Women’s Self-Image: Photoshop Be Damned

I’m an avid supporter of women’s health initiatives. It makes sense: many of my dearest friends, the people I love and adore are women and I want them to enjoy happiness, vivacity and a long active life (that’s one reason I’m trying to kill running). Some may consider this selfish motivation, but if it results in helping the people around me achieve extreme health and longevity, then I’m okay with my lack of altruism: selfishness as virtue, so to speak.

I’m also a big fan of the truth.  That’s why the Israeli government piqued my interest by passing a law that makes advertisers and publications clearly display when they’ve digitally altered a model’s photo to make them look thinner. The Israeli government passed the law on Monday, which also requires that models used in advertising fall above the World Health Organization’s (WHO) definition of malnourished*.

(*The WHO uses BMI to define health which is shitty, at best, since it doesn’t accurately predict body fat percentage or health unless you’re 70 or older[1,2] or are composed of more than 35% fat[3]—which means you’re the same molecular consistency as a pork rind and at that point you should be able to figure out you’re not healthy without the aid of a BMI calculation. But I’m not here to complain about preeminent health authorities using a 200-year-old hack to assess an individual’s health.)

The Israeli law is meant to address the 2% of young women 14 to 18 with an eating disorder and unhealthy self-image. A few of my close female friends had an eating disorder when growing up, as did some of my clients. They often rescued themselves by finding a new way to obtain a look and feel to their body that’s healthy and, honestly, down-right sexy: they resistance train. So I applaud the efforts of the Israeli government for trying to find ways to insulate women from these unrealistic female images that advertisers digitally manipulate (you can’t even say enhance because they sometimes alter images beyond imagination).

Although this is a serious problem, there’s a bigger one that I would like to see addressed: adolescent behavior that leads to overweight physiques. Healthy weight is bounded on both the lower and upper ends, so why don’t governments legislate to prevent the perception that being over a certain weight is also not desirable? Especially in a country where 16% of adolescent girls are overweight and 6% are obese[4,5] (and data shows that Israel is catching up to the US where the numbers, respectively, are 31% and 15%).

I know there’s a healthy-at-any-size movement, and counseling programs to help young women find comfort in their plus-size, but the problem isn’t just psychological; the problem is oncological. An overweight female child or adolescent increases her risk of several cancers in adulthood: premenopausal breast, ovarian, endometrial, colon and renal cancer[6]. Helping them find emotional comfort with being overweight subjects them to a lifetime of physical disease.

Photoshop hides the truth rather well.

I know this is a sensitive problem, and trust me, I have no direct solution, but I can think of a few places to start. For one, we adults don’t even recognize ourselves as fat anymore if we happen to be. When scientists compared self-reported assessment of fatness, they found that over the last 10 years we’ve adjusted our concept of fat to no longer include overweight[7-12]. Overweight people are so common, they form the new average (since, in America more than half the population is overweight), therefore we feel normal when we’re overweight. Only the obese and fit people feel disjoint from their peers.

And, of course, if we can’t recognize ourselves as overweight, we’re not going to do a good job of determining if our children need to shed a few pounds or not. Studies show that we consistently underestimate the weight and health of our children, i.e. we literally can’t recognize a fat child as fat—they look normal to us and what used to be a normal healthy-weight child we now consider scrawny or underfed[13,14]. Our kids don’t recognize themselves as fat either when they are[15].

It’s hard to legislate feeling a certain way about yourself. Sure, we could create public policy to help us recognize when to intervene in our child’s weight gain, when to put the brakes on the Twinkie train with donut wheels. But that still might not be enough. We could follow Denmark’s lead and levy a 25% tax on junk food[16]—much like we do with cigarettes now. More obvious ways exist to combat the problem and this time we could follow Spain’s lead where it is illegal to serve junk food in schools, either from the lunch line or vending machines[17]. It must have taken someone with an Einstein-level intellect to think of that one. We’ll still need more.

