INSIDE OUT

Beauty isn’t an illusion. Perfection is. But for many Main Line women, beauty and perfection are inexorably linked.

Terri Cohen is five feet, five-and-a-half inches tall and 115 pounds. She’s got long blond hair, luminous blue eyes, a contagious smile and the youthful look of a woman many years younger than 41. In jeans, a cocktail dress or running shorts, by any standards, she’s beautiful—inside and out. But if you tell her that, she’ll blush and look away.

“I always wanted a wrap dress,” she says. “But I never thought I’d look good in one. I finally went to Nordstrom the other day. It took a long time, but I tried one on. It was bigger than it should have been. You couldn’t imagine how long I stood there, with my back to the mirror, petrified to turn around. It took such a process to get myself to look.”

Her biggest fear? “That I was going to look like the backside of a barn,” she admits. “When the sales girl saw me and said, ‘Look at you,’ I still wasn’t ready. Seven years of psychological counseling and three years of rehab and here I was scared out of my mind to see myself in the mirror.”

Cohen faces moments like these almost every day. An anorexic since childhood, the Villanova resident has been an “emotional eater” for as long as she can remember, always choosing comfort over nourishment. She struggled with her weight in high school and college. At her heaviest, Cohen was 138 pounds; at her lightest, 103. What she remembers most is being teased. “I can still hear things being said about ‘that fat girl,’” she says.

When she was 18, Cohen stopped eating completely. In 1990, while in grad school, she wound up in rehab. In 2001, she was hospitalized twice. Cohen was a mother of two at the time and had been living on a diet of laxatives, sushi and water for six years. At 36, she was diagnosed “with the bones of an 80-year-old” and required extensive dental work to replace her decaying teeth.

The lowest of lows came for Cohen when she was placed in the psychiatric ward at Bryn Mawr Hospital, where she was given 11 different medications, including two anti-psychotics. “I was 106 pounds, and that was the diet they put me on,” she recalls.

At some point in their lives, far too many women have felt unbearably large and equally invisible, when the only clear thought is, “I’ll just stop eating until somebody notices.” Fad diets; days ruined because they couldn’t fit into their favorite jeans; heartbreaks or arguments so awful they didn’t eat for days; and the sense of failure that arose when, out of nowhere, the appetite returned.

“For so many years, I didn’t find value in myself or my words,” Cohen says. “I didn’t know how to get out things I was feeling—how to get rid of anxiety. The only way I could have a voice was to use my body.”

Today, Cohen conquers these low mo-ments with her feet. “I feel strongest and most beautiful when I’m running,” she says. “I eat because I need to fuel myself and I need my kids to see me eat so that they can see I am taking care of myself. I can’t not eat and then expect them to eat. I cook for my family every night; I eat what I want and they eat what they want.”

She’s also spoken at the Baldwin School and other locations in hopes of reaching “even just one kid” who might be struggling with an eating disorder or low emotional and body self-esteem.

Cohen admits she’s a fanatic about diet and exercise, and that she watches everything she eats. To maintain a weight she can live with, she consumes what she refers to as “safe foods” — vegetable sushi, yogurt, salad, cheese, fruit and lots of water. Occasionally, she’ll go a day or two without eating, but typically she realizes, somewhere around dinner, that it’s time to refuel.

As much as Cohen’s anorexia stems from being overweight as a child and from a skewed perception of her size, there are even deeper psychological roots. Cohen never says, “I’m not eating today.” Rather, it’s a physical response to whatever internal angst she’s feeling at the moment. “By not eating, I could empty myself of these feelings and control my emotions. It became my way of coping. “I sometimes feel this now when I get anxious over situations that I can’t control—I get this physical sensation of being big,” she says. “It’s so uncomfortable; I want to crawl out of my body.”

ACCORDING TO THE National Institute of Mental Health, between five and 10 percent of girls and women suffer from some sort of eating disorder. On the Main Line, that number is between 10 and 15 percent—though Dr. Roz Kaplan believes that’s probably a low estimate. “Women restrict all the time; it’s a fashion statement,” says Kaplan, whose private practice in Haverford specializes in eating disorders. “The paradox is that once you drop to below 1,200 calories a day, your metabolism slows down, making it harder to maintain weight.”

