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News & Research

Understanding EDs

Treatment & Recovery

Body Image

Food & Fitness

(Diet) Culture & Society

The information in this article originally appeared in an Equip Academy presentation, presented by Cara Bohon and 

 to learn about other eating disorder-related topics and earn free CE credits.

Eating disorders often involve body image concerns. Addressing these concerns is an important part of treatment, as it helps protect patients against relapse and set them up for lasting recovery. One way to do this may be to challenge harmful appearance ideals, which are often a major contributing factor to body image distress—and research suggests that cognitive dissonance theory may be a particularly effective tool for dismantling deeply ingrained appearance ideals.

Here, we’ll evaluate the origins of appearance ideals and body image pressures; examine cognitive dissonance-based body image programs and the theory behind them; and explore how to incorporate specific cognitive dissonance-based approaches to decrease body image concerns.

Body image is something we all have. In the simplest terms, body image is a person’s experience in their body. This includes their:

We often talk about “good” or “bad” body image, but it’s more nuanced than that. Body image concepts exist on a spectrum.

The concepts of “body judgment” and “body dissatisfaction” fall under the umbrella of negative body image.

, a drive for thinness, a distorted view of one’s self, body comparison, and a strong belief in appearance ideals.

Someone with a negative body image may say things like “If I looked like x, my life would be perfect,” or “I wish I was toned like you.”


The concepts of “body neutrality” and “body trust” fall under the umbrella of neutral body image.

This might show up as focusing on body function or qualities versus appearance, neutral statements about one’s body, and self-compassion.

Someone with a neutral body image may say things like, “My body is the least interesting thing about me.”

The concepts of “radical self-love” and “body liberation” fall under the umbrella of positive body image.

This might show up as body activism, challenging appearance ideals, loving every single cell, body joy, and body positivity.

Someone with a positive body image may believe strongly in these words from author and activist Sonya Renee Taylor: “Making peace with your body is your mighty act of revolution. It is your contribution to a changed planet where we might all live unapologetically in the bodies we have.”

There are a number of different appearance ideals that can inform (and often harm) someone’s body image. It’s also important to recognize that not all of us experience the same appearance ideals, as some may be more dominant than others. Race, ethnicity, socioeconomic status, disabilities, and gender identity can all influence what we are told is “ideal”.

When you think of the “perfect” girl or woman, how would you describe her?

Though answers may vary, people often respond with words like “slender,” “pretty,” “cute,” or “graceful.” We call this “look” the “feminine ideal.” It’s sometimes called the “thin ideal” because of the emphasis on overall thinness as one of the most important factors that represents femininity.

When you think of the “perfect” boy or man, how would you describe him?

Though answers may vary, people often respond with words like “strong,” “toned,” “muscular,” “lean,” or “handsome.” This is sometimes called the “muscular ideal” because of the emphasis on overall muscularity as one of the most important factors that represents masculinity.

When you think of the “perfect” non-binary person, how would you describe them?

Though answers may vary, this is sometimes called the “androgynous ideal” because of the emphasis on overall androgyny as one of the most important factors that represents being non-binary.

You might rightly wonder, where do these appearance ideals come from? It’s complex.

We have to think about these appearance ideals in the context of various systems of oppression designed to limit who has access in our society. Some of the factors that inform and shape appearance ideals include:

Appearance ideals have deep, historical roots. The ideals have changed throughout history based on what will keep institutions, businesses, and privileged individuals profiting and in power. Even as they change, they continue to stay narrow, restrictive, and unobtainable for pretty much everyone. Currently, the appearance ideals are 

shifting back to the “thin aesthetic” from the early 2000s

, with an emphasis on thin and flat stomachs.

Appearance ideals show up in our lives in many ways, including:

Comments from family, friends, colleagues, etc.

How we view, talk about, and treat ourselves

Ill-informed diagnostic criteria, biased doctors

Wellness or “lifestyle change” programs

The pursuit of appearance ideals has a significant negative impact, both on an individual and a societal level.