In short, we need to recognize and liberally use the word fat. I know it hurts; I know it’s an ugly word; I know it might ignite uncomfortable childhood memories. Today, a decade after achieving mastery over my own weight problem, being called fat, even in a joking manner, stings. So I do understand, but if we can think of ourselves as fat—when we actually are—and can recognize when our kids are fat, we at least know to take action. Fat is a horrible word. But disease and death are worse.

We need to, therefore, re-orient our national-sense of a healthy shape and reinforce it. Most women don’t think cover-model-skinny (Photoshopped or not) is attractive, appealing or even desirable. They also don’t find an overweight female form enviable. In general, women judge healthy-weight figures with a low Waist-to-Hip Ratio (WHR) as the most attractive, associating positive personality qualities with that physique (a good synopsis might be sleek and curvy means confident and intelligent)[18].

Psychologically, the work’s already done. Women innately know what a healthy shape is and project positive qualities onto any woman who possesses it. So whether a woman sees it in herself or not, she knows what’s attractive: a healthy and definitely obtainable shape (unlike those waifish female forms in fashion magazines). Now we only need to encourage and promote this ideal.

We can take the lead of the Israeli government. Part of the legislation mandates that all Israeli models submit paperwork proving their weight is above the “wastrel” threshold set by the WHO. If they can’t provide proof, or fall into the malnourished category, the law forbids them from posing for advertising photos or magazine covers.

Paula Deen makes a Big Mac her bitch

If we want to reinforce the sleek and curvy shape as the goal, we can extend the Israeli law. Why stop with proof that a model is above the minimum threshold of weight, i.e. that she’s not a wastrel? Why not submit proof that she’s also below an unhealthy weight. Overweight women suffer greater risk of cancers (breast[19,20] among others), and portraying overweight as sexy or acceptable is just as dangerous as pushing a waifish form as the pinnacle of attractiveness—possibly even more so**.

(**Why focus myopically on curing breast cancer when promoting a healthy weight — not too skinny and not too fat — goes a long way toward eliminating it[21-25]?)

Maybe this should extend to TV personalities as well, like Paula Deen. Imagine if Paula had to submit documents proving she was healthy. There’d be no Paula Deen. They’re be no million dollar contract to advertise a medication that helps someone die slower from diabetes; there’d be no wholesale dismissal of one of the most heinous, debilitating and prevalent diseases as, in Paula’s words,  just somethin’ to live with, instead of something you will die from.