Adds Kaplan, “Food’s become a dangerous pleasure. Nobody knows how to eat anymore. Everyone is freaked out by what to eat—organic, low fat, low cholesterol. It’s gotten so complicated. Imagine what it’s like for someone who’s already overly concerned with their body.”

Kaplan points out that not all eating disorders are solely the result of a poor body image. Typically there’s an underlying psychological component. And the physical toll can be devastating. Anorexia, bulimia and binge eating put massive stress on the digestive system and other organs, leading to stomach, heart and kidney problems, irregular periods (or none at all), dehydration, dental problems and more. “Eating disorders affect every organ,” says Kaplan. “But the most concerning side effects impact cardiac health, fluid and electrolyte balance, the gastro-intestinal and endocrine systems, the thyroid, and bones.”

While anorexia has been around for generations, the media and other modern societal influences have accelerated its proliferation. “Kids have an innate desire to compare. They learn very young that it’s bad to be fat and they get teased if they’re overweight. A lot is subliminal,” Kaplan says.
Kaplan and Terri Cohen share something in common. Not only is Kaplan Cohen’s doctor, they are both involved with the Jenkintown-based A Chance to Heal Foundation. Started in 2005 by Ivy Silver and her daughter, Rachel, who suffered from anorexia, the organization has gained much-deserved visibility for its innovative philosophies and programs. Its overriding mission is to obtain early diagnosis, financial support and quality care for those with eating disorders, while increasing awareness of the societal factors that lead people down that path.

One of A Chance to Heal’s major goals is getting its representatives into schools to talk with teens and present real information regarding self-esteem, body image and nutrition—a proactive strategy that’s one of the keys to prevention.

It’s hardly surprising that women yearn to be thin and beautiful—and covet whatever might help them attain their version of perfection. We’re bombarded with images and messages everywhere we turn. But it’s not just about Hollywood, fashion and the media.

“There’s more to the psychology of this than wanting to be Paris Hilton or a supermodel,” says Cohen. “We can throw all the magazines away, but we still have mirrors and we still have each other to look at and compare ourselves to. Poor body image didn’t just start in 2007.”

She’s right, of course. But current cultural influences are still a huge factor.

“Our obsession with outer beauty isn’t new,” says Jean Kilbourne, a former model and renowned advocate for positive body image who also works with A Chance to Heal. “But the standards have changed. Never before has the ideal been to be skeletal—or homogenous.”

Kilbourne sites many reasons for this seemingly universal obsession with thinness, one being the subliminal suppression of women. “On the deepest level, there is a subconscious terror of women being too big, too powerful,” she says. “Go ahead and have your careers, but don’t take up too much space.”

If that sounds far-fetched, think about this: At a time in history when there are more influential women than ever, most of us know far more about those who look good than those who do good.

Women who are actually changing the world often are invisible to the ones who stand to gain the most from their accomplishments. “It doesn’t make sense,” says Kilbourne. “We’re giving our girls more opportunities to expand their horizons, yet the emphasis on beauty is greater than ever.”
Worse, says Kilbourne, is the increasing sexualization of young girls—and it starts with the clothes, which are typically more suggestive than sweet. “Plus, everything is geared toward a V-shaped figure, which most models have,” says Kilbourne. “But 95 percent of women are pear-shaped. Too many are trying to fit into clothes that aren’t cut for them.”

Kirah Miles remembers what it was like to try and live up to that ideal. An Agnes Irwin graduate and currently a girls’ lacrosse coach there, she had her own bout with bulimia during high school. “It’s the hardest thing to convince 13 and 14 year olds of their uniqueness,” she says. “Every magazine you look through—from US Weekly to Health & Fitness—shows someone you’re supposed to look like. Even looking at your peers and comparing yourself is dangerous. You don’t see the difference in bone structure or size.”

Research for Dove soap’s “Campaign for Real Beauty” revealed that out of 3,000 women surveyed in 10 countries, a mere two percent thought they were beautiful, three-fourths said they were attractive and half thought their weight was too high. “Women don’t tell themselves they’re beautiful; they don’t know how,” says Kilbourne. “Instead, they’re generous with critical self-talk, and the vast majority start the day with a bout of self-loathing. Too much emphasis is on how we look when it should be how we feel and what our bodies can do.”

