By: Heather Connor, LISW-S

At times it can feel like it’s impossible to have a positive relationship with our body image. We are inundated with ads that encourage us to lose weight via this supplement or that diet/wellness program, guaranteed to give you results. Diet Culture is a multibillion-dollar industry and it’s been around for generations. However, a fact to consider is that diets do not work. In a large-scale 2015 study of 278,000 people, it showed within 5 years, 95-98% regained all the lost weight (or more) (Fildes et al, 2015). Diets are designed to fail and instead of taking responsibility for that failure, they turn the blame onto the dieter. The reality too, is that even when the weight is lost, most of us still don’t feel confident in our bodies. Fatphobia is a driving force for the diet culture industry. The more afraid we are of fat bodies, the more we subscribe and pay into the thin ideal. Fatphobia is woven into the fabric of our culture, and it’s become so commonplace, we may not even notice when it’s present. For years we have rarely seen fat bodies on television or in ads and when we do, these characters are shown as the butt of the joke, the silly friend, or the lazy one who is always eating but almost never the main character or the one who finds love. We live in a world in which certain seats or devices do not accommodate larger bodies. We have until very recently, forced those in larger bodies to shop at specialty stores or online for clothes that can accommodate their size.


It’s become commonplace to gab to our friends about which “program” we are trying this week and we might even find community in joining along. We regularly talk negatively about our bodies or praise others for looking “great” after some noticeable weight loss without stopping to consider how this weight loss was achieved. We make unprovoked comments about other people’s bodies and children and even adults are often bullied relentlessly if they exist in a larger body. And with each time we make these comments we reinforce the narrative again and again that fat is bad and thin is the goal.

And it’s not just our culture that contributes to our unhappiness with our bodies. With our healthcare system waging war on obesity, it’s no surprise that many of us will search out any means to lose weight in the name of health. The BMI continues to be used to determine who is at risk even though BMI only accounts for our height and weight and no other measurement of health. While thin is often promoted at “healthy” for a large portion of the population, working tirelessly to achieve this goal, is anything but health-promoting. If we consider the steps we often take to achieve the thin ideal, we have to acknowledge that most of these involve hurting our bodies. These include everything from denying ourselves basic needs like nutrition to invasive surgeries, all in the name of health. Not to mention the shame and ridicule we often experience not only from others but from our own internal dialogue as well.

“While it is well established that obesity is associated with increased risk for many diseases, causation is less well-established. Epidemiological studies rarely acknowledge factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status when considering connections between weight and disease. Yet all play a role in determining health risk. When studies do control for these factors, increased risk of disease disappears or is significantly reduced.” (Bacon & Aphramor, 2011) In other words, living in a larger body does not automatically mean that one is “unhealthy”.

While we are on the topic of health, let’s also consider that dieting is a major risk factor for the development of eating disorders. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports that 9% of the US population will develop an eating disorder in their lifetime and only 6% of those who are diagnosed are considered “underweight”. Eating disorders also have the highest mortality rate of all other mental health disorders, 2nd only to opioid overdoses and this is true for people, regardless of their size.

As a result of these experiences, we all have certain internalized biases surrounding weight which also contribute to our body image. We might make assumptions of someone’s health, intelligence, willpower, or overall lifestyle based solely on their body shape and size. The reality is however that we cannot determine any of these above traits just by looking at someone.

So if we can accept that all bodies are not meant to be thin and thinness does not equal health, then perhaps we could forge a different relationship with our bodies. When we focus on listening to our bodies instead of on external rules, we naturally lean into behaviors that are health promoting. Such behaviors include eating a variety of foods, engaging in joyful moment, and practicing a relationship with our bodies that prioritizes taking care of ourselves in the way we might care for a good friend. When we are not focused on losing weight, we are able to make decisions based on trust and our own internal wisdom.

The following are some strategies one might consider to begin the journey of moving away from diet culture and fatphobia and into a place of peace, trust, and an overall more friendly relationship with our bodies.

