The Complexities of Body Image: Part 1 with Dr. Michelle Woolhouse and Dr. Gemma Sharp

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The Complexities of Body Image: Part 1 with Dr. Michelle Woolhouse and Dr. Gemma Sharp

Dr. Gemma Sharp shares her knowledge on the origins of body image and the social and environmental influences on body image throughout the lifespan with our ambassador Dr. Michelle Woolhouse. Gemma is a clinical psychologist, founder, leader and senior research fellow of the Body Image Research Unit at The Monash Alfred Psychiatry Research Centre. 

Gemma and Michelle explore the foundations of body image, and discuss the impact puberty, pregnancy and menopause can have on a person’s body image as well as body image for males. The importance of positive role modelling within families and peer groups is mentioned as is the role healthcare providers play. Gemma also shares her latest development – KIT the chatbot that was developed to support young people to develop evidence-based body-image skills. 

Covered in this episode

[00:39] Welcoming Dr. Gemma Sharp
[01:39] Defining body image and how it forms
[03:21] The difference between disordered eating and eating disorders
[05:06] Body image issues during adolescence, pregnancy, and menopause
[10:50] The impact of Western body ideals on different cultures
[12:28] Body image for men and gender-diverse groups
[15:31] The bi-directional relationship between mental health and body image
[17:42] Do certain personality traits link to decreased body satisfaction?
[20:09] The impact of social media
[23:38] How lock downs have affected self-harm and body image
[25:53] Discussing body image with children and other at risk populations
[29:05] The prevalence of orthorexia nervosa within the natural health industry
[34:27] Gemma’s resource: KIT, a chatbot
[37:02] Thanking Gemma and closing remarks


Key takeaways 

  • More than 43% of Australians are highly concerned about their body image. 
  • Body image is our thoughts, feelings and behaviours connected with our body included, but not limited to our appearance and perception of our body. 
  • “We are born with a sense of body image” and a sense of how our body moves and interacts with others and space develops from a young age. 
  • Body image concerns can develop during periods of physical change and development including puberty, pregnancy and menopause. 
  • Pregnancy is a period of great change in a woman’s body and may provoke body image concerns with the rapid change in body shape and societal pressures.  
  • Menopause can provoke body image challenges as we live in a youth-oriented society and menopause is typically associated with ageing. 
  • Body image concerns are not isolated to western cultures, with research into other cultures underway.  When people from non-western countries arrive in a western society, body image distress may be exacerbated by western ideals. 
  • Males and gender-diverse groups are also susceptible to body image concerns as seen in a rise in eating disorder diagnoses in these populations. 
  • There is a bi-directional relationship between body image and mental health. 
  • There are two major traits in the body-image space including perfectionism and neuroticism. 
  • Social media exposure can provide both benefit through connection and harm due to the interactive nature of it.  
  • Following repeated lockdowns in Australia, there has been an increase in eating disorders, body image concerns and self-harm presentations to The Royal Children’s Hospital admissions. 
  • The earlier young people receive intervention for an eating disorder, the better the outcome. 
  • Family influence is strong on young people; therefore, it is important that parents model a positive body image and minimise weight-based or appearance-oriented conversations. 
  • Practitioners who operate in the nutrition space may have an increased prevalence of orthorexia nervosa. 
  • Gemma has been involved in the development of KIT, a chat bot with the ability to have human-like conversations that focus on teaching two types of evidence-based body image and coping skills and is available 24/4 free of charge. 

Resources discussed in this episode

Dr. Gemma Sharp
Body Image Research Unit at The Monash Alfred Psychiatry Research Centre
Five Factor Model of Personality
The Butterfly Foundation: Chat with KIT

Transcript

Michelle: This is FX Medicine, bringing you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr. Michelle Woolhouse, and today we're going to discuss the impacts of negative body image, which is much more prevalent than you might think.

In 2017, a survey was done by The Butterfly Foundation, more than 43% of Australians are highly concerned about their body image. Additionally, over a million Australians today are experiencing an eating disorder but only a third are getting help.

Joining us on the line today is Dr. Gemma Sharp, a clinical psychologist who specialises in the treatment of eating disorders and body dysmorphic disorder. She is founder and leader of the Body Image Research Unit at The Monash Alfred Psychiatry Research Centre, in Melbourne, where she's a senior research fellow. Gemma and her team focus on understanding the cause of and developing novel treatments for body-image-related disorders. 