References (click to expand)
  1. Dey DK, Rothenberg E, Sundh V, Bosaeus I, Steen B.  Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds.  J Am Geriatr Soc. 2002 Sep;50(9):1510-8.
  2. Iwao S, Iwao N, Muller DC, Elahi D, Shimokata H, Andres R.  Does waist circumference add to the predictive power of the body mass index for coronary risk?  Obes Res. 2001 Nov;9(11):685-95.
  3. Frankenfield DC, Rowe WA, Cooney RN, Smith JS, Becker D.  Limits of body mass index to detect obesity and predict body composition.  Nutrition. 2001 Jan;17(1):26-30.
  4. Keinan-Boker L, Noyman N, Chinich A, Green MS, Nitzan-Kaluski D. Overweight and obesity prevalence in Israel: findings of the first national health and nutrition survey (MABAT). Isr Med Assoc J. 2005 Apr;7(4):219-23.
  5. Lissau I, Overpeck MD, Ruan WJ, Due P, Holstein BE, Hediger ML; Health Behaviour in School-aged Children Obesity Working Group. Body mass index and overweight in adolescents in 13 European countries, Israel, and the United States. Arch Pediatr Adolesc Med. 2004 Jan;158(1):27-33.
  6. Fuemmeler BF, Pendzich MK, Tercyak KP. Weight, dietary behavior, and physical activity in childhood and adolescence: implications for adult cancer risk. Obes Facts. 2009;2(3):179-86. Review.
  7. Johnson F, Cooke L, Croker H, Wardle J. Changing perceptions of weight in Great Britain: comparison of two population surveys. BMJ. 2008 Jul 10;337:a494.
  8. Donath SM. Who’s overweight? Comparison of the medical definition and community views. Med J Aust. 2000 Apr 17;172(8):375-7.
  9. Yaemsiri S, Slining MM, Agarwal SK. Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study. Int J Obes (Lond). 2011 Aug;35(8):1063-70.
  10. Duncan DT, Wolin KY, Scharoun-Lee M, Ding EL, Warner ET, Bennett GG. Does perception equal reality? Weight misperception in relation to weight-related attitudes and behaviors among overweight and obese US adults. Int J Behav Nutr Phys Act. 2011 Mar 22;8:20.
  11. Gregory CO, Blanck HM, Gillespie C, Maynard LM, Serdula MK. Health perceptions and demographic characteristics associated with underassessment of body weight. Obesity (Silver Spring). 2008 May;16(5):979-86.
  12. Burke MA, Heiland FW, Nadler CM. From “overweight” to “about right”: evidence of a generational shift in body weight norms. Obesity (Silver Spring). 2010 Jun;18(6):1226-34.
  13. Wake M, Salmon L, Waters E, Wright M, Hesketh K. Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey. Int J Obes Relat Metab Disord. 2002 May;26(5):717-24.
  14. Pu C, Chou YJ. Health ratings for underweight, overweight and obese adolescents: disparities between adolescent’s own report and the parent’s report. Asia Pac J Clin Nutr. 2010;19(2):180-7.
  15. Standley R, Sullivan V, Wardle J. Self-perceived weight in adolescents: over-estimation or under-estimation? Body Image. 2009 Jan;6(1):56-9
  16. Wilkins R. Danes impose 25% tax increases on ice cream, chocolate, and sweets to curb disease. BMJ. 2010 Jul 6;341:c3592.
  17. de Lago M. Spain bans sale of unhealthy food in schools in bid to tackle obesity. BMJ. 2011 Jun 28;342:d4073.
  18. Singh D. Is thin really beautiful and good? Relationship between waist-to-hip ratio (WHR) and female attractiveness. Pers Indiv Differ. 1994 Jan;16(1):123-32.
  19. Lautenbach A, Budde A, Wrann CD, Teichmann B, Vieten G, Karl T, Nave H. Obesity and the associated mediators leptin, estrogen and IGF-I enhance the cell proliferation and early tumorigenesis of breast cancer cells. Nutr Cancer. 2009;61(4):484-91.
  20. Ronco AL, Boeing H, De Stefani E, Schulz M, Schulze M, Pischon T. A case-control study on fat-to-muscle ratio and risk of breast cancer. Nutr Cancer. 2009;61(4):466-74.
  21. Ligibel J. Obesity and breast cancer. Oncology (Williston Park). 2011 Oct;25(11):994-1000. Review.
  22. Liu C, Liu L. Polymorphisms in three obesity-related genes (LEP, LEPR, and PON1) and breast cancer risk: a meta-analysis. Tumour Biol. 2011 Dec;32(6):1233-40.
  23. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer. 2011 Dec 6;105 Suppl 2:S77-81.
  24. Perks CM, Holly JM. Hormonal mechanisms underlying the relationship between obesity and breast cancer. Endocrinol Metab Clin North Am. 2011 Sep;40(3):485-507, vii. Review.
  25. Tan J, Buache E, Chenard MP, Dali-Youcef N, Rio MC. Adipocyte is a non-trivial, dynamic partner of breast cancer cells. Int J Dev Biol. 2011;55(7-9):851-9. Review.



  • Romureti

    hi. Kiefer right on the heart of the matter :):) perfect.