According to Deloitte, appearance-based discrimination (defined as the unjust, prejudicial treatment of somebody purely based on their appearance) has a high cost. Their data shows that in a given year:

Appearance-based discrimination (defined as the unjust, prejudicial treatment of somebody purely based on their appearance) leads to $269 billion in financial costs and $233 billion in lost well-being

Weight discrimination affected 34 million people and cost $206 billion

Skin shade discrimination affected 27 million people in the Black community and cost $63 billion

Natural hair discrimination affected 5 million people in the Black community

Body dissatisfaction (defined as having a severe and persistent negative attitude toward one’s own physical appearance, which has been caused by harmful beauty ideals) led to $84 billion in financial costs and $221 billion in lost well-being

Diet culture thrives on body image concerns, which are fueled by appearance ideals. In our diet culture-informed society, body image distress is extremely common among all populations.

41% of men think they are “too heavy” and are self-conscious about weight

60% of women think they are “too heavy” and are self-conscious about weight

80% of young teenage girls report fears of becoming fat

82% of adults believe weight loss is their responsibility

95% of people who diet regain weight they lost within 5 years

$71 billion spent on dieting and weight loss in 2020

Not all people who struggle with body image will develop an eating disorder, but a significant subset will, and body image distress is often a contributing factor to (and symptom of) an eating disorder. In this year alone, 5.5 million people living in the United States will develop an eating disorder, and only 20% of them will receive treatment; an even smaller fraction will get evidence-based care that works.

Body image concerns, intense pressure to fit the appearance ideals, and the harsh reality of how many people will experience an eating disorder in their lifetime left researchers wondering: What if we could decrease negative body image concerns and prevent eating disorders from developing in the first place?

How appearance ideals can lead to an eating disorder

Eating disorders emerge out of a confluence of different genetic, biological, environmental, social, and other factors. Some common traits that predict the onset of an eating disorder are:

As researchers explored the emergence of eating disorder traits, a theory developed. Thin-ideal internalization (coupled with sociocultural pressure) starts the cascade effect contributing to body dissatisfaction, then dieting and negative affect, ultimately leading to eating disorder symptoms.

They wondered: If we could reduce thin-ideal internalization first, would the other risk factors decrease too?

Research shows that education-based prevention programs are not very effective in creating attitudinal and behavioral change. The theory was put forth that cognitive dissonance could be effective in creating shifts in both beliefs and behaviors.

Learning information can feel good and helpful at first, but there is a difference between educating and empowering people to change. Research shows that disclaimers and warnings on photoshopped pictures or ads are unsuccessful at mitigating the body image distress created by unrealistic images in the first place. We often want to wait for our thoughts or emotions to change first before we alter our behaviors, but experiencing dissonance can actually empower us to act now.

Cognitive dissonance theory rests on the notion that as humans, we want to maintain consistency between our beliefs, values, and actions. When there’s a conflict between our beliefs and actions, we experience dissonance: mental distress like frustration, guilt, shame, discomfort, anxiety, etc. Dissonance is uncomfortable, so we seek out ways to reduce the conflict and return to a state of consistency. We might do this in one of a few different ways:

add in more affirming beliefs to override the conflicting belief/behavior

attempt to decrease the importance of the conflicting belief/behavior

 change and adapt toward the new belief or behaviors

Consider this example: Drew, an eco activist, bought their dream car: a Chevy truck with a diesel engine—and their sister just showed them a graph of how high diesel emissions are and says Drew’s car is awful. To reduce cognitive dissonance, Drew could:

by going to chevysRthebest.com and reading how Chevy trucks aren’t bad for the environment because they R the best.

: by saying their car might not be the best for the environment, but Drew recycles and takes short showers so it all works out fine for their carbon footprint (and their car still totally rocks).

: by turning their car into a dealership and leaving with an eco-friendly truck, realizing their diesel Chevy wasn’t the best car for them because they care about their environmental impact.

It’s important to note that the amount of dissonance that you experience can be influenced by how highly you value a belief or the degree to which your beliefs are inconsistent. For instance, Drew might experience decreased dissonance if his best friend Betty, who died last year, also loved driving a diesel Chevy truck and they bonded over that belief, making this a deeply held value for Drew. On the other hand, his dissonance might increase if this was the eighth time Drew heard new information on why diesel Chevys aren’t the best cars, so they had a larger drive to change cars.

The Body Project: using cognitive dissonance to challenge appearance ideals

Dr. Eric Stice and team developed the dissonance-based eating disorder prevention program The Body Project. The Body Project includes verbal, written, and behavioral exercises designed to position girls to argue against the appearance ideals, as well as discussion-based groups with Socratic questions to highlight costs of pursuing the thin ideal for girls. It was the first prevention program to reduce eating disorder symptoms, and Initial trials showed reduced risk factors and eating disorder symptoms over a short period follow-up.

