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Brianna slipped quietly out of the house before dawn. She had lost 30 pounds by dieting, but now the weight was creeping back. She decided to try non-stop exercising for three days. Brianna wasn’t thinking about missing school or even being alone by herself on the street. She would start walking and just keep going.

Fifteen hours later, Brianna walked into a police station. Her feet ached, and her sweat-pants were covered with burrs from wandering through a park. She was exhausted, scared, and hungry.

A poor body image had led to Brianna’s eating disorder and depression. Her grand exercise plan failed, but it had one good outcome. Brianna finally got help dealing with her problem.

What You See and Feel

Body image is the way you see your body and how you feel about it. People with a healthy body image view themselves realistically and like their physical selves. People with a poor body image feel dissatisfied with their bodies, regardless of whether they are objectively healthy.

Different factors influence a teen’s body image. “Certainly the media are setting standards for how girls and boys should look, defining what is beautiful in our culture,” says Mimi Nichter. When the University of Arizona professor interviewed girls for her book, Fat Talk: What Girls and Their Parents Say About Dieting, most girls chose a “Barbie-doll” look: tall, thin, and large-breasted.

That same image pervades many ads on television and in magazines. When it comes to males, the media emphasize a tall, lean, muscular look. “People are paid to create an image or an illusion,” says Sarah Stinson, head of the eating disorders program at Fairview Red Wing Health Services in Minnesota.

Only about 2 percent of women are as thin as most models, says the National Eating Disorders Association. Models work full-time with exercise trainers, makeup artists, and others to maintain their appearance. At photo shoots, clips and weights mold clothes to flatter a model’s body. Once images are shot, computer artists take over. They airbrush pictures to remove any flaws. They can even change the shape of the bodies in the pictures. Thus, the standard media images of beauty often aren’t true to life.

Faced with such unrealistic ideals, most teens feel worse about their bodies after reading teen fashion magazines. For those who felt unaccepted or unappreciated in their social environment–up to one-third of girls in one study–the effects lasted longer, according to Eric Stice at the University of Texas at Austin.

“From my perspective,” says Stice, “this study is very damning for the mass media.” In real life, he adds, most boys think a starved waif look is ugly for girls. And most girls don’t like seeing mega-muscles on guys.

Peer pressure also influences a teen’s body image. “Teasing can be very painful,” says Nichter. “Kids seem to remember that for a very long time.”

Frequent talking about weight can wear down someone’s body image too. “I guess I started thinking I was fat at the start of high school,” says Brianna. “Girls talk about it all the time at school–who’s on diets. I would compare myself to other people, and I guess I thought I was fat.”

“The majority of young women feel insecure,” says Stinson. “What’s happening is they’re projecting those insecurities on each other, and you’re getting this very competitive environment.”

Families factor in too. When Brianna was little, her father sometimes commented on her eating a lot. Her brother sometimes called her a “fat pig.” In other families, parents may tell a boy to eat so he grows up “big and strong.” Or they may wistfully say that a daughter has “such a pretty face”–implying that the rest of her body is ugly.

Growing Pains

Young people internalize those messages. In a study by the Centers for Disease Control and Prevention (CDC), around 30 percent of students thought they were overweight. In reality, less than 14 percent of students were “at risk for becoming overweight.” (The term refers to students whose body mass index was above the 85th percentile.)

Yet the 14 percent figure is also a problem. Nearly one-third of students get little or no physical activity, reports the CDC. Higher weight and a sedentary lifestyle increase the risks for diabetes, heart disease, and other health problems. Meanwhile, young people at the higher ranges of the weight scale often feel more frustrated by the gap between what they see in the mirror and what they see in the media.

Puberty complicates things. Girls get taller and gain an average of 25 pounds. They need the added fat for breast development and to enable them to conceive and carry babies as adults.

“Young women don’t believe that they should gain fat,” says Stinson. “They’re terrified of it and don’t understand the healthy role of natural body fat in development.”

Boys get taller and more muscular as their bodies mature. That’s generally consistent with our culture’s ideal for males. But not all boys mature at the same rate. And not everyone gains muscle like the images featured in sports and fitness magazines.

When Problems Arise

When teens have a poor body image, self-esteem dips. Relationships suffer too. Conversations with friends may center on dieting and exercise, to the exclusion of other topics. Teens focus more on how they look than on what they want to accomplish in life. Instead of bonding with each other, teens often become competitive. That fuels feelings of isolation.

In the worst cases, eating disorders and other unhealthy behaviors develop. Eating disorders are more common among females than males. Yet the National Eating Disorders Association says about 10 percent of patients are male. (Besides a poor body image, other factors are often to blame. These include feelings of being out of control and, in some cases, a history of physical or sexual abuse.)

Brianna had anorexia nervosa. She did not eat enough to maintain a normal weight for her height. Besides looking very thin, she felt weak and had dizzy spells. Because girls need a certain level of body fat to menstruate, she stopped getting her period regularly. With her immune system weakened, Brianna came down with pneumonia during her sophomore year. Plus, Brianna recalls, “I lost hair. And I was cold all the time.”

In addition to these problems, anorexia can cause loss of bone density, dehydration, and downy hair on the skin. When the heart muscle weakens and blood pressure drops too low, fatal heart failure can happen. By experimenting with diet pills, Brianna added to that risk. Even “natural” weight loss products can over-stimulate the heart and cause heart attacks.