Hi, Gemma, thanks for joining us.

Gemma: Thank you so much for having me, it's brilliant to be with you.

Michelle: I'm really excited about this discussion because it's such an important one. So, I just wanted to start really with the basics. What is body image and how's it formed in our psyche?

Gemma: It's a great question because I think people have a lot of assumptions around what body image means, but it's far more complicated than people give it credit for. So, it's actually our thoughts, feelings, and behaviours connected with our body. It's not just how our body looks, it's everything about it and our perceptions of it. And it has a great impact on how we view ourselves overall. 

So, when I ask people about how they value themselves, what are the different facets of themselves, body image inevitably comes up. So, it is a core part of our identity.

Michelle: And how is it formed? What are the factors that allow it to form? Does it form in that really infantile stage, at the ages of two or three or before seven years? Do we know about how and when it gets formed or is it ever-evolving?

Gemma: We are born with a sense of body image. We don't know it when we're first born.

Michelle: Wow. That’s amazing.

Gemma: But, even as young as two and three, we have a sense of how our body moves throughout space and how it interacts with others. And then, of course, little children get compliments about how they look or comments. And so, it starts really, really young. And as you said, it does evolve over time because our bodies evolve over time, but certainly it's with us all the way through our lives.

Michelle: Yeah, it's such an important issue. I also, again, just to shape the conversation, I wanted to get some of the definitions clear. Because often it's interchanged between like an eating disorder and disordered eating. Tell us about that, is there a difference?

Gemma: There is. And I can understand why people might be confused. Again, we just use them interchangeably. So, an eating disorder is where someone meets our diagnostic criteria for that particular disorder, and there's quite a few different types. So, people would, of course, be aware of anorexia and bulimia, probably binge eating disorder to a lesser extent, but I think that is one that we're recognising more and more. And there's also, what we call, OSFED, which is other specified feeding or eating disorder which doesn't quite fit into some of the other disorders.

Michelle: I have seen that on a referral letter.

Gemma: Yeah. And then disordered eating is where it doesn't meet our clinical cut-off. So, it's still problematic eating but maybe it's not frequent enough or severe enough to meet our diagnostic criteria. But it's still very much an issue and I would stress that, if there's anyone out there who does meet that disordered-eating criteria, that they should absolutely get help before it does start meeting diagnostic criteria.

Michelle: Yeah, absolutely. It's almost like a scale of problematic behaviour, in a way.

Gemma: Exactly. So, it might be like a binge once a month or some semi-restrictive eating practices. It certainly has a lot of body-image concern in it, and it's better to seek help early than not.

Michelle: Yeah, it's a great point. And we'll talk about where people get help and resources, later on in the chat. But also one of the things, when I was researching this and, I think, in our pre-podcast conversation, is just how body image can actually almost like pop up as an issue at various different stages of people's lives. Things like pregnancy where I guess there's this that you meant to feel fantastically vital through pregnancy but some women actually feel challenged.

Gemma: I think illusion is correct, actually. That does not seem to be the norm, that people feel fantastic in pregnancy.

Michelle: Moments of. But yeah, so, pregnancy, breastfeeding, there's so much pressure, post having a baby, about getting the pre-baby body back, in the media, or menopause, peri-menopause, adolescence. Tell us about how different key stages...and because I think this is really important for practitioners to know to really be almost alert to to that and open up a discussion with patients with regards to that.

Gemma: Absolutely. I think you've hit so many great points there. I think practitioners are aware that body-image concerns can creep up in adolescence, I think we've got that right, that time of, usually, a lot of growth and development, including brain development. But I think we tend to forget that our body is ever-changing, and pregnancy is a time when a woman's body will go through radical changes, whereas her body might have stayed quite the same for quite a while of her adult life. And she's growing a human being in there, of course her body's going to change.

But as you said, there's all that societal pressure of, "This is the best time of your life, you have this pregnancy glow," but what if you're not feeling glowy? What if you're actually feeling a bit gross in your body? Who do you talk to about that? And I think there's a lot of stigma around saying that, "Hey, I'm really not enjoying how my body is changing right now. Even though I'm really appreciating growing a baby, I myself am dissatisfied." And then, as you said, there's all that pressure afterwards to just snap back to how you looked before, which, again, is completely unrealistic and perpetuated by media and society most often.