After many years of research and multiple iterations, large efficacy trials revealed The Body Project as the most effective compared to seven other credible interventions in reducing eating disorder symptoms, including thin internalization. Many research teams have replicated these results across languages, countries, and program audience adaptations: The PRIDE Body Project, More Than Muscles, The EVERYbody Project, etc.

The “high dissonance” version of the project showed greater reductions in risk factors and eating disorder symptoms, leading to new program updates, like increased voluntariness of participation, public accountability, and difficulty of exercises. The three- to four-hour intervention produced significant reductions in symptoms that remained three and four years after the intervention was completed. Additionally, fMRI imaging revealed The Body Project participants had decreased activation in reward response (Caudate) when shown thin models compared to the control group.

Applying cognitive dissonance theory in practice

There are a number of different strategies you can employ to apply the learnings of this research with your own patients.

Fildes, Alison et al. “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” 

Frederick, David A et al. “The swimsuit issue: Correlates of body image in a sample of 52,677 heterosexual adults.” 

Kearney-Cook, Ann et al. “Body Image Disturbance and the Development of Eating Disorders.” In The Wiley Handbook of Eating Disorders (eds L. Smolak and M.P. Levine). 

https://doi.org/10.1002/9781118574089.ch22

Pearl, Rebecca L et al. “Prevalence and correlates of weight bias internalization in weight management: A multinational study.” SSM - population health vol. 13 100755. 17 Feb. 2021, 

How Cognitive Dissonance Can Challenge Appearance Ideals in Eating Disorder Patients 

We started Equip with a simple but bold vision: to transform the broken system that leaves too many people without the care they deserve, and ensure that everyone struggling with an eating disorder has access to evidence-based treatment. Today, we are thrilled to announce that Kerry Washington has joined our journey as an advisor and investor in Equip.

There isn’t a better time to announce her investment than during this year’s Eating Disorder Awareness Week, which is dedicated to shedding light on the realities of eating disorders, challenging misconceptions, and advocating for more access to treatment.

Kerry is more than an award-winning actress, producer, and director. She is a fierce advocate for social justice and mental health who has used her voice and platform for years to elevate underrepresented communities and push for meaningful change. When we first met with Kerry, we immediately saw how deeply aligned her values are with Equip’s mission.

Like us, Kerry believes that eating disorders don’t discriminate—but, unfortunately, access to treatment often does. With Kerry’s partnership, we are doubling down on our commitment to reaching those needing virtual, evidence-based care.

Kerry’s involvement is more than just an investment; it’s a partnership built on shared values and a bias toward action. We will continue to work tirelessly to:

Expand our reach so that more people can access life-saving treatment, no matter where they live.

Destigmatize eating disorders and change the conversation about who they affect and who needs treatment.

At Equip, we believe full recovery is possible and that everyone deserves the chance to heal. With Kerry on our team, we are even more confident in our ability to make that vision a reality. This is just the beginning, and we couldn’t be more excited about what’s to come.

Equip Update: Kerry Washington Invests in Equip to Expand Access to Eating Disorder Care

Eating disorders are one of the most complex mental health diagnoses, so it makes sense that coming up with a consistent definition of recovery is equally tricky. Equip’s newest research—featuring nearly 500 people either in recovery from or seeking treatment for an eating disorder—sheds light on the intricacies of the recovery process and what recovery means to different people. Below we’ll unpack some key learnings and insights, touching on the treatment experience, 

, individual definitions of recovery, and more.

Defining recovery: a spectrum of experiences

Eating disorder recovery remains a deeply personal and evolving concept. But when we asked survey respondents what recovery meant to them, certain themes emerged. Most said that recovery means, among other things:

Developing a positive relationship with food and body

However, respondents also reported that challenges can persist even into recovery, and that they sometimes don’t feel “fully” recovered. Among this subset, 93% said they still struggled with disordered behaviors, 89% said they still had 

, and 92% said they still have a challenging relationship with food.

Below are some excerpts from an open-response question that asked respondents to define recovery.

