The Truth About Body Positivity (It’s Not What You Think)

On this episode of We Got Your Number, we sit down with Francesca Emma, LMHC, founder of The Collective, to unpack one of the most misunderstood struggles today: body image.

From GLP-1 weight loss medications to social media pressure, Francesca breaks down why changing your body doesn’t fix how you feel about yourself—and what actually does.

This conversation dives into the psychology behind weight loss, the rise in body dysmorphia, and why so many people still feel unhappy even after physical transformation.

We also explore:

- The truth about “body positivity” vs. body neutrality
- How social media and filters distort reality
- The mental health risks behind GLP-1 misuse
- Men’s hidden struggles with body image
- Why therapy—not quick fixes—is the real solution

If you’ve ever felt like “fixing” your body would fix your life… this episode will change your perspective.

🔔 Subscribe to the podcast on YouTube https://www.youtube.com/@WeGotYourNumberPodcast
 📲 Follow us on Instagram: wegotyournumber_pod
 📩 Contact / inquiries: info@wegotyournumberpodcast.com 

The content shared on the “We Got Your Number” podcast is for educational and informational purposes only. It is not intended to provide medical advice, diagnosis, or treatment. Always seek the guidance of your own qualified healthcare professional with any questions you may have regarding your health, nutrition, or medical care.

Transcript

SPEAKER_01 0:00

Welcome back to the We Got You Number Podcast. We have such an amazing guest and such an amazing conversation. Francesca, who I've had the privilege of collaborating with over the past year. Her private practice is the collective, but you have so much more to tell us. So give our audience a little info on you, and then let's get into some of those hot topics.

SPEAKER_02 0:19

Thank you guys for having me here today.

SPEAKER_03 0:21

Absolutely.

SPEAKER_02 0:22

My name is Francesca Emma, LMHC. I am the founder of the Collective, which is a psychotherapy practice for women and men who appear fine on the outside, but inside are slowly unraveling. I spent the last 15 years really navigating body image and what that looks like for women and men across their lifespan. And so I'm excited to be here today and have this conversation because as we know, body image has taken center stage yet again.

SPEAKER_00 0:47

Absolutely. It's wonderful having you here, Francesca. And uh Allie, go ahead and hit her up with some questions.

SPEAKER_01 0:53

Yeah, so I mean body image I think is the topic, right? Because I, you know, medicine has evolved, right? We have gotten to the point now where we have medical interventions for many things. Um, but what we don't have is the cure for bad body image. And what we need is proper tools for better body image. Um, so we'll start with our first topic. We talk a lot on this podcast. What do we talk about? We talk about plastic surgery, we talk about menopause, we talk about GLP1s, we talk about nutrition, we talk about hair. But let's first let's start with talking about weight loss. So we're living in weight loss culture, right? And you know, you see my social media, I love supporting patients on GLP ones. But I also understand that there is a need for a cognitive support and approach, and I want you to talk to us about that.

SPEAKER_02 1:44

Yeah, so it has definitely changed the name of the game in mental health right now and body image. And when we talk about body image and GLP ones and weight loss in general, what we have to keep in mind is where are the motives for our clients in terms of their weight loss? Are they trying to get healthy? Do they have narratives that need to be shifted? Is their insulin level in a bad place or what's happening for them? If those are not the issues that we're looking at, and instead, if we are looking at a woman who already weighs 125 pounds but wants to hit that 120 magic number, we have a different story. Okay? And so we have to look at the narrative behind why is this body image so important? What are we trying to assess from this? Once we do that, then we can kind of go down and give them the tools they need to understand is this going to be a helpful tool for you, or are you trying to beat the system and find some magic way to feel better? That's not gonna happen, right? The GLP one is not gonna give you some magic way of feeling better if you don't feel good about yourself on the inside.

