ago in the post-war years we started noticing that a couple of different diseases went together. Heart disease, diabetes—those are sort of the main things—but high cholesterol, high blood pressure, these like chronic medical problems that we talk as metabolic problems. And what we noticed was that people in bigger bodies were more likely to suffer from these chronic diseases. And by “we” I mean the medical establishment, we started to study this phenomenon. But it's tricky to study weight because people are also different heights. So, you can't just study what somebody weighs. You have to find some way of normalizing their weight for their height.

Erin Stein: Mm-hmm.

Gillian Goddard: And that is actually what body mass index is. It is a mathematical formula that relates your weight to your height to essentially quote unquote “normalize” your weight for your height. So, relative to other people. And nobody ever talks about this either: They found actually that when you study big groups of people, which is what body mass index was intended for, it was not intended to apply to an individual person, but when you study big groups of people, people with very low body mass indexes and people with higher body mass indexes are more likely to be ill and to die. I just want to point out, really importantly, that they did not show that having a high body mass index caused the illness, caused the death. They showed that they were correlated. This is a massive mix-up of correlation versus causation. It is statistics 101. When I showed this data to my high school son in AP statistics, he said they’d fail the AP stats test because they had messed up the connection, and imputed causation where there was only correlation. Correlation is two things go together, but one does not necessarily cause the other. And it's now taken us decades to pick apart this connection or lack thereof between body size and metabolic illness and to understand the drivers and we're just getting started. And part of the reason I think that it has taken us so long to dismantle this whole thing is because we have imbued body size with value, and it really has gotten in the way. And it gets in the way of other things too. I have patients who come to see me, and they haven't seen doctors in years because they're afraid that going to the doctor, they're going to get yelled at and made to feel bad.

Erin Stein: Mm-hmm, because people are made to feel bad by doctors and PS if your doctor is doing that get a different doctor… 

Gillian Goddard: Yes, please.

Erin Stein: …because that's not what should be happening when you go to the doctor, but it happens all the time and it is unacceptable.

Gillian Goddard: Agreed, agreed.

Erin Stein: We should acknowledge that we also had a rise in manufactured food that is not good for you.

Gillian Goddard: And can cause people to consume more calories because the food is literally scientifically formulated to make people want to eat more of it.

Erin Stein: Yeah, it's literally addictive. And if you ever watch the documentary Super Size Me, you know that you should not live on McDonald's. 

Gillian Goddard: Yes, an oldie but a goodie.

Erin Stein: I know it is an oldie now. God, I'm so old. There is a difference between being on a healthy diet and not on a healthy diet, but also some people live in food deserts and can't get healthy food or afford healthy food. There are all these elements and there is some element of eating healthy and not eating healthy, right? But many people, even if they're eating super healthy and, like your patient counting calories, they're just bigger. And that's not their fault.

Gillian Goddard: A huge difference. Yeah, there's a difference between following healthy habits and being thin. And I would argue that many of the people we see now who are thin are less healthy than people who have bigger bodies. There's a really fascinating study that looked at exercise. What they did was they used body mass index because that's how you do a study, that is an appropriate use of body mass index. So, they took people at different body mass indexes—underweight, healthy, overweight, and obese—and they asked them to exercise and measured how much exercise they could do and then they compared the different groups of people. So essentially what they were trying to do is stratify people by their body mass index and then by their physical fitness. And they found that a person with a body mass index in the overweight or obese range who was physically fit was much less likely to get sick and die than a person with a quote unquote “healthy” body mass index who was not physically fit. And so, we really have to rewrite the script on health and what is healthy. You cannot just look at a person's body size and assume that they are healthy or vice versa.

Erin Stein: Mm-hmm. Mm-hmm. Yeah, this plays into stereotypes and racism in particular, this psychological phenomenon where we create shortcuts in our brain. We've created a shortcut that if you're too skinny or too fat, that something's wrong with you, that you're unhealthy, and that is not true. But we have been told that enough times. If you're told anything enough times, you absorb that, and it becomes a knee-jerk response. This is a push-pull that happens with everything with humans because we can't retain individual knowledge for every single person on the planet. There's just too much detail.

Gillian Goddard: Right, right.