And I think we need to, I suppose, move more towards a body-acceptance approach after pregnancy because your body won't be the same because it has done an amazing thing of growing a baby. And that is very very cool, and I suppose that's why...

Michelle: Super cool.

Gemma: …I’m always about body function over form. I'm like, "Isn't that amazing you can grow a baby?"

Michelle: Yeah, I love that body function.

Gemma: Not everyone can say that.

Michelle: Yes, it is a biological imperative. You need a womb and a couple of other little key components. But I think the point that struck out for me when you said it's like, "Where do we go to talk about that?" Because I'm probably falling to that category of feeling quite overwhelmed by the body changes of pregnancy. And I really didn't feel like I could talk to anyone about it. I'm talking for the first time now, in a way, just reflecting back of how important it is to know where we can talk about these issues. Because it was actually quite full-on for me, the changes and the repeated...how rapid those changes were, I was like, "Wow, I don't have time to catch up."

Gemma: Exactly. The only other time is puberty when you're going through changes that fast.

Michelle: Yeah, that's wild.

Gemma: And everyone expects you to be a bit all over the shop then.

Michelle: Yeah.

Gemma: But no, pregnancy, you're meant to have it all together and just be like, "Oh yeah, great." And of course you're not going to be able to maybe do all the self-care and things that you would normally do for your body because you're carrying a baby, it's really tough.

Michelle: Yeah, that's right. And menopause is another big one I think. We live in a youth culture, we live in a pressurised culture that says a woman's body needs to look a certain way. And then menopause hits and there's a whole raft of different physiological changes.

Gemma: Oh, my goodness. And if we don't talk enough about pregnancy, we don't talk at all about bodily changes in menopause. I didn't even think menopause was really in people's consciousness until fairly recently it would seem...

Michelle: Yeah.

Gemma: I suppose more mainstream rather than medical professionals. I think, agreed, it was like, "Well, you just become older."

Michelle: Yeah.

Gemma: Well, no, the cessation of menstruation really does have huge impacts on the body. And I think there's this, as you said, youth-focused culture, so, it's like, "Well, now I have this definitive sign that I am no longer 'young,'" quote unquote, which I don't believe in at all. You're as old as you think you are.

Michelle: That's right, and I actually had a quote, I think it was Instagram or whatever, a 93-year-old yogi. So, she's a woman, I think she's in Florida, of course, she said, "I don't believe in age, I believe in energy." And I just thought, "That's just a great mantra to think of."

Gemma: Yeah, exactly, it's so about outlook rather than the...

Michelle: And function, as you said.

Gemma: ...biological number that you have reached. We have post-menopausal women doing amazing things, running countries...

Michelle: Yes.

Gemma: ...completing marathons, whatever they want to do. I suppose it's the next life phase and what you want to achieve out of that.

Michelle: So, I think, in lots of ways, we think that this body-image issue is actually a western construct. But is this happening in other cultures? Is this happening in places like India, or Africa, or some of the other things? Are we noticing changes through social media maybe, or the internet or sedentary behaviour, what's happening in other cultures, or is this just mainly a western thing?

Gemma: It definitely does impact other cultures. I'm sad to say that our research really hasn't looked at other cultures enough, and that's something we are addressing now and finding, "Oh yes, this is not just a western thing." In fact, we find that when people from these other countries like India and Africa, as you were saying, when they come to live in western countries, their body image actually, body-image distress becomes worse, because they're surrounded by all of these western ideals. And, by virtue of their culture, they are even further away from that than someone who, say, is western-born and bred. So, we've got the perfect clear white skin, bright eyes, this Instagram look.

Michelle: Yeah.

Gemma: And if you,'re say, for example, from India, you are never going to have that kind of look. And so, we know that, with western beauty ideas infiltrating these other countries, it is definitely promoting body-image dissatisfaction, and it's something that we need to investigate more.

Michelle: And I think it's worth us, as practitioners, really, I guess, opening our hearts and minds to women or men of different cultures. And that leads me on to the fact that we often think about body image as an issue that affects girls and women, but your research tells us that that's not the case. Tell us about the fact that...what's going on with men? Is this a rising issue of men, has it always been there? How is it different for men?