SPEAKER_00 2:42

So is that a um oh yeah, I you know, we've we've for many years we've talked about women wanting to have an idealized uh weight, and and the GLP ones have exacerbated that, and so is social media. Absolutely. So you know, and young women and trying to keep up and on that data. And filters. I mean, what you're seeing. So how do you how do you um uh how do you get them on the right track? How do you you have to do you have to take it all apart and go back to the bottom and try and stabilize them or you you you you you therapize them?

SPEAKER_02 3:15

Well we don't therapise them. We try to get them to really see what's happening inside for them. So if a client is saying to me that weight loss is super important, I'm gonna break it down. Why? Why is it important? What are you looking to get out of this, right? And if they're telling me I can't move the way I want to, or I can't do the things that I want to, then okay, let's look at that from that lens. But if we're saying I want to look like so-and-so, and you're looking at a person whose body doesn't fit that narrative, we have to look underneath and say, what's going on here, right? And so, like I said earlier to you in our conversation, nine out of ten women, when I asked them, were they happiest at their thinnest, the answer is no, right? Because at their thinnest, they were manipulating so many pieces of their lives and their mental health was distraught, as well as their physical health, right? Because the means that they were going to to get to that low weight, those were exasperating them. So instead, we take a fluid look at is there a real basis behind this? And then how do you feel about yourself as a bet as a person? If you weighed 150 pounds, if you weighed 200 pounds, what are you feeling? What's the motive behind that?

SPEAKER_01 4:16

So good. Yeah. Yeah. I think you know it's important, I think, from like a nutritional perspective, and that's why we follow body composition. We live in a world where everyone kind of wants just like a piece of the pie, right? So now, of course, GLP1s, which we are, you know, extremely happy about, and we follow the science and the data and the clinical trials and all of these amazing health benefits, but they are intended for overweight and obesity. And um, following body composition, we can see if someone has inappropriate body fat mass and inappropriate visceral fat. Yes. We can have if they have appropriate muscle mass. So, you know, for that patient that fits that criteria where they have a perfect body composition, it may not be their version of perfect, but it is appropriate. It is not of medical risk. And I think that that's the individual that, you know, is maybe taking a little bit of the light away from the person that does really need it, right? If we if you have a body composition where you have strong muscle, you don't have inappropriate fat, you're not dealing with comorbid conditions, that's a different individual than the person that is struggling so hard and for the first time in their life can have a normal relationship with food. And the abuse is the problem. So I'll say one thing about abuse, and then I need to throw it back to you, right? So I can tell you right now, the abuse is not coming from my circle. It's not coming from Dr. Romo's circle. It's not coming from the brilliant physicians that we work with that have said that have put their life's work into studying physiology and medicine. And I'm never worried. I work with Dr. Dina Peralta, reach at New York weight um wellness medicine. And I'm never worried that the patient that's coming to me is inappropriately being prescribed ever. But what do you see? Because you don't see that. Oh no, I don't.

SPEAKER_02 6:01

Well, I do see that in some cases, which is wonderful. And I and I applaud that. Right. Um but I also the spectrum. Yeah, with the spectrum here. But I will say what I see often is women who are getting it from aestheticians or NPs um who are doing their Botox and at the same time want to, you know, oh, I want to lose some weight, here you go. And which, listen, is okay if not okay with that if they have the medical background and understanding about it. But what happens is those people are being thrown to medication without any direction of what to do with that.

SPEAKER_00 6:28

And telehealth too.

SPEAKER_02 6:29

Telehealth too, online, online from God knows where, like just insane places that they are accumulating the opportunity to get this. And then no nutritional direction, no medical guidance. That's the scary part that I'm seeing, right? I'm seeing those women who are not then trying to build up their muscle mass, who are not eating appropriately. And the byproduct of that is a deteriorating body, but also deteriorating mental health. They are still not happy. And there are some people who are saying, I am happy, but then when you dive a little bit deeper, they're not. They're suffering on some type of level. I've seen a lot, and I think I spoke about this online recently, is that there's an addiction component that comes from it as well. Where then they the body dysmorphia begins to escalate, and they never see themselves for what they actually are. And there is a huge, intense fear of stopping the drug.

unknown 7:13

Right.