Erin Stein: But we have to remember when we're faced with an individual that they have their own individual experience and it's not going to match 100 % with the general stereotypical normalized thing. So yes, some people who are overweight are unhealthy and some people who are underweight are unhealthy, but there's just as many people who are healthy in those categories. But we've created these generalizations that the person with clear skin is beautiful and the person with acne is not beautiful, right? These are shortcuts. Whereas we're projecting that beautiful or not beautiful, we made that up, what's beautiful and not beautiful. Like, that's not a thing. That's not an objective measurement. It’s just, someone told us that and we decided that. So, all of these “standards,” quote unquote? Humans have made up.

Gillian Goddard: Right. Yeah. Yeah.

Erin Stein: And someone's gonna come at me yes there are some instinctual preferences for people who are able-bodied versus non-able-bodied because when we're animals running in the jungle you need someone who can go fetch food, right? Okay fine. We don't live in that society. We have created a much more complex societal framework that we all exist in that should be progressing beyond those instincts. And so, we need to start treating people like individuals and recognize their individual body makeup, like their muscles, their ligaments, their weight, their lung capacity, all of those things, their blood pressure, how their heart works, all of that is part of their health—not just how much fat they are or are not carrying around.

Gillian Goddard: Yeah. We need a much more holistic view. Holistic meaning the whole person.

Erin Stein: Yes, as we've said in every episode of this podcast, your body is a system. Many, many systems interacting in a larger system, no one thing fixes everything.

Gillian Goddard: Yeah, it's true.

Erin Stein: Think about how much money we spend. And now, you know, we just talked about perimenopause symptoms, but now the market is growing to try and target us with that. 

Gillian Goddard: Because we have money to spend.

Erin Stein: …because we have money in midlife supposedly, although I don't know where it is. There's this idea that you can control it and improve it. So, here's a product that will do that for you. Here's some makeup to put on. Here's some skin cream to put on. Here's some clothes to wear. Here's some hair styling products. Here's some supplements. Here's a weighted vest to wear…

Gillian Goddard: Mm-hmm. Mm-hmm. Yeah, yeah, things you need to buy. Now, don't get me wrong, I enjoy some of these things.

Erin Stein: I was about to say, I am wearing makeup at this moment, and I did my hair for this recording. I am not wearing my pajama shirt that I had on before. Yes, we care about our appearance. I'm not saying we're ever gonna not care entirely. However, I don't need to make myself look like somebody else. And the goal should not be perfection. Cause there is no such thing. There really genuinely is not. Barbie is not perfect. There is no perfection. Although Margot Robbie is a perfect match for Barbie but that is not the point. And all this stuff should be fun. Like you said, you enjoy it. And so, if you want to mess around with makeup and try some blue eyeshadow and exaggerated depth, like go for it. I love that when Lady Gaga launched her makeup line, she's like, “makeup is how I transform myself into all kinds of different people and characters and it's fun, it's play,” and that is the right attitude. It is not something you need to have. And that is a big thing. I can't even say that I don't feel like I don't need it.

Gillian Goddard: Mm-hmm.

Erin Stein: We're all so heavily brainwashed from all people and all media that we need to look a certain way.

Gillian Goddard: Yeah.

Erin Stein: But we're in our late reproductive perimenopausal stage. So, everybody, this is when we don't have patience for that bullsh*t anymore.

Gillian Goddard: That's right.

Erin Stein: So, stop listening. Think about it. Some of the psychological theory is that you start to be the observer of yourself, right? That's what all this stuff is making us do, is look at ourselves from the outside and judge ourselves how we think other people will be. So start there, don't be judging yourself by anyone else's standards.

Gillian Goddard: Right?

Erin Stein: Look at yourself in the mirror and be like, do I think I look good enough to go to Target and buy some milk? Yes, you do. As long as you have some clothes on, yes. But otherwise, it's, do I like how my hair looks? If I'm good enough with it, great. I don't even worry that much about what my husband thinks. I mean, he's in it for the long haul, so whatever. But you know, I want to look nice for this podcast for the 10 people who might watch this on YouTube…

Gillian Goddard: Actually, more than that.

