by Sarah McGowan, TT Report Writer and Producer

I’d be happier if I was thinner.

People would like me more if I was leaner, stronger, faster.

As soon as I can fit into a pair of skinny jeans, I’ll stop.

These are the lies we all tell ourselves. They start as troubling thoughts that creep insidiously into our subconscious as we absorb the messages all around us before turning into beguiling, but ultimately empty, promises.

Many of us will struggle with the effect these thoughts have on our emotions, our self esteem and our bodies, but few of us will ever share our pain with others. Though negative body image is rampant in our culture, it has become a silent epidemic, largely because we are all affected, ashamed and afraid to reach out for help.

This week marks the 2013 National Eating Disorder Association’s (NEDA) awareness campaign, “Everybody Knows Somebody.” Compared to almost all other mental health issues, our proximity to eating disorders and disordered behavior around food couldn’t be described more aptly.

Today’s research reveals the critical nature of these issues, especially for young people. According to NEDA, children as young as six begin to show signs of body dissatisfaction. For girls, the cycle of dissatisfaction seems to accelerate, with as many as 60% (ages 6-12) becoming concerned about becoming too fat – a preoccupation that never goes away.

But despite these painful truths, many misconceptions and myths persist when it comes to body image and eating disorders. Unlike all other conversations adults have with youth around decision making and risk behaviors, body image rarely makes the list. Too many of us say that these issues don’t affect us, don’t affect our children or our school communities. But the numbers shed light on a different story and one that deserves to be told.

Myth #1: Body image issues and eating disorders are about vanity and food

The truth is, these issues are incredibly complex, the roots of which can be found in some of the most common concerns and struggles of young people: coping with emotions, popularity, peer acceptance and achievement.

Claire Mysko is an internationally recognized expert on body image and media literacy. She oversees teen outreach for NEDA, particularly their youth advocacy platform She says this most common misconception often alienates those who struggle even more when “helpers” fail to recognize the underlying dynamics at play.

“People dismiss body image and eating disorders as vanity issues and say things like, ‘you’re too obsessed with how you look, you need to get over it’ as if it’s just about food and weight. But these issues run much deeper than that.” The low self-esteem and insecurity that mark those who struggle are often tied to other mental health issues like depression and anxiety. She says being terrified of making a mistake is also closely linked. “Perfectionism is huge, too – the need to please everyone and be perfect,” something far too many children can relate to in a culture that pushes them excel in every aspect of their lives.

Myth #2: Body image only affects teens and women

The truth is, these issues do not discriminate: they do not favor women over men, certain ethnicities or age groups. Over 30 million Americans will suffer from “a clinically significant” eating disorder in their lifetime, a number that most likely doesn’t represent the full scope of the problem due to so many people suffering in silence and the undiagnosed.

Everyone is affected by body image and eating disorder issues, whether through a personal struggle or by watching one of their peers, friends or family members struggle. What is abundantly clear is that body dissatisfaction starts very young, with the most critical of years occurring in adolescence (12-15). And increasingly, body dissatisfaction is being recognized as significant for boys just as much as it is for girls.

Christine Flammer is the Executive Director of Hopewell, an organization in Canada dedicated to providing support and resources to those who struggle with these issues.

“We all know about the way women are portrayed in the media, but idealized male bodies are really prevalent, too – on the front of fitness magazines, for example,” she explains. “There’s a lot of pressure for boys to look a certain way to be successful.” She notes that they’re subject to the very same insecurities as girls, but for them it’s about the 6-pack abs and strength. “Is that achievable for most boys? No it’s not,” she says. “What we see happening is over-exercising and spending more time in the gym to develop that ideal body. And we are seeing increasing steroid abuse.”

Efrain Marrero was like any typical teen athlete who enjoyed sports – he wanted to improve and perform at his best. But his drive for success danced dangerously with peer influence, leading him down the destructive path Flammer describes above. Though his parents aren’t sure exactly how long he used, his father, Frank, thinks he may have been abusing steroids for two years before he came to them in crisis.

“He was already a big boy – always on top of the growth charts,” says Frank, “so getting bigger seemed natural. He was working hard every day in the gym so we didn’t think that there might be something else at play here.” Naturally they were shocked to learn of their son’s steroid use. “As parents back then it didn’t even enter into conversation – other drugs and alcohol, yes definitely – but steroids? Never.”

Myth #3: The media is to blame for our body image issues and eating disorders

The truth is, though the media plays a big role in the images we see and internalize via movies, television and magazines, societal messaging about beauty and desirability greets us at every turn. As soon as children begin to recognize themselves as belonging to social groups, they begin to compare and contrast, astutely noting what society deems “beautiful” or physically “desirable,” which can be different for boys and girls. Children begin absorbing cultural cues from cartoons, toys, their friends and families.

The people who surround us wield even more power than the media in the form of peer pressure, examples set by parents and adults, the widespread normalization of “dieting” in our culture and how we all talk about and treat our own bodies.

The first time Kayla realized she was heavier than her peers was when at the age of six, one of her male classmates taunted her. Her struggle with body image never got easier and bullying at school continued relentlessly, often as teachers passively watched.

“In 5th grade I was on a list of girls who shouldn’t be allowed to go to a swim party and that list circulated all over school,” she says. “One day in PE, one of the kids yelled out, ‘watch out, the whale may squish you!’ and the teacher didn’t even acknowledge it. I was bullied horribly in school, but nobody ever stood up for me.”