SPEAKER_00 7:13

So how do what type of therapy and what do they need? I mean, what is their treatment? They need a pill, they need a shot? No, they don't need that. They need therapy. They need therapy with me. No, no, no. Okay, no, no, but I mean, they don't we don't know. That's this is cutting edge. You know, GLP1s, we're starting to see things really, really from as a physician, physiologically, there are optic neuritis that's occurring. And if you're getting it from telehealth, I mean, you know, people are actually going blind.

SPEAKER_03 7:36

Right. No support, no support.

SPEAKER_00 7:38

I mean, there's but and that is important, it's most important, but also how do you change their mental um as a physician and a surgeon? I can't change their mental component. I try and stay away from them actually, and have to do my due diligence of that.

SPEAKER_02 7:52

Well, I think if you have a client who's on the who you notice is on the edge of something or who maybe isn't the ideal client and they're being prescribed that, you direct them to a real body image specialist. So I have a lot of clients who walk in my door. Well, I went to therapy and I'm fine. And those aren't people who actually are asking the questions like, what happens when you can't exercise for a day? What happens if GLP1's magically disappeared? Those types of questions where you then get to see the intensity of the relationship with the drug, that's where we want to look at. And in those questions, we then start to do the work. And the work is self-confidence boosting, self-esteem, learning those types of things, finding that internal space. We could do that cognitive behaviorally, we can do that somatically. Like there are many different methods depending upon the client that they're going to work with, but it's a real re-examination of the body. And the goal is not body positivity. I think we hear that all the time. It's like, let's love our bodies. I love my body. It's body neutrality. It's understanding. Oh, that's a cool term. You are not gonna love your body every day. Right. I'm a woman and I think I'm here sometimes, and I don't like what I think. But then I ask myself, what's happening today? Like, what's going on? You know, come up for me at work. Those things are playing a role in how I feel like that. Right. And I have the capability to step away and say, okay, it's a bad day, whereas other women perseparate, they restrict the educated curve, they find whatever to do to blame it on their body when they eat out 10 times. Right, and what they're seeing as different. So being able to reconnect, I am huge on mind-body connection. When you can connect the mind to the body and start to see how your mood is affecting your body image or the way that you're seeing yourself, that's where the goal is for us, right? Connecting that and saying, okay, today's a bad day, but my body is doing all the things it needs me to do. My body's letting me walk, it's letting me work out, it's letting me do my job. Today's not a great day, right? And then other days when I look in the mirror and I'm like, hey, I look good today, great. Like that's the body positivity we want to see. But it's not gonna be 100% of the time. Let's be realistic.

SPEAKER_01 9:45

Yeah, that's really important because I think that um, you know, people think that they have to be their perfect self 24-7, and then when they're not, it's not human, um, it's it's really hard for them to face that and and accept it. I something that I really like that you said is that right now, just in general, body positivity, it we've kind of shaken that up. So, what does body positivity mean to you?

SPEAKER_02 10:09

To me, it's that unrealistic expectation, just like all this perfectionism that we see online, that comparable that I have to love my body all the time. My body always has to look a certain way. And I think if you look hard enough, social media has great options out there where you see women who are actually showing what their body looks like during different stages. Let's just even talk the menstrual cycle, or I know you guys love the menopause talk. Like the body shifts and it's not always going to look the same. And so instead, taking away from that idea that we have to be positive all the time, and instead, like I said, that neutrality towards it and really just learning to love yourself outside of what your body is. It's a little bit cliche, but it it it is the truth. Uh, and those people who have that ability are going to feel more positive about their bodies overall.

SPEAKER_00 10:53

So if the mirror and uh the social media are causing the problems, which they are, maybe get rid of the mirror and cut out the social media, uh then you wouldn't see that every day. Uh I mean, you don't stand in front of a mirror and examine yourself.