  1. Grieve the “ideal” body. In order to improve your relationship with your body, we have to first begin to let go of the “ideal” and accept the wonderful body you have. This may involve some of the phases of grief such as denial, anger, bargaining, and depression, before achieving acceptance.
  2. Ditch the negative self-talk. Every time you notice yourself calling yourself names and making negative comments about your appearance, stop, put your hand on your heart, and give yourself a compliment, body-focused or otherwise. You might even consider writing a few compliments down and posting them up as easy reminders that you are more than your body. A good rule of thumb here is begin to talk to yourself in the same manner you would a good friend.
  3. Practice Body Gratitude. Take 5 minutes each day, find a quiet place, close your eyes, and scan down through your body. Notice any sensations, thoughts, or feelings that you notice as you bring awareness to your body. If you are finding a lot of negative energy around one or more parts of your body, begin to shift that focus to what that part of your body does for you. Begin relating to your body as a good friend who trying to take care of you.
  4. Listen to your body and start rebuilding body trust. Start making it habit to begin to check in with your body regularly. This is a practice that is often lost for those that have been chronic dieters because dieting relies on rules rather than our body for what we can eat or how to move. As you check in, begin to respond according to your body’s signals such as eating when you are hungry, moving when you feel restless, or resting when you are tired.

If you continue to struggle with your relationship with your body, consider talking to a therapist who has experience with body image and who is familiar with Health At Every Size (HAES) or the practice of Intuitive Eating in order to help guide you even further in your journey towards body acceptance.


Anorexia Nervosa and Associated Disorders (n.d.) Eating Disorder Statistics.

Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10, 9.

Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A.T., &Gulliford. M.C. (2015). Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health, 105, 9, e54-9. doi: 10.2105/AJPH.2015.302773. Epub 2015 Jul 16. PMID: 26180980; PMCID: PMC4539812

Screen time recommendations vary by the child’s age. Presently, the American Academy of Pediatrics (AAP) recommends that for children younger than 18 months of age, the use of screen media other than video-chatting should mostly be discouraged. For children 2 to 5 years of age screens are acceptable for no more than one hour per day thus allowing them ample time to engage in other activities promoting growth. For older children, current guidelines encourage proactive development of an individualized Family Media Use Plan ( that takes in consideration the particular child’s maturation and needs. This article will focus on a few recent neurobiological findings addressing the effects of excessive screen time exposure on the growing brain in youth to help us be better informed as parents, educators and healthcare workers.

Preschoolers – if the content is educational, that’s all that matters, not how it is presented, right? Wrong! 

In a 2019 study by Cincinnati Children’s Hospital researchers documented associations between higher screen use and lower measures of brain structure and skills in preschool-aged children. The team examined the screen time habits and cognitive skills of 47 children, 3 to 5 years of age and conducted brain scans on each child.  Prior to the scans, the kids took a cognitive test and the parents filled out a questionnaire regarding their child’s screen time habits. The final score, called the ScreenQ score, was based on a number of criteria focusing on AAP recommendations, including whether the child was exposed to screens before 18 months of age, if they had a television in their room, and how much time they spend in front of screens. Scores ranged from zero to 26 and the higher scores represented less of an adherence to general screen time recommendations from the AAP. It was observed that higher ScreenQ scores were associated with lower brain white matter integrity, poorer expressive language and poorer cognitive skills suggesting that excessive time in front of a screen, even if the content is considered educational, might decrease cognitive skills in preschoolers. (1)

Elementary School Age and tweens -Reading is all good, right? Wrong!

A 2018 study from Cincinnati Children’s Hospital explored the time spent using screen-based media versus reading an actual book on the functional connectivity of the reading-related brain regions in children aged 8-12. Time spent on screens might be linked to impaired shifts in brain connectivity, while reading a book is linked to more beneficial neurobiological changes. The researchers had families rate how much time their children spent on various screens and how much time they spent reading actual books. The children’s brains were scanned, to assess how regions involved in language were connected, and it turned out that screen time was linked to poorer connectivity in areas that govern language and cognitive control. Reading a physical book, on the other hand, was linked to better connectivity in these regions. These findings underscore the importance of children reading real books to support healthy brain development and literacy and to consider limiting excessive screen time, even if some of the content presented through screens might be related to reading and considered educational. (2)

Tweens- screens are all bad, right? Wrong!

