If you are a woman, you can relate to the fact that many men always seem “on.” They may work all day, come home exhausted, but if you mention sex, most of them are ready and rearing to go. Women are not like this. We need time to make a transition into sexy. A big mistake many couples with small children make is on date night. If dinner is set for 7 p.m., they have the sitter come at 6:30 or 6:45. The date may feel hurried, tense, and doesn’t usually end with both people feeling relaxed and amorous. It isn’t something the husband does wrong, or that one of you picked a fight, it’s simply that you didn’t allow yourself time to get your sexy on. Women need a transitional time to go from mommy to lover. We need time to pamper ourselves, dress ourselves, and get our makeup on and our hair done without someone spitting food on us, burping on us, crying about something, or solving someone’s crisis. I call this getting your sexy on.

Body image is so highly correlated with women’s sexuality that in a recent study reported in the Journal of Sex Research, Dr. Patricia Barthalow Koch PH.D discovered that body image was one of the top reasons women don’t want to have sex. Men may have difficulty understanding this because many of them tell their wives every day how beautiful she looks only to realize their wife still doesn’t want to have sex. The husbands may not understand that although their intentions are good, their wife doesn’t derive her body image by what he says. It may help and reassure his wife, but more helpful is if she believes that she is beautiful and desirable. In other words, if she beats herself up, or is critical in regards to her looks when she compares herself to others, no matter what her husband tells her, it falls on deaf ears.

Counseling and talking to numerous women, I find that one of the big problems is women feel too rushed and hurried. Women need different stimuli to turn them on than men. We don’t get excited when we see a naked man. In fact, most women prefer a man with shorts on to a man in the buff (if he puts a suit on and parades around the house, even better). Men may like to see a woman in heels, but they forget, we are looking at their shoes too. Many men wear shoes with terrible heels; they look like they walked the fields of Lubbock Texas with dust, and have scuffs from years ago. Women may notice your butt, but your shoes could turn the beginnings of a great mood off. Your sex text may not do it for us, but if we catch a glance at your jaw while you are drinking from a water fountain in the right lighting, we may feel a sexual impulse. Women don’t talk to you about this, because we know you won’t understand. Women are also somewhat reticent about telling you what turns them on, because it is so different than what turns men on, or what the media believes should turn them on. The one area women and men agree turns both of them on, is how a woman looks. The problem is women’s comparison of what makes them beautiful or sexy is so different than men’s that it’s difficult to feel accomplished in that area. We are busy working, taking care of the kids, and the chores (it is still reported that women do the majority of household chores in the U.S). When women take time for themselves they feel sexier, better about their bodies, and more willing to share their bodies with their partner.

Sex and intimacy are so important to women and men. It is healthy for the body; strengthening  the immune system, helping your heart, blood pressure, stabilizing your mood, and making you happier just to name a few. How do you feel better about your body image so you will naturally want to have sex with your partner? I have a few suggestions below.

1.     A healthy woman check is a must. Many women get their checkup each year and report that their doctor didn’t find anything unusual. Most likely this was because you were embarrassed to tell them you have never had an orgasm, don’t want or like sex, or that you are having marital issues. These are important and real issues and they must be addressed to have a stable healthy marriage.

2.     If you don’t know your body, chances are high that your partner will have difficulty pleasing you. It is also likely that you will dismiss the importance of sex. If you are uncomfortable with exploring your body, go to the website www.middlesexmd.com. This is a website that was started by an OB/GYN physician and specializes in women over the age of thirty five with sexual needs.  I am an expert for them; and I believe they are excellent in helping save women’s sexual health as well as their marriages.

3.     Try taking up yoga or an exercise which relieves stress and helps you feel stronger. Women who begin feeling stronger also become more confident. With confidence comes an improved body image.

4.     Reframe your thinking that sex is for men. It is for YOU. In fact, women benefit more so than men. For women, having sex not only makes us feel more connected, but it controls our ability to manage stress. Due to the way we multitask, stress and anger are emotions we feel and usually dismiss every day. Sex helps us purge both in a healthy way.

5.     The next time your partner wants to have sex, give them your sexiest look, and tell them you would love to if they will call the sitter and allow you time to get your “sexy” on.  While getting ready, listen to music that puts you in the mood, and dress in a way you feel beautiful.

TV sex is not real sex. Nor is the sex you see on the internet, or IPHONES. That’s called porn. Real sex is the stuff that happens when you love someone, and holding their hand makes you feel special and loved. Real sex is the kind that happens in the bedroom when the kids are upstairs napping, or on a Sunday afternoon during half time. It’s the kind that builds with a relationship of trust and caring. Unfortunately, after marriage it is also the kind that women become less and less excited about. Men are not the problem, ladies. We have to own our sexuality before we can realize how important it is, not only to our man, but for ourselves.