SPEAKER_02 11:06

I do a lot of work with raising body confident kids because I feel it really starts at an early age. And now at this point, a lot of women are being re triggered by this is the 90s, it's coming back up again, right? Like for a little bit we had the we had the different types of bodies being exposed, but now we're back to that wave thin. And so parents are now being triggered, and we have to monitor that for their children, how they are talking to themselves, right? How they are looking at themselves. So we're not gonna take the mirror away, we're not gonna even take social media away, because realistically, it's just not gonna happen. But what we're gonna do is we're gonna help people curate feeds that show these positive things, that have these kinds of conversations on them. And so I tell parents, sit with your kids, look at what they're looking at, right? Watch it and then see how do they feel, how does that make them feel? Talk to them about filters, talk to them about AI. I mean, now we really don't even know what's real and whether or not they like it. It's like so scary. And you know, when we were growing up, and I'm gonna age myself here, but it was magazines. So yes, there was some airbrushing happening, but it was what it was. And we also were not looking at them nine hours a day.

SPEAKER_00 12:07

Exactly. Uh how about uh cultural? I mean, you know, there's uh there and and different uh cultures have different uh Yeah, send me to Italy, please.

SPEAKER_02 12:17

And I use Italy as a as a space because I spend our s I spend a lot of summers there. But last summer I was there. And if you go on the beach in Europe in general, but in Italy particularly, right, there is women of all different sizes, all different shapes, in very small bikinis.

SPEAKER_03 12:31

Exactly.

SPEAKER_02 12:31

And there's no one piece. If you're a one-piece, you're an American. We shouldn't, yeah, we shouldn't explain the conversation to just women. But you know, there is much more comfort level in that culture around the differing bodies, right? Because culture allows that. There is a beauty that's seen within the different body types. So no women are walking around covering themselves up. They just are existing. And it is a beautiful thing because that's a culture that highlights food and love and compassion in that way. And so it's like a lightness. Like I loved what, and interestingly enough, watching my teenagers' reaction to it. Like it didn't feel comfortable for them. Oh, yeah. And I had to challenge the idea like that's an American culture problem. Right. Right? That is an American culture problem where we are only looking at one image, and that's the only image that people should be.

SPEAKER_00 13:20

I was talking to my wife when she was in Sweden with her girlfriend, and they went to a nude beach, and uh everyone was just took their clothes off. And my wife was shocked. She just couldn't believe it. Uh you know, because it's uncomfortable for us. She ran and hid under a towel. You know, it's it's it's it's the way we look at ourselves, I think.

SPEAKER_02 13:37

Yes, and it's the shame that we are built to have if we don't model in that space. And then, you know, the menopausal just ignites it even more because that body, your body is sort of unrecognizable for a little bit.

SPEAKER_01 13:51

Right. I think also, you know, the body changes, and then what do women do? They're like, oh well, I used to restrict in the 90s or the 80s, right? So, like, let me do that. And then they're really mad because they do that, but they're like, wait, it didn't work this time.

SPEAKER_02 14:06

Oh no, and it is causing havoc on me. I mean, I just posted this. It's like my skin is aging, my hair is falling out, my hormones are dysregulated. Restriction doesn't work anymore. Like maybe at 18 that worked. Yeah, it's not gonna work anymore. And that's why seeing someone like you, Dr. Ali, is like what are what people need because they need to understand that they actually need to eat more.

unknown 14:25

Right.

SPEAKER_02 14:26

What about the real protein?

SPEAKER_01 14:27

Yeah. Yeah. Yeah. Yeah. And I mean, you know, we say, and I think it's it's still not the most well-received message. We understand, okay, you have to be strong instead of skinny. You have to be strong instead of skinny. Yeah, from a theoretical perspective, I do agree with you, but now go convince that to somebody that spent most of their life not doing that. That's where that's the barrier. You're right. I feel I've been feeling so powerful lifting weights, um, and I'm happy that it's a habit that I've developed younger. But if that hasn't been someone's habit for a long time, they still struggle when the number goes up on the scale of its muscle. So I think that the message is great, but it's not received because it doesn't align with their internal value.