  • Guest1

    You are great at research. I would love to know the last time that the government effectively legislated morality. We, as a society, want the easy way out. It seems to me that the best way to get people to change eating habits would be to hit them where it hurts the most, the wallet. So, if you increased health insurance costs, life insurance (already does to some extent), etc., you might end up with a better result.

    • Levi Russell

      So why don’t you just advocate the removal of gov’t subsidies of health/life insurance? Why not remove all the crappy rules about nondiscrimination? Without the gov’t, people tend to bear the cost of their bad decisions. Let’s not heap policy on policy, it’s absurdly wasteful.

      • dhnaomi

        You should read Freakonomics.

        • Levi Russell

          Though I’ve not read it, I understand its premise. I’m a Ph.D student in applied economics, so this sort of thing is what I do for a living.

          If you like my comment, you should read “Economics in One Lesson” and anything by the Public Choice economists.

          • dhnaomi

            Something tells me that your particular academic exposure doesn’t actually bring you into contact with the subjects embodied in Freakonomics. Behavioral economics professors complain about you applied econ folks all the time. :)

          • Levi Russell

            we prefer reality

          • dhnaomi

            And this confirms my suspicion that economists are vastly out of touch with it.

    • dhnaomi

      Your life insurance hypothetical is illogical, because the quality and outcomes of health correlate far more with the availability of health care and good food in any given region far more than it correlates with individual decision-making or willpower.

      Raising health insurance premiums would just result in a greater wealth divide, since wealthier regions have better preventative care statistics and (usually) a better food supply… especially given the fact that the vast majority of American workers do not buy their own health insurance but instead have it effectively docked from their salary.

      If people have no effective control over their buying choices, how do you expect your capitalist fantasy of individual responsibility to actually function in the way you intend?

      • Keith K.

        “If people have no effective control over their buying choices, how do you expect your capitalist fantasy of individual responsibility to actually function in the way you intend?”

        Well the first way might be to actually give them control over their buying choices. When buying choices are effectively outlawed via incentives towards 1) 3rd party payment via generous tax deductions to employer provided insurance vs. individually purchased insurance (which would look more like car insurance than service prepayment) and 2) regulations which do not allow insurance companies to stick it to the fat and chronically sick and thus actually force them to monetarily internalize their poor choices.

        This is to say nothing of the various work-rule regulations concerning what services can be provided in medicine, and which workers can provide them, which increases costs and decreases availability.

        Before we start complaining that a free market could not work in medicine, perhaps it would behoove us to actually try it first. You know, the same way it produces every other capital intensive good in the economy (computers, cars, food, books, clothing, etc.)

  • Panek

    “Twinkie train with donut wheels”? NOW IM FRIKKIN HUNGRY….but seriously, childhood obesity is such a shame. I was unsupervised for most afternoons through middle school, I would come home and eat chips Ahoy cookies with a marshmallow in the middle, stick it in the microwave for 3 seconds and boy what a treat that was. It was partially my parents fault for allowing that shit to be in the house, but its really more than that. Education is the key (look what we are all doing here) and we need to start educating young people so they can make smarter decisions.

  • mac

    dude, when is your Shockwave program coming out? I’m looking for something that can strip my BF% from 22% down to around 10% while building muscle — in the shortest time possible.

    • Draugluir

      Sounds like Carb Back-Loading to me!

  • http://www.proteinpow.com/ Anna

    nice work!

  • Levi Russell

    Typical “expert”… hoping to use the fascistic power of the state to meet their goals.
    I’m glad you include more voluntary means of attaining the end you seek. Peer pressure is extremely powerful. We just need the people who actually want to help others to use it.
    However, no scientist should make policy recommendations. Nothing personal, but you guys just simply do not understand the unintended consequences of these sorts of policies (because there’s nothing in it for you). Once the state is empowered to control behavior, there is no logical end. This is truly disturbing. No thought is given to the cost of the bureaucracy that these policies create. This is why economists need to do the policy deciding, not you scientists.

