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Narcissus the wrong way round

More common amongst youngsters, excessive concern with the body may lead to bulimia and anorexia

The stunning physical beauty of the Greek god Apollo did not guarantee him a happy love life: this mythological beau was systematically rejected by other divinities and even by ordinary mortals. Even without the implicit guarantee that harmonious forms ensure social acceptance, men and women, as soon as they learn to recognize their own image in the mirror, pursue the ideal of physical beauty of the moment – marked today by the thin waist, the slender legs and the almost skeletal body of models Gisele Bündchen and Ana Hickmann or the muscular torso à la Brad Pitt or, amongst the Brazilians, Reynaldo Gianecchini. More common amongst women, dissatisfaction with the real body – and the quest for the ideal form – is beginning to be mapped out by a team from the Hospital and Clinics of the University of São Paulo (USP).

The researchers investigated what the 700 students of both sexes from the area of health, of between 17 and 26 years old, thought about their own body. The result was that three out of every four of them disapproved of their physical appearance and bothered a lot about details, like the excess of fat around the waist, cellulitis on their bottoms or a hook nose. Carried out on students from 11 universities spread over São Paulo, Goiás, Rio de Janeiro and Minas Gerais, the study also revealed that 80% would change characteristics of their bodies to improve their looks. So far, nothing extraordinary, in an age in which hoardings flaunt plastic surgeries that can even be paid for in installments.

It would be normal, were it not for two details. First: of each ten students, nine were far from being obese – the weight of 65% of them was regarded as healthy for their age and height, and 22% were thin. Second, and more serious: 13% of the interviewees stated that they provoked vomiting, took laxatives, or used diuretics after eating, with the objective of not putting on weight.

Although they do not allow a final diagnosis, these findings indicate that these people run a serious risk of developing a serious eating disorder: bulimia nervosa, the uncontrollable ingestion of food in excess, followed by an attempt to get rid of the excess of food. “We were expecting to find a much lower level of signs of bulimia in this group, theoretically made up of people who know how to look after their own health and who run a lower risk of developing eating disorders”, explains psychologist Mara Cristina Souza de Lucia, the coordinator of the study, which is part of the Eating Disorders and Obesity project of the Hospital and Clinics, which for six years has been investigating the relationship people have with eating and their self-image. “If it’s like this in the area of health, it may be even worse amongst then young students from other areas.”

From bulimia to depression
It is not known for sure how many sufferers from bulimia there are today in the country. But it is calculated that 2.4% of adult women – and a portion eight times smaller of men, a mere 0.3% – develop bulimia in the course of their lives, according to the study by Laura Andrade, Valentim Gentil and Ruy Laurenti, all from USP, published in 2002 in Social Psychiatry and Psychiatric Epidemiology. “It is difficult to get to know the nationwide prevalence of this disorder, because there are distinct microcosms in the different Brazilian regions”, says Táki Cordás, from USP’s Psychiatry Institute. “As it can be unleashed or sustained by social and cultural factors, bulimia appears with different frequencies in the different populations”, says the psychiatrist, who coordinates the Bulimia and Eating Disorders Outpatients Department (Ambulim), the largest center for studying and treating eating disorders in Latin America.

Although it is higher amongst adolescents and young adults, arising around the age of 15, dissatisfaction with the body is also common amongst more mature people. In an early survey, published in 2003, Mara Cristina’s team assessed 346 persons from different regions of the state of São Paulo, with the objective of identifying symptoms of dissatisfaction with the body and the losses that this molestation was causing. All the participants – half men and half women – were healthy and were between 18 and 74 years old. The conclusion, though, was not very different from the previous work: although the major part had their weight within acceptable limits, 80% of the women were bothered with some part of their body, a complaint shared by 57% of the men. For a little over half of these people, worrying over their appearance generates frustration, anxiety and depression.

There is also a social loss. Almost one in five of the interviewees said that they missed out on social events, arrived late at work, or failed to turn up to classes, for feeling not very attractive. A similar portion said that their appearance was causing problems at work or in their relationships. The arsenal of methods for controlling weight has been including, in recent years, frenetic physical activity, going so far as to cause social and psychiatric damages, as is demonstrated in the study Sheila Assumpção, Táki Cordás and Luiz Armando Araújo, published in the Revista de Psiquiatria Clínica [Clinical Psychiatry Magazine]. The researchers assessed 47 adults of both sexes, who had joined the Ambulim to treat eating disorders. About 34% of the volunteers exaggerated in their exercises and would spend over two hours a day at the fitness center.

Far from the days when it was flaunted with astonishment – and even credited to problems with an unfaithful husband, as in the case of Lady Di, the Princess of Wales, who died in 1997 in a car accident in Paris -, bulimia seems to be diagnosed today with greater frequency in the doctor’s office. “There are indications that eating disorders associated with dissatisfaction with the body are growing, not only in Brazil, but also in the whole world”, says Cordás. A record of how naturally people, in particular teenagers, provoke vomiting after feeding themselves in excess appears in the prizewinning film Elephant, by filmmaker Gus Van Sant, the winner of the Palme d’Or of 2003 in Cannes. In one of the scenes from the film, about violence in day to day life at a middle class American school, girls stuff themselves with hamburgers and French fries in the school canteen, and as soon as they become aware of the fact, run to the toilets in an attempt to avoid the consequences of the abuse.