The morning after can be difficult no matter if you are a guy or a girl, but it seems to be more difficult for girls than guys. A study from researchers at Pennsylvania State University reports male university students' body images improved after having sexual intercourse for the first time, while the opposite pattern was found with females. The study which was published in the Journal of Adolescents and reported on 100 students from the university between the ages of 17 and 19 years of age who had sex for the first time during their time at the university. During the three year study, the students' satisfaction with their appearance was assessed four times. The results were statistically significant. The girls' self esteem and feelings about themselves increased throughout the school year, until they had sex. Males' perceptions of their own attractiveness, on the other hand, generally decreased over time but improved, at least initially, after their first time having sex.

The researchers had several theories about why girls felt so much worse about their looks after having sex and why guys felt better. It could be that after sex, guys felt desired and accepted in regards to their masculinity and sexuality, which is very important. Girls, on the other hand, may have felt worse because girls in general have more sensitivity with body image, and they feel more judged regarding their bodies after their first sexual experience. Girls may have felt confused about the reasons they had sex. They may have felt abandoned after sex. Girls may have also experienced more guilt due to society's double standards. There is an underlying tone in the US that good girls don't have sex. I don't know if good girls do or don't have sex, but I do know smart girls wait until they are prepared for the consequences sex presents. I also understand and have researched that girls who have an engaged dad in the family report delaying sex until later in life when their own interests are developed and they are mature enough to make better choices in the boys they have sex with. I have researched and surveyed girls to co-author a book for girls and moms regarding healthy sex. We learned that girls who are taught about their changing bodies, their sexuality, and how to keep their body healthy delay sex until they are mature enough to make wise choices in regards to sexual relationships. I am concerned when I hear parents say, “Let the schools teach my children about healthy sex.” Do parents really believe the school is going to teach their child about their own intimate bodies better than a parent could? Do parents depend on the school to teach their daughter about her menstrual health, her changing breasts, and body? What about her values and morals? Both of these will affect her relationships and both should be discussed within the family.

Television, the Internet and many movies are making sex look more and more casual. There is nothing casual about sex. It should remain meaningful and intimate between two people who care for each other. When you decide to give up your virginity it should not be something that happens accidentally. It should be something you decide to do because you want to express your deep feelings to another and are ready to deal with the emotions that may present after the sex. It should never be because you want to secure a relationship, think they will like you more, or feel like they will walk away if you don't have sex with them. Talk to your daughters and sons about sex and relationships. Keep in mind that the longer your child delays sex, the better choices they make, and also understand that children who delay having sex have more parental involvement in their lives.

I receive referrals from physicians specializing in OB/GYN, Urology, Oncology and Internal Medicine. Many of the couples I see are struggling with libido and sexual issues. One of the main problems that I notice among couples originates from the lack of knowledge regarding women and their bodies. Women are not taught to celebrate and touch their bodies, and they may have feelings of shame and embarrassment toward their body. Therefore, they wait for a man to “know” their body and sexually please them. The concept of waiting for someone to please you when you don't know what makes your body feel pleasure is analogous to ordering an ice cream sundae and expecting to have the toppings you love most when you haven't told the server what your favorite toppings are. You may hate coconut, but you get it because it was on the menu.

No area is less understood than our breasts. We know men look at them, admire and fantasize about them, but we are confused about how sensual our breasts are. Most moms can tell you how breast feeding made them feel, how connected it made them to their baby, and the joy they experienced from being able to feed their infant. However, what we may not understand is how breasts alone can make or help us orgasm. We may think bigger is better, in regards to getting attention, but small breasts are actually more sensitive to touch. Sometimes, increasing breast size surgically can damage the feeling within the breast and leave you with big, numb breasts, limiting the sexual experience. Men are, for the most part, clueless in regards to where breasts are most sensitive unless women guide them. Men will automatically go to the nipple area, but actually many women report more sensitivity on the top, side and underside of the breast. Men would do well asking their partner before touching, licking, and kissing the breast in order to heighten their partner's pleasure. The sensitivity of the breasts is also influenced by the menstrual cycle.

During love making, according to Dr. Madeleine Castellanos, who is an assistant professor in the Psychiatry Department at Albert Einstein College of Medicine, the breasts can increase in size as much as 25 to 30 percent when a woman becomes sexually aroused. Dr. Castellanos explained, “Oxytocin release is the reason breast stimulation feels so good.” This feel-good substance, also known as the “cuddle hormone,” is released when the breasts and nipples are stimulated. Oxytocin is also the reason the nipple becomes erect during excitement and stimulation, caused by contraction of smooth muscle underneath the skin of the areola, which pulls on the overlying skin creating a goose bump-like effect. When our partner is touching and loving our breasts in a manner that makes us release oxytocin, we want our partner more and we feel loved by our partner.