Erin Stein: Well, it depends on the episode. We'll see how many watch this one. We all have our vanities. I'm not saying we can completely get rid of them but examine them. The next time you're looking at yourself, ask yourself why you are thinking that. If you're judging yourself, and you probably are because we're women, ask yourself why. Why do you think that? And then when you look at someone else, and listen, I have also been super judgy of other people. I have strong feelings about fashion on the red carpet and usually it's because I think it makes them look better or worse. But that better or worse is not a real measurement. That's my societal conditioned idea of what looks good or doesn't look good, right? So, we're all guilty of it, but we have to become aware of it to start correcting this thinking pattern that we have fallen into.

Gillian Goddard: Yeah. Agreed. Fallen into… that we were taught.

Erin Stein: Well, yes, that we were conditioned from literally from the cradle because our parents dressed us in floofy things or whatever. 

Gillian Goddard: From the cradle.

Erin Stein: It's done so much damage to women, in my opinion. And I think it always was there with men. It was just a little less obvious. But now with social media, it's becoming super obvious these manosphere influencers and what is called looksmaxxing. Men, you can have some body fat and you don't have to have giant muscles with your veins popping out and you don't have to oil yourselves. It's just like, why do we need to now project the same unrealistic standards on to men as well as women?

Gillian Goddard: No, I agree and there's a lot of teenagers around my house and I see how they react to it, both positively and negatively. And we don't need to put that much pressure on ourselves. It's not that important.

Erin Stein: Think about how much pressure on kids, I mean, it's a lot of pressure on adults who should not be dealing with that but think about kids who are not equipped yet to modify those emotional reactions and that pressure and are actively being told every day what to think and how to behave because they're still children. And so, when you see that, and you think that's what the world is.

Gillian Goddard: Mm-hmm. Yeah.

Erin Stein: I mean, no 10-year-old should be crying because they think they're ugly.

Gillian Goddard: I know, it breaks my heart.

Erin Stein: But they do because this is the world we've put them in. It definitely leads to mental health crises.

Gillian Goddard: For sure. it's not an accident that kids in their teens and early 20s, don't have sex, they don't drink, they don't do drugs, and they're all horribly depressed. And it's because they spend their lives comparing themselves to others on social media. That's one reason. One of probably many, but it is one factor.

Erin Stein: Yes, the social comparison factor and in the worst-case scenarios, the adults they rely on are judging them. I just read Jennette McCurdy's book. I'm so glad my mom is dead, or the title is something similar. Her mom? Nightmare. Gave her, mean giving her is not right, but created disordered eating for her. 

Gillian Goddard: Yeah. Yeah. Yeah. Well, and this is the thing that we worry about. We grew up in the 80s and 90s during the low-fat craze. Do you remember Snackwell's cookies? They were like zero fat and full of sugar and they were supposed to be good for you.

Erin Stein: Mmm. I do, I do. Yeah, I didn't mind eating them because they were full of sugar.

Gillian Goddard: Right, right, right, right. We’re given this totally incorrect toolkit for managing our weight with diet products full of chemicals. I think we need to watch out because we don't want to fall into the same traps again and again and again. I feel like the recommendations are different, but the desired outcome is the same with protein supplements and teenage boys thinking that they should be taking creatine and other muscle building products and kids, kids in their teens wanting to go on GLP-1s to lose weight. There may be situations in which that is appropriate, but I think we have to think long and hard before we start prescribing medications that could be lifelong to teenagers.

Erin Stein: Well, it's the same thing as getting plastic surgery for a teenager. Very, very few teenagers have a real need for plastic surgery.

Gillian Goddard: Yes.

Erin Stein: There are some, but you don't need to give your daughter a new nose for her 16th birthday. I mean, that's a stereotype, too, but she doesn't [need it]. Think about the message you're sending. Like, “yeah, your nose could be better. So, I'll pay for it.” Like, hmmm.

Gillian Goddard: Well, and I think as a parent, a lot of times if we're not careful, we're bringing our own baggage into those conversations. As someone who's parenting teenagers now, you really have to stop and think like, is this my thing or is this their thing?

Erin Stein: A thousand percent. You're right, that whole low-fat thing was...

Gillian Goddard: it was a real thing. You could eat a giant bag of Swedish fish and that was supposed to be better for you than having like a steak.

Erin Stein: Yeah, I would have eaten Swedish fish.

Gillian Goddard: It's so backward.

Erin Stein: It's all trends and you should just eat whole foods. All of this, it's so, it's so pervasive and...