Gemma: It absolutely affects everyone. Anyone with a body can have a body-image concern. So, people of all genders, and I'm glad we're finally moving this research away from just girls and women. It, obviously, started there and there's been brilliant research, over probably the last couple of decades, that has really shown that this is an issue, and I credit all those early researchers in the 80s and 90s. But I suppose it was more the 2010s that we're like, "Hey, what about men? Are they always happy with how they feel in their bodies?" And, of course, the answer was, "No."

And we're seeing a rise in eating disorders in men. So, I suppose, when body-image concerns become very severe, coupled with those eating-disorder behaviours, we see eating disorders in men. So, we know that this is a growing issue for them. And, unfortunately, a lot of our, I suppose, treatment and prevention programs are very much geared more towards the female audience. And so, men are far less likely to reach out for help thinking that this is a woman's issue. So, I think it's very much under-reported, the statistics we even do have.

I suppose, what I will say is, I do think it is experienced differently for women and men. I think women have, generally, always been valued for their appearance in society. I think that goes back a very long time.

Michelle: Yeah, back to Cleopatra's age.

Gemma: I don't think men always have that. Exactly. Men tend to be more valued for their power and resources. I'm overgeneralising here, I apologise.

Michelle: Of course. Of course, but it does paint a cultural picture. I think...

Gemma: Yeah.

Michelle: ...and it's certainly not the way we want it to be in the future. And I think there's lots of activity, the last 10 years, explosion of really putting gender on the table. But...

Gemma: Absolutely.

Michelle: Yeah.

Gemma: And gender-diverse groups as well, they're another group. And, of course, there's lots in there, non-binary, transgender, intersex.

Michelle: Yeah.

Gemma: That's only a couple. And we know that they experience body-image concerns at even higher rates...

Michelle: Yeah.

Gemma: ...because of this gender dysphoria, at times, that they're experiencing. So I'm glad we're finally shining a light on these other groups and saying, "Hey, we know that you're struggling with your bodies too, and we want to help."

Michelle: Yeah, absolutely. I think it's just great to have some words around it too so that we can start to open the conversation. Because body image and poor mental health are actually connected through...

Gemma: They so are...

Michelle: ...the research that you've done. So, I'm just wondering if we know, is it a chicken-or-the-egg scenario, does one lead to another? Or how does it work, do we know?

Gemma: Oh, it's a great question. And I think it's very much a complex interplay that one feeds into the other. If I'm feeling anxious, I focus on my body. If I focus on my body, I'm feeling anxious, it lowers my mood, it makes me not want to go out. Which makes me feel isolated, I feel judged when I go out by others because of my appearance. There are just so many factors at play here. But you're absolutely right, it's this bi-directional relationship with overall mental health and body image.

Michelle: So, it is, I think, for practitioners listening to this, even if we've go,t I guess a...I was going to say, "a sniff of body image issues," it really is important, from a prevention of mental-health issues, to see whether we can support people differently with that and open a conversation. Because sometimes...

Gemma: Absolutely. I think I feel like, I suppose, from my own patients, we don't ask about body image enough. Say if someone has come to me for, say, an OCD or a depression or something like that, and I'll say, "Oh, and how's your body image?" and they're like, "Oh, terrible," but that's not their primary presentation.

Michelle: Yeah.

Gemma: But I think, if any health professional asked, they would probably get, "Yeah, it's not great," for people's sense of body image.

Michelle: And I think it's like so many things, if you go back to early psychiatry, Jung would say, "Everybody comes with a story that's never been shared," in their psyche. And so, as we speak about these and as we share, there's that shared humanity, which is also part of the healing. 

Gemma: Absolutely. And I think we, as health professionals, own our own body-image journeys as well.

Michelle: Yeah.

Gemma: Who of us can say that we are satisfied all the time?

Michelle: That's right. But your research also has explored personality traits on body image...

Gemma: Sure.

Michelle: ...and made the connection. Tell us a little bit about which personality traits affect us more? Is there something we could look out for or support people through?