The Komen Society did a lot to teach women everywhere the importance of breast exams and knowing their breasts. Women not only need to know their breasts for health reasons in detecting abnormalities, but we need to know our breasts so we can understand and offer guidance to our partner as to what feels good. This enhances our intimacy and sex and helps us connect and enjoy our relationships. Below I offer 3 tips in getting to know your breasts. These can be done alone or with your partner.

1. For most women, starting out in the tub is the best place. A shower will work as well, but something about the bathtub relaxes us more. We are taking time out for us, so make sure you are with your loved one or totally uninterrupted from noise, kids, and other duties.
2. Sit back, listen to soothing music, enjoy the smell of a nice bubble bath and massage your breasts. Touch them and note where they are most sensitive. Many times, you will experience goose bumps where you feel extreme sensitivity.
3. During love making, keep your clothes on from the waist down. Have some luxurious body cream by the bed and make the next 20 minutes about massaging yours and your partner's chest area only. Love making is so much more than intercourse. Breast touching (experiment with a feather, as it offers such a nice feeling), loving (kissing feels wonderful on sensitive skin that is not usually exposed), and licking can be as intense as anything else you have ever done intimately. If you don't have a partner, simply massage your breasts while lying in a reclined position. This can be a wonderful way to love and take care of you.

Many couples that have been together for more than three years report sex as getting redundant, boring, and passionless. These same couples rarely know the treasures within each other. Each of us has over 117 erogenous zones. If you only know four or five then exploring the breasts will expose you to more, and your love making will be less than boring. Ladies, please keep in mind your man's breasts are also sensitive and should be equally explored.

The day after Easter I took a break and went to Ecuador. I had always wanted to see the Galapagos and it coordinated with a meeting my husband had in Guayaquil. It's amazing what you see when you have no other objective than to enjoy. The overwhelming thing I noticed was women's bodies and the way they moved. A lot of my work is centered with the media and everyone knows that the camera adds 10 pounds (the camera adds a lot of other things too). Many of the women I work with are thin and worried about how to become thinner. It felt so good to be in a country where women were a healthy weight, enjoying food, and enjoying their bodies. It made me want to sit and talk to them and, although they were accommodating of my Italian/English translating, issues of self esteem, body image and sexuality would have proved difficult.

Right before I left for Ecuador, I was asked to comment on a new research study that was recently posted in the Daily Mail. The study suggested that older women are more depressed by what they see in the mirror than younger girls going through their “awkward stage.” Roughly 40% of the teens studied said they were satisfied with their bodies, but only 9 percent of women in their late forties and fifties were satisfied with theirs. If you live in the United States, forget the old thinking that as you grow older you also grow wiser. Forget too, that women over the age of forty no longer value their looks as much as they did when they were in their 20s. Older women are not accepting of their aging bodies as much as we would like to think. According to Dr. Susan Quilliam (one of the psychologists involved in the study), “Women today are living in an age where female beauty is defined as young, and we have become obsessed with achieving that.” This is crazy; we can't all be young. The only way you stay young forever is to die that way. When beauty has such a narrow definition, few can feel or be labeled as beautiful. It's the exclusion of that definition that is driving women of all ages to extremes.

Watching the women in Ecuador was not only enlightening in regards to curvy, female bodies, but it was also thought provoking. Could we begin a movement in the United States to once again widen our view of beauty? Probably not, but we could enact it for one day. How about Mother's Day? Let's start with the moms and then generalize the concept to all women. Take one day to look in the mirror and admire how beautiful you are. Mothers (knowingly or not) are setting the standard in the United States, which determines who is beautiful enough. Moms buy the magazines, invest in beauty products and mentor their daughters and their sons. Moms are the ones who buy the padded bras for their eight-year-old daughters. Moms are buying their babies the latest fashion even if it does leave their child's midriff bare or their bottom exposed. Moms allow and financially support breast implants, Botox, and liposuction. There is little fat to suck off a tween that is mentored exercise and a healthy diet. Moms would not be encouraging and paying for their babies to achieve perfection if they didn't feel imperfect themselves; nor would they be encouraging perfection if they didn't value it themselves.

This Mother's Day I am getting every mom I know a card that reads “You are pretty enough, and too beautiful to be perfect.” I am going to send this card because I am a mom, and I understand how tough it is to feel pretty enough in this society. I work with people who have been criticized, teased and hurt and they have given up on the concept that they are “enough” of anything to be valued.