SPEAKER_02 15:07

Absolutely, because they put so much value on that metric, right? What that number says is so valuable. Um, and that is also another real marker that we work on in therapy, too, is like re reducing the number. Like, you don't need to step on a scale, right? Something like an in-body where you're seeing compositionally numbers that like work metrics, that's different. But when you're looking at just this number that is just actually the gravity that you are against the world, um, it's paid so much forceful attention in so many people's lives for so long and put controlling of their lives, and we have to like definitely reteach that.

SPEAKER_01 15:37

You know how many times I cover the scale? Like, I have a little book right next to my body composition scale, and especially when I'm making a connection with a new patient, I say, Would you like me to cover it? And they're like, How did you know to ask me that? And I'm like, Because this journey before, yeah. Right, this journey is not about self-hatred or focusing specifically on a number, it's about changing behaviors and patterns. And of course, if body composition changed in doing so, then that's a benefit. I want to talk about um the re-emergence of um mental health conditions in this perimenopause menopause. I saw, I went to the Menopause Society Conference and I saw such a cool chart. And essentially, it was um just different moods that women will experience during menopause. And I and I have to say it was like the most cool abstract art I've ever seen. It was like up down, up down, up down, up down, up down, right? Um, so what do you see like in this transition when their hormones are doing up down, up down, up down, and their moods are as well?

SPEAKER_02 16:37

Yeah, there's so much rage and anger, and there's also and it's all displaced, right? So they are their emotions are displaced because they feel unlike themselves. I mean, how many people have walked in your office and say, I don't feel like myself? And then how many doctors have they said that to who have paid them no mind? So I think it's really the validation to the clients that are walking in at that stage. Like, this is, yeah, you're experiencing all of these things, and there's a scientific reason why you are experiencing those. So educating the clients on that and helping them to understand how do you take control, right? I always say control the controllables, like a good friend actually taught me that. And I yeah, and it's like you're not gonna be able to control all of that happens in the wave of menopause, but let's think about the things that we can control and take notable actions on those things, right? So once they get a sense of autonomy, I think there is an improvement in their mood. For those clients who've never tapped into their mental health, it's a little bit more of a long road. Uh, but for the clients who are a little bit more self-aware, I think that really helps move the needle for them. And then they do, like what you were saying earlier. I wanted to interrupt and just say instead of the number, instead of all of these other things, like how about tuning into how you just feel, right?

SPEAKER_03 17:40

Right?

SPEAKER_02 17:40

So when you're coming to see you and they're not tracking that number, but all of a sudden they're doing what you say and they just feel better, they have more energy, their hair's not falling out. Like, those are the markers that we want them to tune into. Similarly, in that menopausal mental health, you know, collide, it's like, where do you start to feel better when you're starting to take care of yourself? And most of the time, these are women who have not been taking care of themselves primarily, right? We're seeing these women right after their childbearing ages when they've put all of their energy and effort into someone else. And so all of a sudden the flip has to switch and it has to go back to like, I I need me.

SPEAKER_01 18:13

Yeah. And oftentimes when women decide I need me, they end up at Dr. Romo's office. Yeah. Thank you, Dr. Romo. And the reason I say that is because um we're really big on giving patients like the all the resources that they can have, right? So let's say a woman wakes up and they're like, you know what? I would like to change this face. This isn't the face that I recognize, this isn't the face that I had 20 years ago. And they show up at your office. What do you hear from them? What are what are those uh thoughts that they're having when they're coming to see you? Are they excited? Are they nervous? Are what are those feelings?