A 2019 study published in NeuroImage explored the effect of screen media activity on structural brain changes and how this might affect specific behaviors in 9-11 year olds. Structural scans of the brains of 4277 participants were correlated to screen activity like watching television, playing video games, or using social media. Some finding were expected, like individuals with significant exposure to activities engaging the visual system (watching TV or video) showing structural patterns suggestive of greater maturation in the visual system (i.e., thinner cortex). Some structural brain changes related to increased screen exposure were associated with more psychological issues and poorer performance on cognitive tests, while other latent variables did not show such relationship. The authors summarized that it remains difficult to conclude that brain structural characteristics related to screen media activity have uniformly negative consequences. Moreover, while some media activity associated brain structural changes were related to poorer cognitive performance, others were related to better cognitive performance suggesting that screen media activity can not be simplified as overarchingly “bad for the brain or for brain related functioning”.

Regardless of the age group discussed, one strategy to mitigate the potential risks associated with excessive exposure to screens is to ensure that the child has an overall well balanced and healthy lifestyle. This includes reinforcing proper eating and sleeping habits adequate for the age of the child, sufficient and diverse physical activity and providing plenty of opportunities for not screen related social interactions. Establishing a flexible family matrix of screen rated “rules” which dynamically adapts to the growing child would ensure that parents and educators factor in screen time exposure as one of the determinants when raising a healthy kid.

  1. John S. Hutton, Jonathan Dudley, Tzipi Horowitz-Kraus, Tom DeWitt, Scott K. Holland.
    Associations Between Screen-Based Media Use and Brain White Matter Integrity in
    Preschool-Aged Children. JAMA Pediatrics, 2019.
  2. Horowitz-Kraus T, Hutton JS. Brain connectivity in children is increased by the time they spend reading books and decreased by the length of exposure to screen-based media. Acta Paediatr. 2018;107(4):685-693.
  3. Paulus MP, Squeglia LM, Bagot K, et al. Screen media activity and brain structure in youth:
    Evidence for diverse structural correlation networks from the ABCD study. Neuroimage. 2019;

Anna Guerdjikova, PHD, LISW, CCRC
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program, Lindner Center of HOPE, University of Cincinnati, Department of Psychiatry, Research Assistant Professor

A New Way to Balance Digital Usage

It’s a concern for parents across the country.

Teenagers are consumed by countless digital distractions. Smart phones, gaming consoles, or any number of devices connected to the Internet compete for their attention.

Concerns over growing and habitual media use are nothing new, but the broad availability of portable devices seem to have “leveled up” the problem. Now, more children are becoming addicted to online content and gaming.

Popular video games like Fortnite are played by more than 200 million people. Some teens spend as much as 12 hours or more[i] a day playing online, while others spend the same amount of time engaged in social networks. This obsession can affect health as well as school and work performance.

A 2012 study estimated In 2018, The World Health Organization even classified video game addiction[iii] as a mental health disorder.

But how do you know when a habit has crossed over into an addiction? And what do you do when it is clear your son or daughter is addicted?

For children who show signs of internet addiction, a recent study[iv] suggests each child needs to be evaluated in context of their own unique situation. Personality traits, type of game(s) played, life situations and cultural expectations can all explain excessive gaming. For example, if the habit is used to replace real-life social interactions or escape from life traumas and stress, an Internet or gaming addiction may be in play.

“Today’s society is dependent upon technology, mobile devices, social media, and the Internet,” says Dr. Chris J. Tuell, clinical director of addiction services at Lindner Center of HOPE. “However, when dependence crosses over to an addiction, it’s time to take steps to regain control.”

Several habitual behaviors can indicate Internet and gaming addiction. “The three C’s of addiction also apply to Internet addiction,” says Dr. Tuell. “If someone exhibits a loss of control, a compulsion/obsession to be online, irritability when offline, or continues to use technology despite negative consequences, they may be suffering from Internet addiction.”

The Reboot Program

To combat Internet and gaming addiction, and provide a resource for families who need help, Lindner Center of HOPE has introduced a new program called “Reboot.” The first two weeks of the Reboot program involve a comprehensive assessment of the teenager to draft a course of treatment. The second two weeks focus on developing better habits with technology.

“For those struggling with self-control, this program helps them re-center their lives and avoid additional complications,” said Dr. Tuell.

According to Mental Health America[v], the nation’s leading non-profit mental health advocacy organization,  children with Internet addiction often struggle with other mental health problems like alcohol and substance use, depression, and/or aggression.