Below are some things that may help you feel beautiful this Mother's Day and everyday that follows. Start small, practice being beautiful every other day and, in two weeks time, you should begin feeling as good as you look:

1. The first thing you have to do is get a size out of your mind. There is no universal perfect size. Stop reading the magazines that promote anything perfect. Anything perfect is not real.
2. Do not say anything negative about your body, hair, or face all day. Replace anything negative you would usually say with something positive.
3. When you look at people, instead of noticing their “physical flaws” notice their beautiful aspects. Notice lips, eyes, neck, arms, shoulders, and anything else that is physically beautiful to you.
4. Don't let anyone say anything disrespectful about your looks all day. Many women let people talk to them in a disrespectful way. They have grown so use to it, they no longer notice. Today is the day to notice it and make it verboten.
5. Move your body. Think of something beautiful and move your body to that thought. In a recent report of what men thought most beautiful about women, “the way they moved” was in the top 3.
6. Any smell that makes you feel beautiful is a good smell to have in your presence. Women are very sensitive to smell. Sometimes a smell can change our whole mood.
7. Sing to “your song.” What is your song? That song should make you feel beautiful, happy, sexy, and alive. If you don't have one, you need to identify one and sing it to feel vibrant and beautiful.
8. Are you watching a show that promotes something to help you get rid of something ugly? Switch the channel. Advertisements are created to get you to buy their product. They know the power of beauty. Beauty is not for sale, but plastic surgery and treatments are. Beauty comes from feeling beautiful and acting on that thought.
9. Feeling beautiful has a lot to do with feeling comfortable about your body. Do you feel like a stranger to your body? Begin touching, exercising, and listening to your body so you know the sensitive parts, the strong parts, and the areas of your body that need more attention. Don't expect a partner to know how to love your body if you don't.
10. Take care to smile more when you want to feel more beautiful. Everyone always looks more beautiful when they smile.

All of us want to look good, but it becomes a liability when you go to extremes to achieve perfection or begin to project the need for perfection onto your children. We all have a spark of the divinity within us. Getting in touch with our spiritual side makes us feel more beautiful. Women who focus on their looks and surround themselves with women who hate growing older or constantly criticize the looks of others, will grow more spiteful of their body and their imperfections. Most of the husbands I work with tell me that their sex life worsened as their wife grew older. They also tell me it wasn't them who rejected their wife (most of the men I work with tell me their wife is beautiful), but that it was their wife who rejected themselves. Looks change as we grow and evolve. How much healthier our children will be if we can set an example of loving ourselves all the way to the end. Happy Mother's Day!

I run several support groups for the morbidly obese in the Houston area. Two of the groups specifically deal with food addictions. The members in this group participate in a 12 step program that helps them learn new coping mechanisms besides turning to food. It is very difficult. They have been using food as their lover for years. Their use of food is different from mine or others. They actually have a relationship with their food. Just as an alcoholic or a drug addict turns to their vice before they turn to their partner, food addicts turn to food. It would seem odd to the person who doesn't struggle with food to listen in on my groups. You would hear things such as, “If I can just have a bowl of Ben and Jerry's Cherry Fudge, I will make it through this,” or you may hear, “I was so upset. All I could do was run to Sonic and get my fix.” When I first began listening to this, I felt confused, or perplexed, thinking maybe they were kidding. Believe me, they were not. They cannot stop once they get started with their vice anymore than an alcoholic can stop after half a bottle of wine. Just as an alcoholic will go to the extent of drinking someone else's drink to get a fix, the food addict will eat off of other's plates, and several have admitted to going through the trash can for food previously thrown away.

As the group progresses, what becomes clear is the majority of these patients have been brought up with another addiction. Maybe their parents were alcoholics, abusive, gamblers, smokers, or hoarders. The child learned it was safer to turn to food or some other substance for comfort because turning to a human for a hug or soothing words was impossible. Many food addicts lose weight to get married, only to find that they don't have the skills to communicate loneliness, boredom, or anxiety to their partner. They slowly begin to turn to what has helped soothe them in the past, which is food. Before long, communication is compromised in the relationship. There is severe weight gain, which begins a disastrous cycle of withdrawing from sex, and turning to food. Soon the partner isn't happy and the food addict feels shameful and guilty. These feelings of guilt and shame lock the cycle of turning to food even more securely. Members in the group tell me often that their eating has ruined their marriage, or the way they look disgusts their partner. For anyone in the health profession to tell these people to simply stop eating or to get the weight loss surgery without addressing the underlying feelings and emotions is malpractice. I say this, but understand it is done every day. After all, my food addiction group is filled with patients who failed with a weight loss surgery prior to joining. When I ask them if they had been counseled prior to surgery, the response is always, “No, I could not afford that.” In truth, they cannot afford not to get counseling prior to surgery.

How can you help if you are married or know a food addict? I am so glad you asked. Below are a few suggestions to help you get started.

1. Realize that your partner or friend has a bigger problem than just eating too much. They need professional help, and they need it now. Find out who is on your plan for insurance and what it allows for help with eating disorders.
2. Encourage your partner to begin turning to you for comfort. This can be done by paying attention to when they eat, and what they eat. Food addicts find the evening especially difficult to manage. They are tired, overwhelmed and depressed. Hold them, talk to them, and avoid food.
3. Help them join a food addiction group. There are several in Houston and “Over Eaters Anonymous” offers a 12 step program for food addicts.
4. Your partner suffers shame and guilt every day. Try to remember this, and be gentle. There is a lot of secrecy in this disorder. If they let you in, respect that.
5. If you are the over eater, I want you to know you are still loveable despite your weight. You many not love yourself right now, but that is possible to change. You need to make the first call, but there is help.

