What is spreading is dieting. Not just not eating enough (that has gone on since time began), but not eating enough when there is food available. And that does something to the brain of certain people – a small minority of people. It creates a self-perpetuating cycle of malnutrition.

Body image dissatisfaction is a different issue. At different times we’ve been convinced that tiny feet, or alabaster skin, or being rotund were the standards of beauty. The difference is that when the dissatisfaction that leads you to diet – even a little – you can set into motion biochemical reactions that cannot be stopped by force of will.

Yes, we must fight the ridiculous and damaging beauty images out there – for all of our sakes. But the relationship between this and eating disorder – a brain disease – is not so connected as it seems intuitively. And certainly it does little good in treatment to concentrate on helping someone with their body image. A person can be nearly emaciated or constantly purging and still think they are “too fat.”

Treatment requires healing the body with nutrition, thereby healing the brain so it can think rationally again. That’s when talking about body image is helpful.