THIS NOTION OF body image—how we see ourselves, how we think others see us, and how we physically feel living inside our own body—is complex. Our physiology, overall health, ethnic or cultural identity, social experiences and relationships all play a role in how we feel when we look in the mirror. “Body image is about what you see that others don’t and what you perceive others see that they don’t,” says Terri Cohen. “It’s what happens when you look at me vs. when I look at me.”

Problems arise when perceived imperfections dominate one’s self-image. For teenagers, that might mean avoiding social situations, activities or sports; showing a reluctance to speak up at home or school; or lacking the confidence to express an individual sense of style. For parents, sincerity and specifics are key when dealing with teens.

“Blanket statements don’t work,” says Kilbourne. “Be specific in your praise. Compliment your child’s sense of style, their awesome soccer goal or an interesting science report.”

The same rule applies to physical appearance. “Don’t say, ‘You look beautiful.’ Say, ‘I like the way you did your hair’ or ‘That shirt is flattering; it matches your eyes.’ Too much blanket praise leads to narcissism, and that creates another set of issues,” Kilbourne says.

Modeling is also important. Jane Shure, a Philadelphia-based psychologist and co-founder of Selfmatters.org warns moms not to criticize themselves in front of their daughters. Saying thing like, “I’m fat” or “I can’t eat that” sends a message of anxiety and self-doubt.

Parents should avoid the topic of dieting when their daughters are around. Too much exposure to weight and diet woes can put young girls on a path to an eating disorder—especially if the women in their lives express similar dissatisfaction and are within their normal weight range.

If your daughter participates in sports, watch how much she eats and drinks. A strict diet can be a detriment to her performance, and drinking less water to lose weight can lead to dehydration. Skipping meals isn’t a good idea either—kids are likely to overeat at the next meal just because they’re so hungry.

“Eating healthy is very different from restricting, and weight is not across the board,” Shure says. “We need to focus on finding a weight that corresponds to our body type, our food preferences and the amount of exercise we do. Rarely do you hear people saying, ‘I want to be at this weight so I can eat healthy, exercise and feel good.’”

That said, teens tend to have a lot of misinformation about what foods are appropriate for their age group. “Certain fats can be good for hair and skin, but most people think all fats are bad,” says Shure. “The new craze is no/low carbs. But you have to know the difference between the good and bad carbs.” Teens should consume a minimum of 1,600 calories a day—and multivitamins won’t make up for a lack of nutrients from food. General guidelines call for up to 2,200 calories per day for 11- to 18-year-old girls and 3,000 calories for 15- to 18-year-old boys.

Contrary to popular belief, boys and girls feel similar pressures to be physically attractive, even if that pressure manifests itself in different forms. For boys, weight-class restrictions in high school and college wrestling leagues have caused a recent stir—so much so that new guidelines have been established to discourage crash dieting. And young men are susceptible to anabolic steroids and growth hormones in their quest for the perfect body—substances whose use and abuse can carry serious health consequences.

We all want to feel attractive. But more importantly, we want to feel confident, strong and capable of participating in any activity we desire. And while no one will argue that childhood obesity is a growing concern, thin doesn’t always equate to healthy.

“Kids need to learn that a healthy mind and a strong body go together,” says Cohen. “The only way to get a healthy mind is to have value within yourself above and beyond how you look. When you find that value, then you will naturally take care of yourself and you won’t worry about looking like anyone else but you.”

Learn more at campaignforrealbeauty.com, jeankilbourne.com and achancetoheal.org.
 

Charting your Body
Body mass index (BMI) is a measure of body fat based on height and weight, and is a reliable indicator of total body fat. It’s also helpful in assessing overall fitness and reassuring doubtful women and teens that they are within a healthy weight range. Assessments are made based on the following parameters:
 

The chart below shows approximate BMI and potential level of risk for obesity-related diseases. BMI is calculated by matching your height in the first column with the weight ranges in the adjacent columns.