SPEAKER_00 18:48

All the above. Uh there it's if we go back, and and since I have an I I train residents and fellows uh how to do this, it's not can you do it, but should you do it. Right. So it's it's a surgery you know, surgery is pretty commando, so it's it's again um and what you need to do is drop back, listen to the patients number one, be sympathetic, uh uh take in uh what their concerns are, and then go back to being a physician again. Uh uh. Make a diagnosis, come up with a treatment plan. Uh from more simplistic to more complicated. Uh and and educate them and and and also assure them that um this isn't a kidney transplant. You don't have to do a facelift. You you may need a kidney, you really may need a kidney. But this is something you need to go and think about. This is something you can do in in parts segments, uh do the upper part, which Ace is usually a decade prior to the lower part of the face. Uh-uh, uh, uh, uh, you can do it segmentally like that. And and you don't have to make it uh it's not emergent. Uh listen to them. Um really kind of what's driving them. Um it goes both ways. You you you want to ha you want to have a happy patient at the end of the day. Uh-huh. Um and it's not a it's not an emergent thing, so it's something that they're going to live with. And if you have enough experience, and I've been doing it a long time. But you really have to listen to your patients because before uh I I have a patient and she's got body dysmorphic syndrome, um I have to pick that up.

SPEAKER_01 20:17

Right.

SPEAKER_00 20:17

And so physicians, uh plastic surgeons particularly, really have to have that touch of uh a therapist's and listening in the other ear going like this woman's never gonna be happy. Wow, why do that surgery? Why make you're not gonna make her happy and you're not gonna make your own life happy? And and there's no r reason to do that. And maybe go to therapy. I have a patient I saw this week who uh it's funny, I talked to a friend of mine who's well connected uh in New York with psychiatric community, and I asked her, um, uh, do you have a psychiatrist that I could uh he has um drug addiction uh and he needs a he needs a therapist as well. And she was kind of explaining to me uh those are kind of two different kinds of problems uh need to be addressed by uh uh someone who handles addiction first and then handles the other problem. Um for me, surgical intervention is not the way to go at this point. They need they need to optimize, just like with you, and we've been talking about this for so long on We Got Your Number podcast, uh optimizing their weight, uh going into surgery, uh their health, the physiology. All patients are checked and cleared by their uh internists or doctors. Um and and mentally you want to be the same way. Um you want those patients to take them on that journey and and and be involved because it is, it's elective cosmetic surgery on their body, uh, and particularly like I do a lot of face uh and facelifting. Um you're you uh I I I it's a funny thing. I make it up because I know I'm right up there with their hairdresser and their makeup on this stuff and their facelift doctor. So I mean, you know, I can't, you know, in the modern era that's where I am. But at the same time, you want to be attentive to their feelings and make sure you can. Support them through that period when they don't look real good because a week after surgery and then you they look pretty beat up. It takes a couple weeks before they're going like and and and there are well recognized uh problems where you really need to be supportive because patients get into this point and they're by themselves or something and they're going like I look like crap and I did this to myself. What was I thinking? And they got to be able to get a hold of you, and you gotta be able to be attentive to them and say, look, this is part of the process. Let it let it heal. Get some time under your belt. You're not having any complications. This is just part of the healing process. And on the body, it's easier to hide than on the face. So it's it's stuck out there, and um and just support them, give them the support that they need. But having someone like you around will help before the surgery to make sure you're not operating on people that aren't stable.

SPEAKER_02 22:51

Well, the first thing that comes to mind though, too, is like the person who's not stable, that post-op week, I mean that must be a hell of a week for those people because so being able to tease that out, and I love that you're saying as a surgeon, you think about that because there are surgeons who will continue to do surgery on women who are not mentally stable and who are trying to continue to do those things. Uh, but being able to have insight into it, I just think it's a good idea to ask the question, like, why, right? What is this gonna accomplish for you? And if it's just, hey, I wanna look like this and raise myself esteem, and I've been okay, right? Like women have autonomy to do what they want to feel the best. I truly believe that. But it has to come from the right place.

