Dear DOCTOR Owen:

I hate my body. No matter how much I exercise or diet, my shape is “the pits.” I feel like a circus act. My thighs are huge, but my chest and bust are tiny. I can’t lose the thigh fat for anything. Is there anything I can do?

Saddlebag

Dear “Saddlebag”:

Do you hate your body or do you hate the way you think others perceive your body? Do you think you are treated differently or rejected because of your thighs? How would you feel if large thighs were the major criteria for beauty—as they once were?

The vast majority of patients I see have serious medical problems related to their weight, and some are on the verge of death. Most of these problems resolve or improve, however, with serious diet intervention and perseverance. Yet, the first or last sentence most patients utter to me is not “Please save my life.” On the contrary, it’s usually “I want to lose weight.” “Why?” I ask. The reply, “Because I don’t feel good.” Then we go through myriad medical, social, and psychological reasons as to why they don’t feel well. Even the sickest people often are as concerned about how others perceive and treat them as they are about their medical issues.

Your feelings and perceptions—as well as any actions you take to reverse your present situation—are very important to me. For example, you can motivate yourself to act on those feelings or not act, which will get you nowhere from where you are now. I am concerned at your complete sense of frustration and failure. I also am troubled that your sense of failure will spill onto your long-term efforts at creating a healthy lifestyle for yourself. I frequently see people who have either given up or sought out dangerous treatments.

My guess is that you are probably Caucasian, Anglo Saxon, and Protestant (WASP). In our society, WASPs are at the greatest risk for eating disorders and worry unreasonably about social stigma. Eating disorders are the result of having no effective means, or knowledge, about how to control a painful part of one’s existence. People with eating disorders are initially likely to do what they think might help, but those patterns then become part of their “normal” behavior—probably, because they helped for awhile or gave them some control. Binge eating may be the problem, but it has the opposite result—over-eating out of a sense of failure, “so what the hell.”

Your particular “hourglass” body shape is genetically and hormonally determined. Short of liposuction, there is little you can do to equalize your upper and lower body. Liposuction is an alternative if you feel that it will help you in your work or personal life. Long before undergoing such an operation, however, I would suggest that you consult a psychologist and make sure you understand your feelings and know what you are really trying to achieve by altering your appearance.

We all have some genetic predisposition to our body shapes. We can affect our shapes only generally, and there is really no such thing as “spot reduction.” Aging will affect distribution as hormone levels and ratios change. One day, we may be able to change fat distribution by changing hormone balances, but that time is far away. By then, I hope that the new Communication Age will have changed our perceptions of body image and it will no longer be necessary to change our bodies to meet other people’s expectations.

People can invent a million ways to discriminate against others. Believe me—if you have your legs “fixed,” people may still find fault with you. You’ll get “constructive” criticism from the ones who are close to you, not necessarily from everyone you meet. Never forget that you are beautiful. You have the right to be treated as who you are—not for your genetic blessings or limitations. Accept nothing else.