Gemma: Oh, this is such a complicated issue because, if we think body image is complicated, personality is even more complicated. And I have a great PhD student looking at this at the moment. I hope, by the end of her PhD, I'll be able to answer this question even better. So, what we tend to find, I suppose, there's two major traits that we talk about in eating-disorder space or body-image space. And the first is perfectionism. We know that perfectionism can actually be really beneficial sometimes, it helps us get good grades at school, get promoted at work...

Michelle: Yeah.

Gemma: ...throw awesome parties, things like that. But sometimes...

Michelle: Attention to detail.

Gemma: Exactly, exactly. You want that in a surgeon, don't you?

Michelle: Yes, absolutely.

Gemma: You just don't want someone who is slap dash. So, it can be really helpful but it can definitely go into that pathological realm pretty easily. And when focused on the body, which we know is inherently imperfect because it is our body. Then that's when it's an issue. So, that appearance-oriented perfectionism is quite problematic. 

And the other is neuroticism, going back to our five-factor model of personality, if your listeners have heard of that. Check it out if you haven't. So, yes, I suppose being a bit more intense about things. But neuroticism covers a range of behaviours. So, I suppose my PhD student is drilling down on that a bit more, which I'm pretty interested in.

Michelle: Yeah.

Gemma: So, I think that's a really evolving space and I think, at the moment, our treatments don't take into account enough individual personality traits. We tend to deliver the same treatment irrespective. Perfectionism is something we tend to address a bit better but, in terms of other things like temperament and personality, we don't do such a great job at the moment.

Michelle: Yeah, they're trickier. Well, that leads me into…

Gemma: They really are.

Michelle: Yeah, it's like we've got personality traits and a family of origin. But one of the big issues that's changed, over the last decade, is, of course, social media and its impacts.

Gemma: Yes.

Michelle: Channels such as Instagram, Facebook, TikTok. And it's very difficult for parents, particularly after these lockdowns. It's almost like the landscape has changed dramatically. I know myself, we recognised that, from a social perspective, we needed to loosen the reins of our 1-hour-a-day-thing through lockdown.

Gemma: Yeah, it's more like 23 hours a day during lockdown.

Michelle: Yeah, and the horse has definitely bolted.

Gemma: Yes.

Michelle: Tell us about the research for social media and how much of an impact do we know that it's happening on body image.

Gemma: Yeah, so, it's such an interesting space, media impact. So we knew that media was having an impact decades ago, like movie clips, music clips, magazines, things like that, but now social media has really changed the media landscape even more because it's so interactive, you're part of it. For example, TV shows and magazines, you just read and watched, you weren't really a part of it. But because social media is so interactive, there is the chance for more harm, unfortunately. But also more good too. I think social media gets a bad rap sometimes, I think it does connect people who may not have a community. So, I think we shouldn't forget that.

In terms of social media's impacts...so, we know that it's not necessarily the amount of time young people spend on there. So, obviously, I don't want your listeners thinking, "Oh, 24 hours a day is fine," but, if you're a young person who's spending quite a bit of time on there, it's okay. It's more the activities which they are participating in that have the potential for harm to their body image. And these tend to be more of the photo-based activities, so, taking selfies, editing selfies, posting them, looking at other people's selfies and photos. So, it's really the images that have the most powerful impact on body image. And if we think back to, say, magazine covers and things like that, it's a little bit like that, isn't it?

Michelle: Yeah.

Gemma: Except now we all have smartphones and can edit our own photos. And so, now we have that technology to use on ourselves.

Michelle: Yeah, and I guess it's the normalisation of that, the normalisation of beauty pressures.

Gemma: Oh gosh, yeah.

Michelle: We were speaking to our daughters about unrealistic beauty ideals and the impact of them. They're like, "Yeah, yeah, yeah," like, "we know that they've been filtered and whatever." But I know, when I look at a filtered image of myself, if I've got a filter over the top, I'm like, "Wow, that looks better."

Gemma: Absolutely.

Michelle: That's the way...

Gemma: It's that classic before and after, that's the basis of cosmetic surgery.

Michelle: Yeah.

Gemma: The before is always pathologised and the after is glorified. It's really...

Michelle: That's right.

Gemma: ...challenging.

Michelle: So, it's challenging even for a 50 year old...a 49-year-old woman to have these kinds of things, go, "Yeah." For young teenagers, that's what they actually, at times, aspire to. 

