A Case Example

Women's Health |

Lisa is a 34-year-old teacher seeking treatment for Binge Eating Disorder. She weighs 225 pounds. Lisa’s predisposition to obesity appears to be inherited, both genetically and from an environment where family gatherings and expressions of love revolve around food. As a child, her parents rewarded Lisa with food. As an adult, she continues to reward herself at the end of each pay period by dining at an all-you-can-eat buffet.

Our culture further contributes to Lisa’s belief that she can control the shape of her body and, if she cannot, she will not be able to do certain things. Thus, Lisa thinks she cannot have a relationship until she loses weight. Though she loves clothes, Lisa refuses to buy them above a certain size. She believes that she must wait until she loses weight before buying new clothes. Furthermore, Lisa has fallen into the habit of blaming her weight for the unhappiness in her life. Finally, Lisa is in the habit of making disparaging remarks to herself and believes that these comments will help motivate her to lose weight.

Part of Lisa’s treatment includes cognitive restructuring of poor body image thoughts. Although Lisa worked with a therapist, this exercise can be done at home using the form provided below. We have also provided an example of Lisa’s form for your reference.
Print blank copy of worksheet

In the first column, identify situations or triggers that led up to an unpleasant thought(s). For example, Lisa writes “Look at models in fashion magazines.” Write in the second column your automatic thoughts associated with the event. In this column, Lisa wrote, “I’m worthless. I’m horrible. I’m fat and will always be fat. Look at these cottage cheese thighs!” Column three will help you examine these thoughts by describing the evidence for and against these negative thoughts. Column four will help you examine the advantages and disadvantages of continuing to think this way. Look at Lisa’s responses in these columns to help guide you in your responses.

The final column should include restructured thoughts, or alternative self-talk statements to replace the negative thought. You may ask yourself, “Is there any other way to look at this?” or “What would I tell a friend in this situation?” It is important to begin with restructured statements that are neutral or not exaggerated or too positive. Another strategy is to change negative comments about one’s visual appearance to the important functions of one’s body. For instance, replace “Look at my cottage cheese thighs,” with “These legs allow me to enjoy a walk along the beach.” A final strategy is to replace one’s negative thoughts about global, uncontrollable goals with credit for concrete, achievable goals. Replace “I haven’t been able to lose 25 pounds,” with “I’ve eaten three well-balanced meals today.”


Poor body image can affect men and women of all sizes and shapes. The thoughts. feelings, perceptions, and behaviors we have about our body size and shape are what make up our body image. Treatment for negative body image is important. Negative body image is associated with decreased quality of life, low self-esteem, depression, social difficulties, self-consciousness, sexual difficulties, eating disturbances, and can be a risk factor for more serious problems . Including techniques to improve body image in weight management programs is critical because losing weight does not insure improvement in body image. We have discussed a cognitive technique to address negative body image. Cognitive restructuring of thoughts associated with body dissatisfaction helps improve all three dimensions of body image, and thus, improves body satisfaction and overall quality of life.