Food addicts are hurt, and we as a society can become part of the problem or part of the solution. Most addicts of food (and other addictions) have an enabler. The enabler complains about the behavior but also supplies the fix. They cover for the addict by making excuses for them. People who are co-dependent or have a low self-esteem may derive their security from enabling an addict. The perfect example is a man who is married to an obese woman. He keeps bringing home junk food to keep her happy and obese. He never worries about her being unfaithful to him because he knows her weight limits her confidence in finding someone else. Obesity has gotten so out of control that it is limiting the lives of our children, driving our medical costs sky high, and touching the majority of lives in the United States. Surgeries and medicines are helping us lose weight, but until we get at the issues underneath the weight we will never be able to cure this serious problem.

“Today you are you! That is truer than true!

There is no one alive who is you-er than you!”

-Dr. Seuss

You have curly hair, but you want it straight; you spend hundreds at the salon to get that look. You are curvy, but you want to be stick thin; you spend thousands to achieve that look you want. You have brown eyes, but you want blue; you spend money for those colored contacts to achieve that look. You are getting older, and you want to be young; thousands are spent to achieve this look. Yet, at the end of the day, you are “you” and you cannot change that. We all want to be something we are not, and this feeling that we are less because we aren't what we picture is making us depressed, anxious, moody, and insecure. Men struggle with this thinking, but not nearly as much as women. Women are trapped by it. We can become obsessed with it. Not only are grown women trapped by it, but six year old girls are reporting that they want to be thinner or prettier.

When you ask someone what they notice about another person, most of the time you will hear things such as their energy, their interests, or their unique quirks or personality. Rarely will it be about how someone looks. When looks do come up, they are usually in the context of extremes. When you get close to someone, how they look becomes less and less important. This feeling of knowing someone well and no longer caring how they look does not generalize to ourselves. In fact, the longer women are in their bodies, the more critical they become. I work with men and women, and I have yet to hear two guys sitting together ripping their bodies apart. I don't have to go further than the first coffee shop to listen in on two women doing that. The conversation would look like this:

“My eyelashes are even falling out. I hate this.”

“My butt is falling into the legs of my jeans.”

All day, every day we have these kinds of conversations. Imagine what we could give others if we quit obsessing about our imperfections. The next generation of girls would be so much healthier if their moms were not as obsessed with their imperfections. Marriages would be so much healthier if women loved and felt confident in the bodies where their souls reside.

Insecurity is created whenever the focus is on how one looks, rather than who they are.

How this happened or how we obtained this ideal standard of beauty is complicated. Yes, the media plays a part, however, most of the editors of popular magazines are women. It is women, not men, promoting this ideal of the perfect body or look. In the United States, the majority of men are married to a woman who is 5'4'' and weighs 135 pounds. Who are we as women if we give men the power to decide what is “sexy” or “desirable” anyway? When I talk to men regarding this topic, they say they aren't looking for the perfect woman. They are looking for the woman who feels confident in her own skin. A man is attracted to a woman who likes herself, and what he is looking for is hard to find. Most women are too busy beating themselves up for their flaws to entertain the thought that they are sexy and desirable in their own right. It doesn't stop there. Women who aren't happy with themselves put pressure on their daughters to look the part they weren't able to achieve. Rather than promoting their daughter's interests, they focus on her looks. Insecure moms create insecure daughters.

The way out of this madness requires small steps in changing how you think about yourself as well as others. Below are a few tips to help getting started:

1. Notice the first thoughts you have when you meet someone new. If you begin thinking of how they look, stop yourself. Ask them what they do or what makes them happy.
2. When your friends meet and begin talking about their face lifts, sagging eyes, or yellow teeth, interrupt them and tell them something you admire about them.
3. If your parents told you in any way that you wouldn't be worthwhile if you didn't look good, remember that you most likely had insecure parents (no matter how they masked it).
4. Most of the time when women feel bad about themselves, it involves their body. There is nothing better for your body or mind than movement. It makes you feel more confident, too.
5. Purchase magazines that promote healthy living, not perfect faces or bodies. I work in the media, and I can promise you that when you see models or celebrities, they don't look like they do in the magazines. The magazines have perfect lighting, perfect clothing, perfect hair, perfect make-up and an ability to photo shop beyond your wildest dreams. They are NOT real.

In a book called “Journey of the Heart,” the author encourages us to “stop worrying people will find out the real you and begin hoping they will.” Open yourself so others can see the real you. When you are comfortable with yourself, you have more energy to give and love others. Giving your power to a magazine, TV show, movie, or a person to depict whether you are good enough is not only heart breaking, it's demeaning and abusive.