Because what I was looking at through the lockdown was just this...because in the newsGP, there were coming reports of The Royal Children's Hospital emergency admission rates for things like self-harm and body-image issues and eating disorders in teens due to the lockdown. Do we know much about that yet? Do we think that this is going to be an ongoing trend? What are we doing about this recent imposition that happened that has almost thrown all of the cracks open?

Gemma: Yes, I think we're still managing this. Maybe I'm cynical, I can't see things getting better quickly. You're absolutely right that it showed that we didn't have enough workforce in this space.

Michelle: Yeah.

Gemma: And this isn't something that's addressed quickly either, it takes time to train people and build up the workforce. So, we know that wait lists are longer than 12 months for specialised eating-disorder services and things like that. I had to close my books because I just couldn't take anyone else on. So, I'll be very interested to see what happens with this cohort of young people. I'm sure they'll be the most studied cohort of young people ever because they've lived through a pandemic at that particular time of their lives.

I do know that, particularly with young people, the earlier the intervention in the eating-disorder realm, the better. We tend to actually have very good outcomes with adolescents and family-based therapy...

Michelle: Yeah.

Gemma: ...for eating disorders, but when they...I don't mean to be, I suppose, a Debbie Downer or anything like that but, when it comes to people who are in their 20s, 30s, 40s, if they're coming to treatment for the first time, we tend to not have as good outcomes. It doesn't mean they shouldn't come but just the earlier someone can get into treatment, the better. Particularly as a family unit as well, we just know that that works brilliantly, rather than individual therapy later on.

Michelle: And is there certain language we should be using around ideas of body image or food or exercise, for example? A lot of our practitioners are going to be parents as well, is there something that we can do from a prevention or even as family members? Is there something that we know that can be really helpful?

Gemma: Yeah, we know that people's families are very influential in how young people form a sense of their bodies.

Michelle: Yeah.

Gemma: Obviously, their peers become quite important later on, but certainly, at those earliest stages, it's parents and siblings and grandparents, whoever's around. And I think, first up, if you have your own body-image concerns as a parent or carer, please go see someone. Because even you talking about your own body does impact how the young person around you looks at theirs. Even if you're not talking to them directly, they really pick up on how bodies are talked about. If you're on any diet or anything like that, please don't mention it in front of the young person.

So, I suppose, yeah, sorting out your own sense of body image is a really good thing. In terms of how you talk to them about their own body, if you can avoid, I suppose, more appearance or weight-based conversations, that's really, really, really helpful because they tend to never really go that well.

Michelle: Yeah.

Gemma: I know some people will say, "Well, can't you compliment someone if they're looking good?" Of course, of course you can do that. But I would rather hear that compliment mixed in with, "Oh, aren't you good at tennis?" or, "Wasn't that a kind thing you did for your brother?" It needs to be mixed in with compliments about the person's character, what they do well. I suppose it comes back to how little girls are always told, "Don't you look pretty?" and little boys are like, "Oh, don't you play with trucks well?" It's readdressing that, really. 

It's like complimenting people for what they do, rather than what they look like. So, I think it's just, I suppose, treating young people like whole people from the start and not really having those appearance-based conversations very often. And talking about other people as well. Like I hear this, "Oh, isn't she a bigger person?" or something like that. Even talking about someone else...

Michelle: Yeah.

Gemma: ...just don't talk about people's body shapes, full stop.

Michelle: That's right. I think that's a really great thing. And even if we're picking up our unconscious bias. Because I think, as a culture, we've been so ingrained about body image and what we look towards the outside world. So, even picking it up in yourself to go, "Well, I actually identified that person as a big person," But also noticing how much we do that with women and not men or etc., etc.

Gemma: Yes.

Michelle: So, I think noticing differences that we do do, even just our own unconscious bias, can be so supportive. 

But that actually leads me to orthorexia nervosa.

Gemma: Sure.

Michelle: And so, I've been fascinated with this. I've been working in integrative medicine for 20 years and, obviously, been prescribing different nutritional interventions and diets and been really conscious of the aspect of orthorexia nervosa, which came in when people had really...I had a group of people that I struggled to get them to adhere to a diet, and then others would be like, "Yep, I'm on. Here you go, what food do you want me to restrict? I'm there, I'm done," like, "Yep, I'll say no to this." And it was like, "Whoa."