    Nevertheless, thank you for the post. Healthy women are beautiful women and each of us needs to take it upon himself to help the women around him. As you allude, lasting change comes from decentralized efforts from the ground up, not bureaucratic control.

    • dhnaomi

      “However, no scientist should make policy recommendations. Nothing personal, but you guys just simply do not understand the unintended consequences of these sorts of policies (because there’s nothing in it for you).”

      And politicians have such a great track record?


      I submit that the world would be a better place if a prerequisite to public office in this technology-driven world was to hold a degree in science or engineering.

      “Once the state is empowered to control behavior, there is no logical end. This is truly disturbing.”

      What country do you live in where behavior isn’t legislated in some form? I know a few hundred Libertarians who’d love to know about it.

      • Levi Russell


        No, politicians don’t have a great track record. The problem is centralization. The problem is that they try to control far more than they will ever be capable of.

        What we need are less politicians and more markets. Markets are decentralized, voluntary means of cooperation. The more decentralized the decisions, the more sensible they tend to be. Please check out Friedrich Hayek’s essay “The Pretense of Knowledge” (his Nobel Prize Winning lecture. found here: http://www.nobelprize.org/nobel_prizes/economics/laureates/1974/hayek-lecture.html) or a shorter, more poignant essay that is similar: http://www.fee.org/articles/tgif/pretense-regulatory-knowledge/

        An understanding of physical sciences is not a good proxy for an understanding of the economic processes and hidden effects that have massive consequences.

        “What country do you live in where behavior isn’t legislated in some form? I know a few hundred Libertarians who’d love to know about it.”

        It’s not about such a place existing, it’s about determining what such a place would look like if it did and figuring out how to make the place we live look more like that. Decentralization and voluntary association are the keys. This view sprouts from an intimate understanding of the underlying economic realities we face, not an understanding of physics and chemistry.
        Besides, just because these people in fancy clothes on the east coast try to control our lives doesn’t make it right.

        • dhnaomi

          I used to work for Patri Friedman, I’m familiar with the tune you’re singing.

          Centralized control of large states is a bad idea, I agree. But massive amounts of control placed in the hands of “free” markets is not a good idea either.

          I’m short on time — the market has decided I am not a good candidate for having a home on April 1st, and I have one more day to ply the housing microniches around here to try to prove the market wrong.

          So I’m just going to cut to the chase and say I’m basically an anarcho-syndicalist who thinks changing culture is more important than rules, and that rules are just a way of influencing culture. Markets have their place, but not as replacements for central control.

          • Levi Russell

            That’s interesting that you worked for Friedman.

            It seems to me that you think what I’ve said has to do with my political views. It doesn’t. It has to do with economic theory.

            I appreciate the rest of your comments. It confirms for me the idea that anarcho syndicalists are merely statists by another name. Good luck using the “syndicate” to control culture to fit your demands.

          • dhnaomi

            *shrug* The difference between me and a REAL anarcho-syndicalist is that I’m not striving to create the syndicate. In fact I think that’s the back-assward way to go about it. You have to change culture into the environment that can support a given system. Not the other way around.

          • Jort Duijnker

            Mad respect for you Naomi. (Please pardon the
            vocabulary, I grew up in Amsterdam where we learn English by the age of seven
            from MTV and ‘Menace to Society’.. ;))

            Hard-line economic theory and ‘invisible-hand
            reasoning’ has no basis in reality. It is arm-chair theory, disjointed
            from reality yet applied to legislation, and has caused more drama for humanity
            than anything since the Black Plague.. Maybe more, the Plague never caused the
            global economy to crumble in such an unprecedented manner..

            Behavioral economics are a step in the right
            direction, but it will take a long time and Kiefer-levels of fact-based
            reasoning and reason-driven legislating to lift us from the swamp that is pure
            free-market reasoning; especially because the world is still flooded with
            delusional supporters of Keynes and others like him.