Though she played soccer and water polo in an effort to be active or healthy, nothing seemed to work for Kayla. “At 13, I was bringing Jenny Craig meals to lunch at school and it was awkward because suddenly you’re that kid who’s eating carefully portioned containers of food. At that point,” she remembers, “I’m just not feeling a sense of normalcy.” By the time Kayla was 14, she was gaining an average of 40 pounds per year and soon hit her maximum weight of 255.

Claire Mysko points to our national obsession with dieting as a big reason for why so many youth struggle alone like Kayla did. “It’s really confusing because there’s this expectation that everyone is going to want to lost weight,” she says. “We have a very confusing national conversation about obesity, which is a serious issue, but there’s a negative aspect to that, too. There are so many confusing images about ‘health’ that really aren’t so healthy.”

Myth #4: You can tell if someone has body image issues or an eating disorder just by looking at them

The truth is, body dissatisfaction and eating disorders come in many shapes, sizes and extremes. They are often far too easy to miss until crisis hits, much to the devastation of parents.

Claire Mysko is adamant that every parent should assume these issues are going to come up in their children’s lives, whether personally or through their peers. “They are so prevalent, there’s no avoiding them. Every single parent needs to be educated,” she says.

But most are woefully unprepared and usually, parents report feeling blindsided.

“Truthfully, we had no idea until he came to us,” Frank Marrero says. “Only then did we learn about what Efrain was going through – paranoia, psychosis and depression.”

Kayla agrees. “My parents didn’t know this at the time, but I was ready to not live anymore if I had to be heavy. At that point I didn’t care if I died on the table (during surgery).”

Even with the best intentions, parents, family and friends often miss critical signs simply because they don’t know what to look for.

Myth #5: Body image issues go away when you get closer to or reach your “goal”

The truth is, the “goal” is always a moving target. Even if someone reaches or exceeds their “dream dress size” or muscle growth, obsession with appearance does not magically disappear, and in fact, can often become even more extreme. The longer one struggles and resorts to extreme measures, the harder they are to treat.

Kayla certainly learned this the hard way. Though her decision to seek gastric bypass surgery at 14 helped her lose the unwanted weight, the bullying didn’t end. Instead, every time she used the bathroom, her peers accused her of becoming bulimic. Eventually she switched schools to start a new life.

Though she doesn’t regret her decision to take extreme measures, she does recognize that she did it for the wrong reasons. “As much as I’d say I was doing it was for my health, the truth is, as a 14-year-old girl, I just desperately wanted to look like everybody else, be thin and be accepted.”

But her struggle didn’t end with her surgery. “I got the weight loss, but I didn’t get the appreciation from my peers,” she explains. “You think, ‘Everyone’s gonna love me because I’m not gonna be fat anymore’ but it’s not true.” She says therapy prior to the surgery would have really helped, but it was never offered to her.

“I wish I had gone to therapy 6 months before surgery to discuss the reasons why I wanted the surgery and what my goals were after the surgery.” She says that she became obsessed with her weight loss after surgery. Now 20 years old her path to self-discovery still continues to this day. “I found out after the surgery more of who I was – that same nice person who cared.”

Efrain and his family weren’t so lucky. Though by all accounts he was strong, excelling in sports and gaining muscle, steroids had already taken their toll. After suffering from depression, paranoia, fits of rage and hopelessness, three weeks after their son came to them in crisis, Efrain took his own life just one day before his first appointment with a therapist.

“Do not think for one second that your family is immune from these kinds of problems,” cautions Frank Marerro, “or you may be the one that gets struck down with a terrible tragedy because you won’t have even seen it coming.”

We only hear about the extreme cases – the children who we lose to these illnesses, the families who are left to pick up the pieces and the lingering pain we must all deal with knowing that there was probably something we could have done. For all the tragedies we learn of, there are countless more that do not make the front page.

Look around you. What do you see? Who is struggling and who looks perfect?

The answer is devastatingly simple: from the perfect kids to the outcasts, the overweight, the short and the tall, everyone is struggling with their own inner demons.

The solution starts with talking about it.

Be sure to read our next article in this 2-part series that gives youth and adults the tools to start this critical dialog early and often.


To learn more about the developmental needs of youth and effective ways to talk to youth about body image and the pressures they face,BUY THE BOOK: Teen Truth – Why Youth Have Something to Hide. Check out TTL: Body Image and Self Esteem, our interactive, multi-media experience that incorporates a motivational presentation with an award winning 22-minute film shot by youth that focuses on body image issues. Funded in part by four leading non-profit organizations focused on educating the public about body image issues, this school-based program presents a raw look at girls in their quest to be skinnier, boys trying to get bigger and stronger, and the ever-growing issue of compulsive eating. To view the film’s trailer CLICK HERE.

To learn more about this epidemic, access resources and seek help with body image and eating disorders, visit the National Eating Disorder Association and Download their straightforward Toolkit for Parents and Toolkit for Educators to learn how to start a conversation with youth about these critical issues.

To learn more about the important work being done in Canada by the Hopewell Eating Disorder Support Center, visit

To learn more about Efrain Marrero, the dangers of steroid use and the educational outreach program his parents started in his name, visit


To receive our monthly Truth Report articles featuring experts, youth voices and valuable insight into the issues affecting youth, click HERE.