Binge eating disorder involves frequent episodes of uncontrolled eating, without regard to physical hunger or fullness. Patients suffer from guilt, shame, or disgust with their behavior. They often gain weight, which adds to any body image problems.

A person with bulimia experiences cycles of binging and purging. Even if a patient’s weight stays normal, frequent vomiting causes decaying tooth enamel, swollen glands, a sore throat, and a puffy face. If patients take laxatives, they risk damage to their digestive systems and suffer from nutrient deficiencies.

Exercise bulimia compensates for eating with excessive physical activity. In her junior year of high school, actress Jamie Lynn Sigler exercised every day for hours. Her weight dropped to 90 pounds.

“As time went on, it began to take over my life and interfere with other things that were important to me,” Jamie recalled, “like hanging out with my friends, my family, dance and theatre, and even my health.” When she began thinking about suicide, Jamie finally confided in her parents. The book Wise Girl: What I’ve Learned About Life, Love, and Loss tells the story of her recovery.

Body dysmorphia, a distorted body image, can also lead to excessive bodybuilding, especially among boys. Some also abuse steroids–drugs that unnaturally mimic the hormone testosterone to spur muscle growth. Risks of steroid abuse include possible outbreaks of violence during use and depression after cycling off the drugs, plus other physical and psychological consequences.

“When you have an eating disorder, you really don’t want to talk about it,” said Sigler. “You get very defensive. You isolate yourself a lot.” If you’re concerned about a friend, keep telling that person, “I’m here for you when you’re ready to talk about it.”

Building a Healthier Body Image

A doctor specializing in eating disorders gave Brianna a thorough check-up and prescribed medicine to help her clinical depression. Brianna also meets regularly with a psychologist, who has given her strategies to build a healthier body image.

“She had me write a list of things I like about myself,” says Brianna. “When I start comparing myself to people, I think of one of those things rather than thinking, `Oh, she looks so good and I look so bad.'” Among other things, Brianna is very intelligent. She is a hard worker. She is great at ballet. She plays the flute beautifully. And she likes her pretty blonde hair and blue eyes.

Dance class can still be a challenge, since the other advanced students are very thin. Brianna is learning to accept that people have different body shapes: ectomorphic, mesomorphic, and endomorphic. Ectomorphic people are very thin. Mesomorphic people are muscular. Endomorphic people tend to carry more fat. Many people’s bodies mix these characteristics. Thus, one part of the body may be muscular, while another part may gain fat easily.

Brianna also met with a dietitian. When she was constantly dieting, she skipped meals. By nighttime she was so hungry that she might eat half a box of cereal. Now she’s eating regular meals and including a reasonable amount of fat. She feels healthier and stronger. Now that she’s eating regular meals again, she socializes more with other students at lunchtime too.

Another helpful strategy is to change the pattern of “fat talk” among friends. Sometimes teens join in the talk as a way to fit in. Other times, “I feel fat” can be code for other feelings that young people feel uncomfortable talking about: loneliness, disappointment, anger, insecurity, and so on. If teens encourage each other to talk about what’s really bothering them, they can break the cycle of putting their bodies down. Clearer communication also frees teens to help each other deal with problems constructively.

Taking Charge

The media emphasize unrealistic standards of beauty. But, says Stinson, “You don’t have to buy into these messages.” She encourages young people to become activists: Write letters to companies praising ads that show normal teens with different body shapes and sizes. Conversely, send complaints and boycott companies that exploit young people by sexualizing them or glorifying thinness.

Don’t fall prey to the dieting industry either.

Even “natural” weight-loss pills can contain stimulants that cause serious health problems. And despite “money-back guarantees,” diet gizmos and gimmicks don’t work. If any one did work, would Americans continue to spend $40 billion a year on books, diet programs, pills, gadgets, and everything else the dieting industry produces?

You can help educate other young people about having a healthy body image. In Minnesota, teen members of Red Wing GO GIRLS! make frequent presentations to help other young people develop a positive body image. By teaching others, the teens have become role models who are very proud of their own bodies.

Your Body, Your Health

“It’s not your weight that determines your health,” says Stinson. “It’s your lifestyle.” Here are some tips for a healthy lifestyle:

* Eat a variety of foods when you’re physically hungry. Refer to the U.S. Department of Agriculture’s Food Guide Pyramid (www.nal.usda.gov: 8001/py/pmap.htm).

* Don’t forget the calcium: The Food and Drug Administration (FDA) recommends four servings of calcium-rich foods a day for teens.

* Enjoy regular physical activities. Aim for at least 30 minutes a day most days of the week. Set realistic goals for yourself, and have a good time. The more your body can do, the better you’ll feel about it.

Brianna is enjoying dance more now. She also has joined her school’s swim team and enjoys the camaraderie with her teammates. When the team members feel tired after a practice, it’s a good feeling. “As long as you’re healthy and active, and your body is doing everything it’s supposed to do, there’s nothing wrong with your body shape,” she says.

Based on her experience, Brianna adds this message to teens: “You’re OK the way you are. Think of the many great things you are–you’re like no one else. Just don’t ever try to compare yourself with anyone because it’s not worth it. You have to be yourself.”