Gemma: Okay.

Michelle: And also the research shows that orthorexia nervosa, or those kinds of issues, are actually much more prevalent. In one study, it showed 68% of dietetic students had aspects of orthorexia.

Gemma: Isn't that a worry?

Michelle: Yeah, dieticians had a two-fold increase in eating disorders, as compared to control.

Gemma: Yeah...so, what are they saying to their clients and patients? That’s a worry.

Michelle: Yeah. And naturopaths and nutritionists would fall into that, and then personal trainers, and etc., tend to have more of an inclination towards an unhealthy relationship to food. And when we're prescribing that, do we know enough about that? Is there any support for people that are working in the diet industry, weight-loss health industry, etc., that we can shine a light on and see whether we can support that? Because, obviously, that's an issue for people coming for support as well.

Gemma: It really is. And I think orthorexia nervosa is so interesting, it's not in our diagnostic and statistical manuals yet.

Michelle: I know.

Gemma: I'm not sure if it'll make it into the next iteration, I'll be interested to see.

And I suppose there's this debate, like, "Is orthorexia nervosa just anorexia by another name?" I just...yeah, it's this socially-acceptable eating disorder, which I don't like one bit because it's still very harmful. And as you said, there does seem to be a higher incidence in certain types of professionals who tend to encounter people with eating disorders, which is a real struggle. I think, potentially, programs, for example, dietetic programs at university should be maybe screening for these behaviours before permitting people into these programs. Not excluding them of course, however, maybe saying that perhaps they could benefit from seeing a psychologist in conjunction with conducting the program, just to make sure that they are not unintentionally passing on any harmful messages to their clients.

And I suppose I was speaking to a group of dieticians last year and I realised that, unlike psychologists, they don't have a peer consultation, they don't really talk with other dieticians very much. At least that was my understanding from my interactions with them. And I think it would be very hard for a dietician to say to another dietician, "I think I'm a bit worried about my eating behaviours." Because they're meant to have it all together, because they're dieticians, they're personal trainers, they're meant to be the experts in this. So, it would be quite shameful, I think.

Michelle: And I guess it's similar to psychologists that have anxiety and the breakdown, because often...

Gemma: You know what, I've never met a psychologist without anxiety. I think it's part of the job description.

Michelle: But I guess we do naturally get attracted to what we feel is our most pertinent relationship...

Gemma: Exactly.

Michelle: ...in many ways. So, it's a natural attraction.

Gemma: As you were saying, like a psychologist whose anxiety is maybe escalating, they would talk to another psychologist, they might be seeing a psychologist themselves. In fact, a lot of people in the field do.

Michelle: Yeah.

Gemma: And I think that's really really helpful. And I think, if other professions were to have that, where they could talk honestly to each other about struggles that they're having within themselves that might be impacting their clients, all the better.

Michelle: I think that's a fantastic idea because, I know myself, as an integrative GP, there'd be some times when I did see a patient that was really adhering to a diet in such vigour, and I'd actually question myself and think, "Why can't I do that? They seem to be able to do it so easily." Or whatever. 

Gemma: You know what, I'm glad you can't, that's really good.

Michelle: But I guess we're all human and we share this human journey. And so, really what we’re suggesting…

Gemma: Oh, exactly. We're always going to identify or not identify with our patients and clients, to some extent. We can't leave, as you said, our human side out of the clinic room, it's always there.

Michelle: That's right. And I think encouraging people to speak about it to our patients but also to ourselves, we become a mirror of the people that come into our clinic. It's just remarkable how much we share our humanity with other people, even with vastly different backgrounds.

Gemma: Absolutely, it makes you the best practitioner you can be, it's why you're not a robot.

Michelle: Yeah, that's right. Talking of robots, what a beautiful segue, and completely unplanned.

Gemma: Thank you. I can't imagine what you were about to ask me.

Michelle: So, Gemma is such an innovative psychologist, probably one of the most...

Gemma: Oh, thank you.

Michelle: ...innovative in Australia, has created this incredible resource. Tell us about what you've created. Tell us about KIT.

Gemma: Well, thank you for the opportunity to talk about my chatbot child, KIT. I'm super proud of KIT.

Michelle: Yay.