Addiction experts at Lindner Center of HOPE assess if patients are suffering from one or more co-occurring disorders, like depression. Identifying underlying mental health conditions helps to personalize treatment plans for each “Reboot” patient – increasing their odds of winning the battle with internet and gaming addiction.

Addictions Expertise

In addition to internet and gaming addictions, Lindner Center of HOPE treats most substance and behavioral addictions, including heroin, morphine, hydrocodone, oxycodone, amphetamine, methamphetamine, LSD, alcohol, cocaine, marijuana and tobacco, gambling and pornography. Plans may include medication-assisted treatment, therapy or support groups, and screenings for underlying issues like depression and anxiety.

About Lindner Center of HOPE

Lindner Center of HOPE, located in Mason, OH, is a comprehensive mental health center providing patient-centered, scientifically advanced care for individuals suffering with mental illness. Learn more at

# #  #

[i] Feely, J. & Palmeri, C. (2018, Nov. 27). Fortnite Addiction Is Forcing Kids Into Video-Game Rehab.

[ii] Cash, H., Rae, C. D., Steel, A. H., & Winkler, A. (2012). Internet Addiction: A Brief Summary of Research and Practice. Current psychiatry reviews8(4), 292-298.

[iii] Price, L. & Snider, M. (2018, June 19). Video game addiction is a mental health disorder, WHO says, but some health experts don’t agree.

[iv] Kuss D. J. (2013). Internet gaming addiction: current perspectives. Psychology research and behavior management6, 125-37. doi:10.2147/PRBM.S39476

[v] Mental Health America. Risky Business: Internet Addiction.


Do you know someone who gambles excessively?  If so, perhaps you’ve wondered if this individual just had a bad habit or if he or she was actually addicted to gambling.  It’s a question that even the experts have debated.  But the latest diagnostic publication of the American Psychiatric Association, the Diagnostic and Statistical Manual (DSM)-V, confirms that excessive gambling can indeed be an addiction, just like substance abuse.

The Nature of Gambling Addiction

“Problem” gambling, also referred to as pathological or compulsive gambling, affects an estimated 2 – 4% of the population. Before recent changes by mental health clinicians, it was classified as in impulse control disorder.  Like kleptomania (uncontrollable stealing) or pyromania (impulsive fire setting), compulsive gambling was considered a mental disorder associated with poor impulse control.

With further research, a new classification of the disorder has been made.  In the DSM-V, compulsive gambling is considered to be one of the “substance-related and addictive disorders.”  Why the change?  There is growing clinical evidence that pathological gambling has much in common with traditional substance abuse disorders.

First, the effects of the respective disorders on individuals’ work, financial, and personal lives can be similar. Neurochemical testing and brain imaging have also made a case for the belief that gambling activates the brain’s reward system in a manner similar to drugs.  For example, compulsive gamblers report highs from gambling as well as cravings.  Furthermore, gambling problems tend to run in families, indicating potential genetic factors. Finally, pathological gamblers are more likely to abuse alcohol and other drugs.

Symptoms of Gambling Addiction

In order for an individual to be classified as having a gambling disorder, at least 4 of the following symptoms must be present:

  • Frequent preoccupation with gambling;
  • Tendency to gamble increasingly large amounts of money;
  • Using gambling to cope with feeling distressed;
  • Lack of success in controlling, cutting back, or stopping the behavior;
  • Lying to others to hide gambling or committing illegal acts to finance;
  • Restlessness or irritability when attempting to decrease or stop gambling;
  • Frequent and often long-term “chasing” of losses with increased gambling;
  • Loss of a job or relationship due to behavior;
  • Reliance upon others to get out of financial straits.

Many of these symptoms resemble classic addictive symptoms, such as withdrawal and loss of control.

Individuals with pathological gambling problems are more likely to exhibit symptoms of other psychiatric problems.  In addition to substance abuse, such problems may include mood disorders, anxiety, or personality disorders.

While the effects of pathological gambling should not be minimized, viewing the behavior as evidence of an addiction rather than a character flaw can be helpful in encouraging an individual to seek treatment.  It may also remove some of the stigma associated with the behavior.  With appropriate intervention, individuals with gambling addictions can recover and live productive lives. (And that’s a sure bet!)