Sparked off by a concurrence of four factors – genetic, social, cultural and psychological -, this eating disorder probably has an organic origin, in the malfunctioning of areas of the brain related to the mental image that each person has of himself, not yet mapped by psychiatrists and neurologists. In a way that is also not completely understood, eating disorders like bulimia and anorexia nervosa – the latter rarer than the first, and characterized by a kind of aversion to food, for fear of getting fat – appear to be associated with dissatisfaction with one’s body, fed in the last century by continuous exposure to the standards of beauty stamped over the newspapers, magazines and television programs, or even in adverts for medicines and cosmetics.

In the first half of this year, the exhibition “The Price of Seduction” displayed at Itaú Cultural, in São Paulo, the varied forms of sacrifice to which women have resorted in the course of the 20th century, in order to fit the standard of beauty of each decade. Used about a hundred years ago to leave the feminine silhouette S-shaped, the corset, a belt of cloth that went from the hips to the bust and would so squeeze the waist as to cause a lack of air, recently gave way to esthetic plastic surgeries, which sculpt the body with a scalpel and silicone implants, or by the removal of localized fat.

Beauty on sale
The yearning for the ideal physique, today far less plump than the bodies of the muses of the painters and sculptors of the Renaissance, continues to be widely broadcast by the means of communication. There are no surveys in the country on the number of publications focused on the cult of the body, but you only need to pay a visit to the nearest newsstand to notice the predominance of magazines and books on diets, physical fitness and plastic surgeries. Just in the first half of this year, the main weekly general interest magazines dedicated several cover stories to the transforming potential of the operations that remodel the body.

Behind the cult of the well-defined shape, whether it is sculpted with diets based on medicines and plenty of workouts, or by scalpels in operating theaters, there is a whole complex network of profits capable of turning over billions a year. It involves, in several degrees, everything from the means of communication and the fitness centers to the pharmaceutical industry, the clinics and the doctors specialized in esthetic plastic surgeries. After all, never have so many had so much access to resources for molding their bodies as they see fit, under such attractive conditions, in some cases with payment in installments.

Data from the Brazilian Plastic Surgery Society (SBCP) indicates that every year some 500,000 persons submit themselves to plastic surgeries in Brazil, in a sort of Narcissus the wrong way round, in which, instead of adoring the body they have, they see only the defects in it. The country loses only to the United States, the leader in the number of esthetic surgeries. According to Osvaldo Saldanha, the SBCP’s secretary-general, the estimate is for the number of surgeries to increase 20% to 30% a year – or five times more, in the last five years, when it is a question of silicone implants in the breasts. In the United States, the American Society of Plastic Surgeons (ASPC) recorded 400,000 esthetic surgeries in the country in 1992. Ten years later, this figure had leapt up to 6.6 million – an astronomic growth of 1,600%, or of 16 times.

Putting in silicone to increase the volume of the breasts, the buttocks, or the calves. Extracting, by means of liposuction, unwanted fatty bits from the waist or from the plumper thighs. Erasing from the face the lines of the years lived. After all, sculpting one’s own body, giving it the contours dreamt of, has now become a subject for popular prime time television programs. In the second week of July, a popular program in the second most important TV network in Brazil exposed women, live, on the surgery table, while doctors talked about the benefits of these operations. But this is not a merely Brazilian phenomenon. On the traditional American network ABC, since the end of 2002, the program “Extreme Makeover” has been showing the transformation of people who were previously not very glamorous into sculptural gods – without depriving themselves of displaying the period following the operation, full of swelling, bruises and complaints of pain.

In the opinion of Cordás, the influence of the media outlets on the discontent with one’s own body and the desire to mend little defects is incontestable. But the precise mechanisms of how the media stimulate behavior that leads to eating disorders have not yet been defined. In a study published in 2003 in Eating Behavior, the team coordinated by Marleen Williams, from Brigham Young University, in the United States, interviewed 28 women, in an attempt to understand the influence of the mass media on the development of anorexia, and proposed the following model: sparked off by preexisting vulnerabilities, a cyclical process starts in which the eating disorders lead to the quest for controlling weight. Tortured by disagreeable thoughts, the person seeks information in the means of communication to solve the problem, and finds in them the illusion of controlling the situation. But the incapacity for solving the real problem generates sentiments of guilt and shame, which feed again the expectation of losing weight.

In an earlier survey, published in 2002 in the British Journal of Psychiatry, the team of Anne Becker, from the Harvard Medical School, United States, analyzed how television interferes with the eating habits of adolescents. They discovered the ideal environment for this study in the Fiji Islands, where the first television channels appeared in 1995, bringing western habits to this community in the East. Divided into two stages, the work investigated, among other aspects, the practice of dieting amongst girls from the community – they were about 16 years old at the time of the surveys – with the objective of slimming. Practically nonexistent before 1995, diets were being followed, three years after the introduction of television in the archipelago, by seven out of every ten adolescents who took part in the research – the major part of them regarded as healthy for their age and height.

“The quest for the body idealized by fashion can have a sense of protection, it may be a form of seeking love and acceptance”, says psychologist Niraldo de Oliveira Santos, from the team of the Hospital and Clinics. “The belief is that the eye of the other is only going to appreciate us if we are meeting the specifications of the moment”, he comments. The problem is that not even Apollo managed this, perhaps because love is not intrinsically related to the measurements of a Miss Universe.

The Project
Physical exercise and its relationship with eating disorders: a syndrome or a symptom? (98/10876-9); Modality: Regular Line of Research Grants (FAPESP); Coordinator: Táki Athanássios Cordás – Psychiatry Institute (USP); Investment: R$ 8,838.13