“I define recovery as existing without a constant cloud over my head. I know the thoughts will always be there, but recovery to me is making that voice as tiny and as far away as possible, being drowned out by better, healthier, more positive thoughts.” -30-39 year-old pansexual woman

“Recovery, I hope, will be one through which I can take my life back and live not crippled by food and body image preoccupations, fostering health in both my body and my mind through good eating habits and self-care. I also do hope to develop self-compassion, build meaningful connections with people, and 

live a full and purpose-driven life filled with joy

“I will feel fully recovered when my eating habits and routine no longer involve the so-called ‘binge/purge’ process. I still experience these encounters less than before. When I can go sustained periods of time—months/years—then I will feel confident of recovery” -40-49 year-old bisexual man

We also asked people about their motivation for seeking treatment and what treatment they sought. Encouragingly, 64% of respondents cited desire for recovery as a motivating factor, which is contrary to the widespread idea that people with eating disorders don’t want to get better. Other motivating factors were mental health concerns (69%), and physical health risks (65%).

 was the most common treatment setting (67%), followed by inpatient care. Notably, treatment satisfaction was higher among those with strong support networks and access to 

. The most important aspects of treatment that came up again and again were:

: Therapists, dietitians, and psychiatrists were key members of treatment teams, with many respondents citing their empathy and personalized approaches as pivotal.

Nearly half (46%) of those discharged from treatment cited peer support and family involvement as aids in recovery, but the treatment team was the top contributor (78%).

: Coping strategies, such as challenging negative thoughts and developing resilience, played a critical role in progress.

Our research highlights widespread concerns about relapse, with 88% fearing it and 51% having relapsed multiple times. Stress, societal pressures, and co-occurring mental health issues are common triggers.

Among those currently in treatment, 40% worry about post-discharge relapse, citing stress, body image struggles, and past relapses. While most (78%) respondents had a positive treatment experience, the high relapse concerns emphasize that recovery isn’t linear—and that treatment must include 

relapse planning to support lasting recovery

Every relapse is different, but some patterns emerged among respondents.

: Most relapses occurred within two to six months of discharging from treatment.

: Marginalized groups, including LGBTQ+ and racial minorities, reported higher vulnerability to relapse due to systemic inequities and lack of affirming care.

While men and women share similar relapse rates, women more frequently report disordered thoughts, mental health, stress, and social media as a concern.

Body image concerns were more frequently mentioned by younger respondents (18–29 years) across all genders.

“Looking at myself in the mirror or in unflattering photos makes me feel like completely relapsing. Plus, food costs cause me to think that eating is optional.” -18-29 y/o queer man

“When I feel overwhelmed by stress, loneliness, or sadness, I notice those feelings can make me more vulnerable to old patterns. It's hard to resist the urge to cope in unhealthy ways during those moments.” -30-39 y/o Black woman

“It feels unavoidable. A lot of the social media content I interact with serves as a huge trigger because they are all so thin and beautiful. Even the thought of shopping can trigger a relapse since I have to see how my sizes fluctuate (even though I know sizing isn't standard—at all).” - 18-29 y/o Asian woman

Our study highlighted disparities in treatment experiences among marginalized populations, like LGBTQIA+ individuals and racial minorities:

Stigma and lack of gender-affirming care were significant barriers to treatment, and family support emerged as a critical factor for recovery. Nearly half (44%) of survey respondents identified as LGBTQIA+, highlighting the disproportionate impact that eating disorders have on this community.

Black respondents were more likely to rely on intensive treatment, and reported positive outcomes linked to family involvement and community-based support.

BIPOC individuals were twice as likely to cite pressure to recover fast and unrealistic goals as a barrier to treatment progress compared to white individuals (10% vs. 5%).

of LGBTQIA+ youth have an eating disorder, and that BIPOC individuals are 

 to be diagnosed or receive treatment, there’s work to be done in supporting these communities better in treatment. Learn more about eating disorders in 

The path to eating disorders recovery is challenging, but recovery is both possible and worth it for everyone affected by an eating disorder. The perspectives shared in our survey reveal these challenges, as well as the resilience and hope within so many people struggling.

Sustainable recovery for everyone requires:

: Affordable, evidence-based treatments tailored to individual needs.

: Peer networks and family involvement are crucial for lasting change.

: Treatment that addresses mental, physical, and emotional health, as well as co-occurring conditions, is essential.

This research is a powerful reminder of the ongoing work needed to support those on their recovery journeys. By amplifying diverse voices and addressing systemic barriers, we can build a future where it’s possible for everyone to not only achieve recovery, but maintain it long-term as well.

