Box 4 Body image

Distressing and distracting eating, weight and shape preoccupations, fear and avoidance of social eating and body exposure, behaviours such as frequent body size checking/weighing, and weight/shape (negative) overvaluation are problematic symptoms across all eating disorders. These symptoms are particularly difficult for people with higher weight where health professionals and others may assume them to be ‘understandable’ or at worst, desirable. For this reason, most psychological therapies (e.g., cognitive behaviour therapy for eating disorders) incorporate specific elements aimed to reduce body dissatisfaction, address weight stigma internalisation and improve body image. In this regard, as part of the decision-making process around weight loss or weight management, the clinician should assist the person to explore the driving factors that underlie the desire to lose weight and offer options for the person to upskill in addressing weight stigma and improve body acceptance.