SPEAKER_01 23:27

Let me give you guys this made me think of, and it's it's a great example, bariatric surgery, right? So in the process of doing bariatric surgery, there's many specialists that you have to see. Um, you know, pulmonologist, cardiologist, therapist, dietitian, um, general physician, and so on. But um, there's a question that I would always ask, because I have worked on teams that have cleared a lot of bariatric patients for surgery, and I will ask them when they sit down in consultation number one, what is your relationship with food and what is your relationship with your body? And they'll look back at me and say, I'm fine. Oh my god. And then we'll opt a therapist. Right, and we and then, you know, it it really is kind of trying to catch those red flags. And I think that the reason that it becomes so important is because I work with many patients pre-operatively, pre-surgery, even before starting a GOP1 medication. Okay, you go through the steps, you have the surgery, you start the medication. Now you come back to my office after you've had the surgery and you're bulimic and you don't see what you see in the mirror, and now you're not only having psychological distress, but you're also having medical problems. Yes. Um, and oftentimes I get those patients where I never really about I I never got to see them until after they had started the process. Um and I looked at them and I go, Did you struggle with this before you had surgery? Yes.

SPEAKER_00 24:56

Well, that's one of the things we need to uh like many things uh in in medical training, bring that part out, bring that psychological and mental mental uh health evaluation uh as part of uh you know, you it's once you get into surgery, you're kind of like commandoing, so you've got to be pull back and realize you're dealing with the whole patient. From your point, you're inside and you're outside.

SPEAKER_02 25:21

Yeah, yeah, yeah. And and it that happens so commonly. And I think it was happening more pre-GLP1s, I would say. We were seeing I was seeing more of that, but people who would come into my office post-surgery and have horror stories of what that post-surgery, I mean, yeah, post-surgery looked like because it was just they couldn't manage, they had this big surgery, and then they were still back at square one.

SPEAKER_01 25:40

Well, so something I want to talk about is um for patients on GLP one medications, like I said, life-changing intervention, but it doesn't it helps, right? We understand GLP one saturate parts of the brain and it helps with food cravings and food noise and all of that, but it doesn't fully take it away, and your brain is so strong and powerful. So, okay, I send I send a patient to you where they have a beautiful medical intervention, they have a beautiful nutrition intervention, but they're still binge eating. What do you do?

SPEAKER_02 26:12

Well, we start with the behavior, right? So we start honestly, we have to start with the behavior, but the behavior in and of itself is not gonna be the fix, that's gonna be a short-term fix. And so once we nail down the behavior and get them sort of on a baseline, then we kind of go underneath and examine their relationship with food. And the relationship with food is so indicative of people's other relationships in life. Like I go often into other practices and just talk about ask that question at an assessment, even if you're not thinking about an eating disorder, because you'll be surprised at people's responses to this. So it's like, let's not shy away from it. It holds so much relevance. So then we dive into where did that relationship with food start, right? What were the patterns that you grew up knowing? What were your self-confidence? What do you see as your strengths? You know, I always ask clients, what are your five least favorite things about you? And it's like and they list like 20 things. And then I say, What are your five favorite things about you? And I get like, uh, my eyelashes, my hair. And I'm like, what about you? Like you, and what what would your friends say are your five best things about you? Oh, I'm friendly, I'm trustworthy, I'm like ding ding-ding. Like you have to, so it's reconnecting to that, to having them see who they are outside of this external world, making the external match the internal, and then kind of that's when they can release those urges and abilities to watch that cycle. Because the binge cycle, the restrict cycle, it all just continues to cycle ongoing. And you know, I'm big on, I want women to feel good on the outside too. Like I think I love getting, I tell people get up and get dressed, get yourself ready, like do what you want to do, have that autonomy, but you have to tap into that inside.

SPEAKER_00 27:43

Incredible. Just so as the uh as the only male on set here, I'm gonna bring in uh, and we've been talking about women, uh, and men have certain perspectives on women anyway, uh, and uh their emotional ups and downs. But uh how do men uh uh interface with this? Because you know, men are told to uh uh stiff upper lip and hold it in and and and and that looks like a recipe for explosion.