Learn more about accessible, evidence-based eating disorder treatment at Equip

What Does It Mean to Recover? Insights from Recent Equip Research

When we think about eating disorders, we often picture young people: adolescents, teens, and young adults struggling with body image and disordered eating behaviors. But, as Equip’s recent survey makes clear, eating disorders and body image issues don’t disappear as we age: they affect people at every stage of life, including older adults.

In fact, hormonal shifts during menopause and andropause—key life transitions that typically occur after age 40—can play a significant role in triggering or intensifying 

 typically begins around age 40, when estrogen levels drop by about 60%, and progesterone production ceases almost entirely. The rapid decrease in these hormones can trigger a variety of symptoms, including mood swings, weight gain, and hot flashes, all of which can have an effect on eating behaviors and body image.

Men also experience their own version of hormonal changes, known as andropause. Starting around age 25, testosterone levels decrease by about 1% annually, and then begin to decrease more rapidly in middle age. Symptoms of andropause include lower energy, depression, increased belly fat, muscle loss, a decrease in libido, and more emotional reactivity, which can have their own impact on body image and eating habits.

These hormonal shifts, along with other life challenges that show up in older adulthood, can contribute to disordered eating, body image struggles, and diagnosable eating disorders. Our recent survey of over 1,000 people aged 40+ highlights this reality, showing that eating disorders are not just a youth issue—they are a lifelong struggle that needs greater attention, especially as we age.

Key findings: eating disorders and body image struggles in midlife

Equip’s survey reveals that eating disorders and concerns over body image are not confined to younger individuals. The survey shows that hormonal changes, particularly those experienced during menopause and andropause, contribute to eating behaviors and body dissatisfaction in midlife and beyond. Here’s what we learned:

 aged 40+ are dissatisfied with their bodies. Among them, 

 reported that they often judge their worth based on their weight, indicating how body image struggles persist throughout life.

Eating and appearance concerns take an emotional toll

More than half of respondents admitted feeling 

 because of its effect on their weight or appearance. This widespread guilt suggests a deeper psychological burden, often intensified by the hormonal changes that occur during midlife.

 stated they think about body image more frequently in midlife compared to their younger years, feeling even greater pressure to control their weight.

Disordered eating behaviors can begin in midlife

 reported picking up disordered eating behaviors—such as meal skipping, 

, or restrictive dieting—for the first time in midlife (ages 36-65). Many attributed these behaviors to feelings of loss of control over their bodies, particularly during hormonal shifts like menopause.

The role of hormonal shifts: menopause and andropause

Hormonal changes during menopause and andropause often have a profound impact on eating behaviors and body image. These shifts can cause weight gain, emotional instability, and body dissatisfaction, all of which can trigger or exacerbate 

 reported negative changes in how they felt about their bodies. Many women noted that weight gain, mood swings, and feelings of losing control over their appearance led them to engage in disordered eating behaviors, such as 

While much of the conversation around body image focuses on women, our survey also found that 

 felt worse about their bodies as they aged. Symptoms of andropause—such as increased belly fat, muscle loss, and decreased energy—can exacerbate body dissatisfaction. Among our respondents, 

 met the clinical threshold for andropause, but only 

 with the condition, indicating a significant gap in awareness and treatment.

Diet culture can make it hard to seek support

Our findings made it clear that the effects of 

 don’t go away once people age out of teenage or young adulthood: societal pressures continue to shape eating habits, particularly for women in menopause. Among our sample, 

 in menopause reported that they were actively managing their weight, often engaging in disordered behaviors such as dieting or meal skipping to meet unrealistic beauty standards.

The good news is that most survey respondents believe that people of any age can seek mental health support: 

 agreed that it’s never too late to seek treatment for disordered eating behaviors. This statistic highlights an opportunity to address this issue with more targeted care and support.

The survey results are powerful, but the real-life experiences shared by respondents add a personal dimension to the data. These voices illustrate the emotional and psychological toll that eating disorders and body image issues can take in midlife and beyond:

“I absolutely feel more constrained by societal expectations to control both my weight and the overall look of my body than when I was younger. It’s harder to reach that ideal as I get older. It’s harder for me to get the exercise and well-balanced diet that society expects me to have now than it was just a few years ago.” - 40-45-year old male

“The same disgust about my body has returned, but now I have a reason to be. When I had anorexia as a teen and young adult, I was actually very thin/underweight. My current mental health issues have affected my body image. I’ve started restricting my food intake.” - 57-61-year-old female