I attended the International Society for the Study of Women's Sexual Health this past week. This is one of the greatest meetings I go to during the year, and this one in particular was phenomenal. One of the lectures was about sexual desire and women. The lecture touched on many different components to female sexual desire, the awareness that sexual desire alone does not lead to sex for women. When men have sexual desire, they seek out sex because it is a positive experience. This sounds obvious and rational, but the presenter went on to discuss “disincentives to sex in married women” (Sims & Meana 2010). Dr. Meana has a PhD from the University of Nevada, Las Vegas, and she was the presenter. The first of three most likely disincentives to sex for married women is fatigue and energy consumption. The women surveyed felt like the amount of energy it would take to make love wasn't worth their time or effort. The second factor was boredom. Basically, this was when the woman felt that her partner knew what worked and went to that technique quickly and finished quickly. It was thought of as “animalistic,” and the women in the study reported that despite having opposable thumbs they didn't feel made love to, but more likely a physical recipient for their partner. Thirdly, and most prevalent, was a negative body image. Women worried about whether their partner was looking at their cellulite, seeing their fat roll, or fantasizing about larger breasts than they actually had.

Glamour magazine recently reported on a survey in which more than 300 women of all shapes and sizes reported on what they say to themselves each day. The average was 13 brutal thoughts about their body each day. That wasn't all. Many reported more than 100 each day. Can you imagine what you would feel like if you told yourself all day, each hour how ugly, fat, stupid, or skinny you are? Anne Kearney-Cooke PhD, who has done expansive research in this area, says it is not surprising. More and more we are conditioning young girls to worry about how they look, compare themselves to friends, and to look like the celebrities they see on TV and read about in teen magazines. If women now in their 30s, 40's and 50's feel the pressure of not looking good enough, or being valued for their beautiful curves and body shape, can you imagine what the next generation will feel like? Facebook, MTV, reality TV, as well as most magazines tell girls and women what they are supposed to look like. There is a correlation between how we feel about our bodies at the age of 9 and 10 and when we are adults. That correlation is going to influence whether or not women can enjoy having someone love them, and be sexually healthy as adults.

The International Society for the Study of Women's Sexual Health has begun a major push to study women because most of what we believe is true with women's sexuality was based on what is true for men. We are finding the sexes are very different in their experience of sex. Women have many excuses not to engage in sex. Many of these excuses have nothing to do with their partner. Their rejection is mostly of themselves. Medications and counseling may help some women deal with their feeling depressed or anxious with low body image, but these methods may not cure or prevent these feelings. We need to begin thinking about what we are telling women about their bodies. What are we telling our children about their bodies, and mostly what are we saying to ourselves when we talk to ourselves?

Below are a few suggestions you can begin to work with this week. The easiest way to begin is to set aside time each week to work on improving your body image. People who feel good about themselves are happier, and more successful at work and in their relationships.

1. If you are a parent, watch what you say in front of your child. Many children parrot what they hear their parents say. If you walk around the house talking about your fat thighs, or split ends, you make your children (especially daughters) more prone to being critical of her flaws.
2. For everything you say critically about your body, tell yourself one good thing. For example, if you are talking about your “roll around the middle,” make note out loud about your beautiful eyes or smile.
3. Your body hears everything you say. I don't know how it happens, but people who continue to berate themselves actually seem to exaggerate the flaw they berate. I have watched and listened to obese patients who talk about how “fat” they were, and they continued to gain weight. The body reacts to what you tell it.
4. Movement and body awareness is so important. Touch your body, learn it. Exercise helps women feel so much more capable and confident. You don't have to run a marathon, but you do need to feel the euphoria of a brisk walk or swim.
5. Many times, what you don't like about your body is something you don't like about you. If you are at a party and like a particular person, all of a sudden you become very self conscious about your nose. Your nose didn't change at the party. It is your insecurity in yourself. Try to address the real issue. Being afraid of rejection is different than hating your nose.

Working with couples who are struggling with intimacy and sex is difficult if we don't address how women feel about their body. Most men would agree with me, that they rarely reject a naked body. However, that may not comfort women. When a woman doesn't feel good about her body, she doesn't feel desire for her partner, nor does she feel desirable. Understanding women's body image battle may help men feel less rejected when she says, “Not tonight, I have a ___________________” (any excuse will do). After attending that conference, I am quite confident that the best thing a man can do for his partner is to help her in any way he can to feel better about her body.

If a child is overweight or underweight, the first person a health care professional turns to is Mom. Mom is usually responsible for what is served at the dinner table and for what foods are brought into the home. Although dad is starting to fill this role, a new study just published in The American Dietetic Association found that “school-age children whose mothers tightly control their diets may be prone to overeating, while those with moms who pressure them to eat tend to be picky about food.” Moms often say the reason they restrict certain foods is because their child has a weight problem or the reason they force foods is because their child is underweight. What the ADA announced is nothing new. Many articles have laid the blame on moms before. However, now there is evidence supporting moms. Maybe she is reacting to the child's problem that came first, but is inadvertently making it more likely her child will grow up with a weight problem that will carry over into their adult life.