SPEAKER_02 28:09

Yeah, men are often misdiagnosed in in the mental health world, so it doesn't show up as an eating disorder, it shows up in other aspects of their lives, whether it's depression, anxiety, or you know, a variety when they're younger, it shows up a lot as like ADHD or um even like just this different space than than eating disorders. So I if anybody's interested in watching the Noah Con, they just he just came out with a documentary and he talks about his old body image distortion and he even says, like, I'm this successful now, and I still look in the mirror and don't feel great about myself. So it was really bold, and I loved that it came out because I think it opens the door for more conversations around men and this because men definitely suffer at extensive rates. It shows up in the gym, it shows up in so many like other spaces. When they finally get to my office, it's way later. Oh, yeah. It's way later than the average woman who's coming into my office with this. And so I think it's being more attentive and more awareness that men are still dealing with this stigma across the board as well.

SPEAKER_01 29:06

I think that, you know, uh I have to say the most severe eating disorder cases I've had have been men. Um and but the second thought that I have is so, you know, we may not see it. I mean, of course we could see it with, you know, anorexia, bulimia, binge eating disorder, uh, and so on, but um, we're also seeing it with muscle dysmorphia, right? And now, and I'm interested in hearing your perspective, right? But in this desire to be so super physiologic, Hulk like perspective, now they're injecting themselves with random peptides that they have no data on, and they're taking, you know, testosterone, yeah, creative. And they're, you know, they're creating like a a m metabolic disaster in their bodies for all for the desire of a certain image. So can you analyze that a little bit in the perspective?

SPEAKER_02 29:50

Yeah, it goes back to that cultural, that cultural space. And not feeling good on the outside, on the inside and reflecting it on the outside, and your worth is tied to what you look like. And I think it's a it's a mix of what we see in the culture, right? What is attractive, and then back down to someone's confidence level and ability to manage. I mean, you know, you can't tell someone has an eating disorder, right? So, you know, the average, I think it's the number is like seven or eight percent of people that actually look like they have an eating disorder. And everybody else, it's just they have them, they exist with them, and no one ever knows. So I think that you have we have to pay attention to the fact that there is not a certain look or a certain way. It's really more that mental noise that you were talking about, that inability to shut off this. And I talk about eating disorders as like an angel devil on your shoulder, right? Like the angel is your voice, and we try to strengthen that voice in treatment and get your voice louder because that devil voice is the eating disorder voice. And it allows clients to kind of like see, okay, it's not that there's something wrong with me, it's just something that's happening to me, and I can take control over the situation. And so men particularly like that because it's like, you know. Yeah, it takes it, yeah, it takes it out of them. Something's not wrong with me. Okay, let me kind of fix this. And so, I mean, it takes a lot. It takes a lot, and I think particularly with men and the muscle dysmorphia is very similar to the women wanting to hit that number on the scale.

SPEAKER_01 31:06

Yeah. And I think I want to end with just one more question for you is um I really always think about the reason that to, you know, work with a therapist is that nobody's written off, right? And we can healing is possible. Yes. Um, and that if you have the right resources, it doesn't mean it's gonna happen overnight. But it's such a shame to not use those resources. So, Francesca, how can we find you? Where can we find you?

SPEAKER_02 31:30

Yes, if it resonates with you, um you can find me at www.francescaemma lmhc.com. Um, I also have an Instagram, which is Francesca Emma L M H C, trying to spread some positivity out there on social media. And, you know, even if you just if this resonates at all with you, my biggest takeaway is just inquire, right? Like inquire with a therapist. Try not to just find any therapists. Like a lot of people can be out there and say eating disorders and body image, but a lot of times the people that end up in my office have sought out people because they were less expensive or because their insurance took them and then they were left with continuous years of kind of going down this. So really do your research, find someone who knows. You can reach out to me. If it's not me, I definitely can send you to someone else. Um, I just think like take care of yourself, I think is my biggest thing, really. Just take care of yourself and ask yourself the question like, what am I really yearning for? What's really going to make me happy?

SPEAKER_00 32:23

Great, great segment.

SPEAKER_02 32:25

Thanks for having me.

SPEAKER_00 32:26

I love this conversation. Absolutely. So, Helen, you want to close this out here?

SPEAKER_01 32:30

So, thank you on joining us of this episode of We Got Your Number podcast.