Background: Body image is a multifaceted construct that involves feelings, perceptions, and attitudes about one’s body (1). Body image evolves even well into adulthood in response to many factors including aging, disease, or disability. Most of the published literature regarding body image concerns in patients with serious illness focus on cancer, particularly breast and head and neck cancer. However, many patients with a serious illness experience major changes in their physical functioning, weight, and appearance which can result in body image disturbance. This Fast Fact will highlight the quality-of-life and nutritional impacts resulting from body image dissatisfaction from a serious illness. 

Quality of life considerations: Health-related quality of life (HRQoL) has been shown to be affected by changes in body image from illness or treatment of an illness in a variety of ways (2). For example, weight loss can be viewed as an indicator of the cancer’s presence and progression and subsequently lead to social isolation and worsened emotional and existential distress (3). Alternatively, some may perceive any weight loss (regardless of cause) as a positive development that will improve their overall health (3). Body image concerns from an illness go beyond nutritional considerations, however, and include impact from hair loss, surgeries, hormone dysregulation, and reproductive function (2-4). Across multiple studies, body image dissatisfaction from a serious illness is statistically correlated with HRQoL concerns including depression, anxiety, decreased sexual interest and enjoyment (see Fast Fact #293), pain, fatigue, disordered sleep, shortness of breath, and caregiver distress (2-5).  

Nutritional considerations: Anorexia-cachexia syndrome (ACS) develops in 40-80% of cancer patients before death. See Fast Fact #386. The impact on ACS and body image is bidirectional – ACS can cause social distress and body image concerns; additionally, body image dissatisfaction may worsen nutritional outcomes via an increase in depressive or anxious symptoms (6,7). Patients who view themselves as “unattractive” due to their illness also may lose motivation to eat, perpetuating a cycle of nutritional and body image concerns (8,9). Eating struggles brought on by a serious illness affect family and caregivers too: food-related conflicts (especially around meals) and role/relationship changes are common (10). 

Impact of medically administered nutrition and hydration: While there are many patients who determine that the benefits of a feeding tube/infusion line/stoma/etc outweigh the burdens, they may still view these as external signs of illness and be reminded of their clinical vulnerability and loss of normalcy (11). One study found that the two most common psychological reasons patients refused an enteral tube for feeding were due to a disruption of body image and difficulties in socializing with others (12).  

Screening: In any patient with a serious illness, clinicians should watch for (13):  

• Premorbid disordered eating since body image issues are often heightened in patients with a history disordered eating.
• Social withdrawal due to changes in appearance.
• Excessive preoccupation with a bodily change.
• Expressing a belief that their change in appearance impacts their self-image.
• Expressing any feelings of shame, disgust, or avoidance of mirrors or taking photos. 

Opening the conversation early: Because patients often hesitate to share body-related concerns due to fear or embarrassment, clinicians should offer early psychoeducation about potential expected bodily changes. The aim is to normalize the patients’ experience and reduce shame. Some phrases include: 

• “It’s common for individuals with this illness to notice changes in the way they feel about their body. Have you noticed anything like this?”
• “Changes in physical ability, appearance, and weight can affect how people view themselves. Have you noticed any changes in how you view yourself?” 

Illness and improvement: Over time, many patients adjust to the body changes associated with their illness, however, feelings such as shame, guilt, and anxiety commonly persist to a certain capacity, even among those with an improving illness trajectory (14). Therefore, discussions about body image, should not be a one-time occurrence. Clinicians should continuously normalize and support patients as they navigate their evolving physical and mental sense of self (15). 

Psychosocial interventions: While body image concerns are common, extreme demonstrations (e.g., persistent checking, obsessive concerns) warrants consideration for a referral to a mental health professional as it may indicate Body Dysmorphic Disorder (BDD) (16). BDD is a DSM-5 recognized mental health condition typically diagnosed by a mental health professional. It is characterized by excessive, time-consuming preoccupation with perceived physical flaws (16). Patients without a formal BDD diagnosis often still benefit from psychosocial interventions for body image concerns (17). Evidence-based interventions include cognitive behavioral therapy, motivational interviewing, acceptance and commitment therapy, family-based therapeutic approaches, peer and group support, practical aids (e.g., wigs, scarves, prosthetics), physical therapy, nutrition counseling, and exercise (18,19). 