Research from a new study with Dr. Jane Wardle and colleagues at the University College London surveyed 213 mothers with children between the ages of 7 and 9 from five London schools. The mothers completed a questionnaire that asked about their children's "responsiveness" to food. That is, whether the child would typically overeat if given the chance. They also looked at signs of food "avoidance," like eating slowly or routinely failing to finish meals. Moms also kept track of their own mealtime strategies, including whether they tried to get their children to eat even when they said they weren't hungry or whether they believed their children would overindulge if they were given no eating restrictions.

Dr. Wardle's team found a correlation between mothers' pressure to eat healthy and children's degree of fussiness over food. Similarly, mothers' restriction of food correlated with children's responsiveness to food; the more restriction, the more likely mothers were to say their children would overindulge if allowed. These results were seen regardless of the child's weight. Dr. Wardle and her colleagues concluded that moms were responding to what they saw in their child. If their child was underweight, it was a mother's worry for the child that made them force feed, where as an overweight child caused mothers to restrict food.

Most health experts continue to suggest getting your child interested in healthy food from a young age. The American Dietetic Association recommends offering colorful foods to your young child and staying away from fast food restaurants or places where there is distraction. My work with obese adults has taught me several other tips to help parents encourage their heavier child to make wise choices at mealtime.

Tips from my weight loss surgery patients:

1. If your child is heavier, don't criticize or comment on their weight, especially at meal time. Keep meals a time to connect with family by talking about what your child does that is kind or helpful. Most obese adults remember meal time being stressful and, therefore, began eating more and hoarding as a means of comfort.
2. Don't compare your kids. Siblings grow differently. When one child is favored because they are thinner, the heavier child begins to see body size as part of their self worth.
3. Kids are watching you. If you are eating bad foods and give your overweight child healthy or steamed food, your child will become resentful of you and develop self-hate. If you are asking yourself why your obese child has low self esteem, compare what you are eating to what you are asking them to eat.
4. Get rid of junk food for the whole family. It is toxic and NO ONE should eat it regardless of their weight.
5. If you tell your child to exercise when you don't exercise at all, it is analogous to telling your spouse not to spend money and save while you spend money with total abandon. It doesn't work.
6. Lastly, love has nothing to do with size. Keep the focus on what a great person your child is. When you talk about weight, keep it correlated with your child's health. Make a family plan that the whole family will get healthier.

Growing up with a weight problem is complicated. It has to do with genetics, food, and one's relationship with food. There are correlations with sexual abuse, obesity and anorexia. If your child has a weight problem, begin by doing an inner-search as a parent. From there, elicit the help of your pediatrician as well as a dietician and counselor. Go back to preparing food at home. Make family dinners sacred and involve the kids in preparing meals each evening. Children who grow up appreciating different foods and experimenting in the kitchen learn that food is fuel. They learn that family and friends comfort and love you, so food won't have to.

One of the most common things I hear patients say after weight loss surgery is, “Why do I still feel fat?” This may be said years after the patient has lost weight. They continue to wear baggy clothes and judge themselves as inadequate. No one can fully comprehend how obesity affects people. Many don't realize how obesity can cause not only self hate, but also self incrimination. It is easy to understand how society and well-meaning family members may have hurt the obese person's sense of self. However, little is known about how the obese person tortures themselves due to their weight. In a sense, they have become numb to how cruel they have treated themselves. Research suggests that people who undergo major weight loss may experience improvements in appearance satisfaction, though not necessarily as much satisfaction as someone who was never overweight. Negative tapes are not easy to extinguish, and most overweight people have lots of negative tapes.

Experts say part of the problem in our body-obsessed culture is that many women (and increasingly more men) have very unrealistic expectations of what weight loss can do for them. Too often people think hitting their ideal weight will make them look like a movie star or a model. They are then disappointed when that's not the case. Add to that the fact that many overweight people were told things such as, “You have such a pretty face, if only you lost some weight” or “If you don't lose weight, no one will want to be with you.” Weight, rather than whom you are as a person, becomes the focus. When you begin to think this way, you project all of your faults or weaknesses onto your weight. When you lose the weight and your life isn't perfect, you focus on your body and become critical of the way it looks. Maybe your buttocks isn't plump or you have more of a boyish look and aren't curvy. You tell yourself you need to lose more weight because you are not perfect yet. The issue has nothing to do with you weighing less, it has to do with adapting to your changed body and developing other areas of interests.

Along with this idea of perfection being a certain weight are the past attempts of weight loss these patients have gone through. Most patients that are overweight have experienced several weight fluctuations. They first experience a sense of success and then the incredible impact of failure. After bariatric surgery, they are very aware that this tool can fail if they aren't vigilant in regards to their lifestyle. Most of them have great difficulty giving their “fat” clothes away. They ask themselves, “Is it safe? Will I go back?” This is a rite of passage. Some patients go through it quickly while others evaluate every pound before giving their clothes away. Some of these patients are more comfortable dressing in big clothes for a long time, just in case. They are unsure that they are as thin as the scale claims. This takes time. It is like walking on a thin plank; falling is a step away.