Gemma: And thank you so much for the lovely innovation comments there, I really appreciate that. Because I think, in mental health, there's so much demand and so few of us that innovations are absolutely crucial, and the pandemic really pushed that along. And KIT was launched in November, 2020. KIT is a chatbot, which is a computer program that has human-like conversations.

And KIT focuses on teaching, I suppose, two types of evidence-based body-image skills. The first being basic education around what body image is, what it isn't, what to look out for in yourself and others, what treatments are available, that kind of stuff. So, the nuts and bolts there. 

But KIT also has 19 different coping skills that I would routinely teach in my practice. These are generally cognitive-behavioural therapy and mindfulness-based, which we know has positive impacts on people's body image. And I think because KIT's there 24/7, freely-available, a cute character that people seem to really be attracted by, KIT's had over 23,000 users in just over a year. So, we're really really excited that people are benefiting from KIT and enjoying speaking with KIT.

Michelle: Ah, that's so fantastic. I've had a play with KIT, so, I'm one of the 23,000.

Gemma: Thank you.

Michelle: And I would encourage all of our listeners to go online and have a play with KIT. We'll obviously have links on the website to KIT.

Gemma: Oh, thank you. Yeah, just go on Butterfly's website and you'll see a green pop up there.

Michelle: And I think also to familiarise ourselves with what he does, what he can do. So, if we're asking patients about body image or if any of our listeners have identified that maybe they could explore the issue a little bit further as well, KIT's a great place to start, and then I guess seeking help and other resources as well. 

So, Gemma, thank you so much for being on the show with us today to discuss negative body image and what it is and how significant an issue and impact it has on our lives and our relationships. And you've helped give us a hugely beneficial understanding of how society's expectations and social media play a role in it as well.

I guess particularly what I loved was your focus on body function. So, what does my body do, focusing on that experience of what it feels like to do things with our body rather than what they look like, and how we can better support people to build better body image for ourselves and for our patients.

Gemma: Thank you, yeah. I think this is an area we all continue to work on. It's an evolving space and it's just so exciting to see the future directions in the field.

Michelle: And don't forget to check out KIT. So, thanks, everyone, for listening today. Don't forget that you can find all the show notes, transcripts, and other resources on the FX Medicine website. I'm Dr. Michelle Woolhouse, and thanks for joining us. See you next time.


About Dr. Gemma Sharp

Dr. Gemma Sharp is a Senior Research Fellow at Monash University in Melbourne funded by the National Health and Medical Research Council. She established and leads the Body Image Research Unit at Monash where her team focuses on understanding the causes of and developing novel treatments for body image related disorders such as eating disorders. Her team is particularly interested in using artificial intelligence to power the creation of novel body image interventions.

Dr. Sharp is also a clinical psychological and has her own private practice in Melbourne where she specialises in the treatment of eating disorders and body dysmorphic disorder.

Dr. Sharp originally trained as a biomedical scientist and her career in biomedicine and clinical psychology has seen her study and work in multiple countries including UK, Japan and Australia.

She is well recognised for her science communication skills. She was invited to give a TED talk in 2017 and is a regular host of the Melbourne Triple R radio program, Radiotherapy.


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Michelle Woolhouse
MBBS, FRACGP, ACNEM, FASLM, Grad Dip. Mind-Body Med Dr Michelle Woolhouse is an integrative specialist GP. Her philosophy is that health addresses the whole spectrum of a person’s life: emotional, physical, mental, spiritual and environmental. Dr Woolhouse has an in-depth understanding of the underlying cause of diseases and in the healing principles of the body from an energetic, biochemical , psycho-spiritual and relational level. In addition to her medical degree from Monash University in 1996, and her fellowship with the Royal Australian College of General Practitioner’s (RACGP), she also has post graduate qualifications from Swinburne University in Nutritional Medicine and Mind-Body Medicine, as well as training in hypnotherapy, acupuncture, and various meditation techniques. She was the founder and medical director of Whole Medicine, the second largest integrative medicine clinic in Victoria, from 2009 to 2020. Dr Woolhouse is co-founder and co-host of the award-winning health podcast, The Good Doctors, and is currently the medical director of Australia largest wellness platform and soon to launch online wellness support program, called vive.ly. Her number one piece of advice to patients is: everything in moderation even moderation. She loves surfing, watching her children grow up, yoga and walking in nature.