            I fully agree with your point of knowledgeable
            citizens and a strong ethics-backed culture to allow for good

            I think that government regulation is necessary
            and can be a great thing, as long as it has the right morale basis and a
            transparent support structure.

            I lived in Denmark (DK) for a while, which is
            about as socialist as a country gets before their flag turns red and we start
            to call each other comrade in one version or another. Their basic health-care
            is free, the unemployed receive some of the best support of any country I know
            of and taxes are levied progressively (highest bracket is around 55% (1)) and
            even the highest-paid jobs receive only a good-but-not-ridiculous level or
            remuneration: the average wage for a CEO in DK is ‘only’ around $700.000 (2).

            Despite (or more likely because) of all these
            facts, Denmark tops the list of happiest
            countries in the world (3), and is an amazing place to live in terms of health care,
            low crime rates, and so on (4).

            To all those out there who still think that pure free-market economics hold the
            key to a better world, better functioning society or happier life for anyone: if
            you prefer reality, then please check your facts, do your research and try to open
            up to a more facts-based, human-centric paradigm.

            1) CNBC (2010)
            ‘Countries_With_the_Highest_Income_Tax_Rates’ [online]. Available
            at: http://www.cnbc.com/id/47290212/Countries_With_the_Highest_Income_Tax_Rates?slide=9

            Highest income tax rate: 55.4%

            Average 2010 income: $64,000

            Denmark’s top marginal rate has come down from
            62.3 percent in 2008 to 55.4 percent today after the government reached a deal
            to cut taxes worth $4.8 billion in 2009 to boost the economy. But the country
            still has the world’s third-highest income tax rate.

            (2) Nina Smith, Valdemar Smith, Mette Verne,
            (2011) “The gender pay gap in top corporate jobs in Denmark: Glass
            ceilings, sticky floors or both?”, International Journal of Manpower, Vol.
            32 Iss: 2, pp.156 – 177

            (3) United Nations (2012) ‘World Happiness
            Report. Available at: http://earth.columbia.edu/sitefiles/file/Sachs%20Writing/2012/World%20Happiness%20Report.pdf

            (4) Strongman, C. (2012) ‘Copenhagen really is
            wonderful, for so many reasons’. guardian.co.uk, Saturday 7 April 2012.
            Available at: http://www.guardian.co.uk/world/2012/apr/07/copenhagen-really-wonderful-reasons

  • Mre

    calling people fat is not the answer. Claiming health is more important than people accepting themselves is wrong…..last time I checked, people in modern America live longer than any other generation of humans.

    I think health should be encouraged. and healthy thin people do live happier and more fulfilling lives…but this article sucks.

    • DHKiefer

      Thanks for taking the time to read the post critically, I appreciate all thoughtful comments.

      In the article, I never suggested calling people fat, I actually suggested that we start to recognize ourselves as fat when we are. The word stings a little – truth stings a little and sometimes it’s enough to spur us to action.

      Also, the last time I checked as well (today, actually) people in modern America actually have a lower life expectancy than previous generations, especially women (the focus of this article). You can check the updated stats and research here:


      Our self-inflicted health problems, quite simply, are killing us faster than any previous generation.

      I emphasize health and a healthy body (healthy shape, even) because the research clearly shows that not only is a healthy shape, well, healthier, but that adolescents with a healthy shape feel better about themselves and suffer less depression in adolescence and later in life. Being healthy, looking healthy and having a positive self-image are intertwined:


      I think my point should be clear: when we’re fat, we know it and we hate it, so why hide it? A lot of us are fat. If you’re fat, just look in the mirror and say it. Let’s admit it to ourselves (you don’t need to call anyone fat because they probably already know) and we can start to make changes to feel good again.

      Again, thanks for your comments. I hope you found the updated statistics and correlation of health to body image interesting, refreshing and useful.