How can patients learn to adjust to their new size with a greater sense of confidence? Below are a few suggestions:

1. Counseling will help you realize where you have been. Knowing this will offer you greater understanding of why you are feeling this way. Making changes will be easier if you understand yourself more completely.
2. Tracing your body once a month will help you visualize the true reality of what your body looks like.
3. Writing your thoughts or starting a journal will help you understand how you used denial in the past to cope with your weight. This will make it less likely that you will see your body unrealistically.
4. Taking photos of yourself each month will help you see your body more clearly. When people are obese they begin to look at their body from the neck up; rarely do they see their whole body.
5. Praying and praising your body for what it can do will help erase some of those negative tapes in your head.
6. Attending support groups offer you objective advice from many people who struggle as you do with their weight. There is knowledge and power from being with others who share the same journey.

The journey of weight loss is a challenging one. It involves the mind almost exclusively. Most journeys have a beginning and an end. The weight loss journey is unique in that it is ongoing and takes on a life lesson all its own. How you view your body affects how your children will view their body. Begin today to make a peace with your body. Choose to celebrate your body in all of its incredible abilities. The only person who knows when you are perfect or no longer “too fat” is you. Give yourself permission to be perfect today.

I work with people who have struggled with morbid obesity most of their lives. Many of these people have never gone to a prom or a homecoming dance. When I talk with them, they have memories of not joining clubs, not being chosen for class activities and feeling criticized by their family and peers. It is no wonder that they struggle with dating as they lose the weight. They are unsure of themselves, and although many of them have had success in careers, dating scares them to death.

I begin helping these patients build their own sense of self. When you have struggled with obesity, this can be an arduous task. Our society is prejudiced with obese people and, for the most part, they get labeled with being lazy, lacking will power, and not being smart enough. Building up their confidence correlates with watching their bodies transform as they lose weight. Many of the people who get weight loss surgery lose weight so quickly that they are stuck in the “obese mindset” even though their body is normal weight. It can be years before their head catches up to their “new” thinner body. Teaching charisma to people is one way they can build confidence and feel more secure on the dating scene.

Charisma is something anyone can learn, and it exudes a confidence that makes people walk toward you rather than away. It is about being able to relax in your own skin and feel comfortable with being you. You can achieve charisma by being brought into the world by loving parents and having a receptive, supportive extended family. Many people don't have that. If you struggle with obesity throughout your life, it is likely society has not embraced you. If you feel ready to date, but aren't comfortable with a person focusing on you, then these quick tips may help. Building charisma not only helps you with dating, but it may help you get your dream job too.

Quick tips for building charisma:

1. Relax. People are drawn to others who manage to be calm in their surroundings, as well as their own body. When we are around anxious people, we often find ourselves getting more anxious. On a date or at an interview, remember to take your time answering questions and focus on listening to the other person.
2. Focus on thinking of yourself as a “peer.” Many people who struggle with weight become judgmental of others. This is a survival mechanism for them. They look at others as possible people who can (and many times do) hurt their feelings. If you are going to be charismatic, you need to stop this. You need to begin seeing yourself as everyone's peer and possible helper. You can achieve this by telling yourself that you are here for this person and for a purpose. This will help you get out of your fear, and more into focusing on what the other person is saying.
3. Sit up straight, the idea is not to blend, but to make a point. When people struggle with obesity, they want to blend in so they aren't noticed. Charismatic people are noticed, and you will be too when you improve your posture. Sitting up straight in a chair or walking with your shoulders back will accentuate your weight loss and also make you feel more confident.
4. Be true to what you think. Your job is not to agree with others so you won't be noticed or ridiculed. Your job or self-purpose is to be true to yourself. Others are attracted to people who stand up for what they believe while tolerating other's ideas. Many times, obese people I work with are lost in their beliefs. They never felt it was okay to say what they wanted. It's okay and I encourage you to speak your mind.
5. If your weight loss is relatively new and you want to practice online dating or applying for a new job, I suggest you have someone close to you write your profile. Your profile reflects whether or not you feel good about yourself. People that read it, judge it. It's difficult to be enthusiastic about “YOU” if you don't feel good about “YOU.” Until you are feeling comfortable and healthy about you, let someone else help promote you.

One of the most exciting parts of my job is seeing the transformation of people as they lose weight and gain confidence and charisma. It is scary for them, and yet the joy they experience when they see all aspects of themselves that were hidden under the obesity is incredible. I am not sure how obesity begins, or is kept in place, but I am sure the elation of knowing one's self and feeling comfortable in that self is one of the most important passages we can make.