References 

1. Rhondali W, Chisholm GB, Filbet M, et al. Screening for body image dissatisfaction in patients with advanced cancer: a pilot study. J Palliat Med. 2015;18(2):151-156. doi:10.1089/jpm.2013.0588.
2. Yin S, Njai R, Barker L, et al. Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Popul Health Metr. 2016;14:22. Published 2016 Jul 11. doi:10.1186/s12963-016-0091-3.
3. Yuen EYN, Zaleta AK, McManus S, et al. Unintentional weight loss, its associated burden, and perceived weight status in people with cancer. Support Care Cancer. 2020;28(1):329-339. doi:10.1007/s00520-019-04797-y. 
4. Fingeret MC, Teo I, Epner DE. Managing body image difficulties of adult cancer patients: lessons from available research. Cancer. 2014;120(5):633-641. doi:10.1002/cncr.28469.
5. Lo Buono V, Bonanno L, Corallo F, et al. The Relationship between Body Image, Disability and Mental Health in Patients with Multiple Sclerosis. J Clin Med. 2023;12(10):3606. Published 2023 May 22. doi:10.3390/jcm12103606.
6. Hager KK. Management of Weight Loss in People With Cancer. J Adv Pract Oncol. 2016;7(3):336-338.
7. Ravasco P, Monteiro-Grillo I, Vidal PM, et al. Cancer: disease and nutrition are key determinants of patients’ quality of life. Support Care Cancer. 2004;12(4):246-252. doi:10.1007/s00520-003-0568-z.
8. Merino M, Tornero-Aguilera JF, Rubio-Zarapuz A, et al. Body Perceptions and Psychological Well-Being: A Review of the Impact of Social Media and Physical Measurements on Self-Esteem and Mental Health with a Focus on Body Image Satisfaction and Its Relationship with Cultural and Gender Factors. Healthcare (Basel). 2024;12(14):1396. Published 2024 Jul 12. doi:10.3390/healthcare12141396.
9. Yuen EYN, Zaleta AK, McManus S, et al. Unintentional weight loss, its associated burden, and perceived weight status in people with cancer. Support Care Cancer. 2020;28(1):329-339. doi:10.1007/s00520-019-04797-y.
10. Oberholzer R, Hopkinson JB, Baumann K, et al. Psychosocial effects of cancer cachexia: a systematic literature search and qualitative analysis. J Pain Symptom Manage. 2013;46(1):77-95. doi:10.1016/j.jpainsymman.2012.06.020.
11. Umrania R, Patel D, Patel BC, et al. Survey of Psychosocial Issues of Nasogastric Tube Feeding in Head-and-Neck Cancer Patients. Indian J Palliat Care. 2021;27(1):113-117. doi:10.4103/IJPC.IJPC_255_20.
12. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20(26):8505-8524. doi:10.3748/wjg.v20.i26.8505.
13. Thakur, M, Sharma, R, Mishra AK, et al. Psychological distress and body image disturbances after modified radical mastectomy among breast cancer survivors: A cross-sectional study from a tertiary care centre in North India. The Lancet Regional Health. 2022; 7:2772-3682. Doi: 10.1016/j.lansea.2022.100077.
14. Dolezal, L. Shame anxiety, stigma, and clinical encounters. Journal of evaluation in clinical practice. 2022; 28(5): 854-860. Doi: 10.1111/jep.13744.
15. Merino, M, Tornero-Aguilera, JF, Rubio-Zarapuz, A, et al. Body perceptions and psychological well-being: a review of the impact of social media and physical measurements on self-esteem and mental health with a focus on body image satisfaction and its relationship with cultural and gender factors. Healthcare. 2024. 12(14): 1396. Doi: 10.3390/healthcare12141396.
16. Bolton MA, Lobben I, Stern TA. The impact of body image on patient care. Prim Care Companion J Clin Psychiatry. 2010;12(2):PCC.10r00947. doi:10.4088/PCC.10r00947blu.
17. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 23, DSM-IV to DSM-5 Body Dysmorphic Disorder Comparison. 
18. Alleva, JM, Sheeran, P, WEbb, T, et al. A meta-analytic review of stand alone interventions to improve body image. PloS one. 2015; 10(9). Doi: 10.1371/journal.pone.0139177.
19. Harkin, K, Apostolopoulos, V, Tangalakis, K, et al. The impact of motivational interviewing on behavioural change and health outcomes in cancer patients and survivors. A systematic review and meta-analysis. Maturitas. 2023; 170: 9-21. doi: 10/1016/j.maturitas.2023.01.004.

Authors’ Affiliations: 1University of Texas Southwestern Medical Center, Dallas, TX; 2City of Hope, Duarte, CA.
Conflicts of Interest:  The author does not have any conflicts of interest to report.
Version History:  Originally edited by Sean Marks MD; first electronically published in April 2026.