Gillian Goddard: It's so pervasive.

Erin Stein: …to the extent that we had to start passing legislation about people's hair so that people of color can just have hair, which is insane. The Crown Act is still only passed in 27 states, completely necessary, should be a federal standard, but the fact that we call it natural hair, like, of course it's natural hair, it's hair that grows! All of our hair is natural.

Gillian Goddard: It’s hair growing out of your head. It's all natural.

Erin Stein: It’s so gross to suggest that kids who have hair on their heads are somehow not appropriate to go to school just because they have hair. Yeah. So, think about these things.

Gillian Goddard: I don't think we're gonna solve anything today.

Erin Stein: Well, no, the solving it is a little bit at a time. Think about how you talk to children, especially, or in front of children, but think about how you talk to yourself when you look in the mirror. And think about your doctors. And if you are getting crap from doctors, mm-mm.

Gillian Goddard: Yeah. Yeah. Yeah. Time to look for a new doctor.

Erin Stein: Time to look for a new doctor. Just because there is an old school way of looking at these health conditions doesn't mean you need to put up with that old school way. Do you have any other suggestions for someone who encounters something like that?

Gillian Goddard: Agreed. Yeah. One thing I always recommend is if you feel like your doctor is not up to date, asking a question about a study. So in this case, you know, have you heard of this study that showed that people who are physically fit in any body size are healthier than people who are not physically fit at any body size? You know, I think is a way that if you're feeling up to it to push back in a getting curious kind of way. But I think this is a place where you really have to select your doctors carefully. And I know that sometimes that's easier said than done, but at the end of the day, that's probably the best answer.

Erin Stein: Yes, but also as you say, when you're up to it; you don't have to do this. But if you're willing to give someone a second chance, is there some way to say, this is my genetic makeup, this is my family history, like somehow to say, this is how I am made. I am not walking in the door because I eat 10 bags of Doritos a day or something.

Gillian Goddard: It's really hard. I mean, this is the problem, right? I hate to put the solution back on the person who's already being disadvantaged by the problem.

Erin Stein: You shouldn't have to. I mean, yes, and the reality is people have to deal with it. 

Gillian Goddard: Yes, and the reality is yeah. No, I mean, I think that some gentle education about our understanding of body size and the genetics and epigenetics that dictate that, is probably your best bet.

Erin Stein: Yeah, and you do give some family history, and that might be a way to not so subtly inform someone, but you're not obligated to give them multiple chances.

Gillian Goddard:  Mm-hmm. That's correct. I always think give somebody one second chance, unless whatever happened was so egregious that… I mean there are exceptions to the one second chance rule. I've heard of situations that to me sound abusive and I wouldn't give someone behaving like that a second chance.

Erin Stein: Yes. Correct. Yes. It would be a gift you're giving them, frankly. And it may be because you don't want to take the time to go see someone else and you just want your bloodwork to get done or whatever.

Gillian Goddard: I know, some people live in places where there just aren't as many medical practitioners. I mean, we're spoiled in this way because there's doctors all over the place in the New York metro area. But there are parts of the country where specialists in particular are difficult to come by and it may be hard to find another doctor. And then I think your best bet is to engage in some education and curiosity.

Erin Stein: I think we should end with saying, these body image issues and beauty standards can be very serious. They can have really serious impacts on people and on you. And if you are someone struggling with it, this self-judgment and judgment from others can cause real health outcomes with anxiety, depression, suicidal thoughts. It can simply increase your stress and anxiety and put you at cardiovascular risk. We say all of this is bullsh*t because we need to start training ourselves to think outside of it, but the repercussions in the real world are real and serious and you shouldn't have to be dealing with it, but you might be. And so, step one, get some help. Whatever help you're comfortable getting, therapy, an antidepressant, a hotline, call someone, but I really encourage you to stop judging yourself. Work toward that and don't worry so much about the other a**holes. So that was a little ramble on body weight, body image, how it affects you at the doctor's office and in life. I'm going to post a link to a study review that I reviewed before we talked about this that goes through some of the psychological elements of it that might be helpful for some of you to read through. You can skim it. It's very long article. I think I'm also going to post a hotline for people who may need it and send us your thoughts and questions it's a pretty broad societal issue that we have created for ourselves so I'm sure there's more to talk about.