With the arrival of summer, our thoughts turn to poolside get-togethers, beach outings and barbecues. For some, summer is a more relaxed time of year, one where we enjoy the company of family and friends in the outdoors. For others, this time of year brings pressures to slim down or tone up in preparation for bathing suit and tank top weather. And it’s no wonder.

Advertisements for diet and exercise products showcase ideal bikini bodies, and tabloids harshly rate appearances, with articles like the “Best and Worst Celebrity Beach Bodies.”

As a psychiatrist specializing in the treatment of anorexia, bulimia and other eating disorders, I see how summertime presents a unique challenge for individuals who struggle with body image. Even for those with a healthy body image, beach “body ideal” can spark feelings of inadequacy and depression. In some cases, particularly among individuals with a family history of eating disorders and those with perfectionistic, people-pleasing and reward-dependent personality traits, seasonal pressures to lose weight can trigger unhealthy behaviors related to dieting and exercise.

In fact, many eating disorder treatment professionals observe an increase in patients and families needing eating disorder support as the weather heats up, and we shed our sweaters for shorts and swimsuits.

For youths and teens and even young adults the desire to lose weight to look good in skimpy summer fashions is not the only factor that can trigger an eating disorder. Young people who are more likely to develop eating disorders prefer structure and predictability, yet summertime’s unstructured “down time” takes the place of normal daily routines.

Additionally, summer is filled with milestones related to adolescent separation, attachment and “launching” spending the summer away from home at camp or on a trip, preparing to leave home for college in the fall or graduating from college and entering the “real world.” These changes, transitions and new situations can result in anxiety and feeling out of control, triggering coping mechanisms in an effort to regain a feeling of control.

Dieting (including restricting calories, eliminating foods or whole food groups or purging calories) as well as excessive exercise helps alleviate this anxiety. Young people can easily control their calorie intake and energy output, oftentimes in secret and without drawing the attention of friends or loved ones. While these behaviors can be unhealthy and dangerous as a coping skill, they are difficult to identify in a culture that encourages and applauds dieting, exercise and weight loss.

To create a healthy summer environment, think beyond losing weight to achieve the coveted beach body and instead take steps to nurture your physical, emotional and spiritual health. As the weather gets warmer, the risk of developing an infection at the site of a surgical wound increases, a new study reports. Surgical site infections are a leading cause of increased hospital readmissions, longer hospital stays, greater health care costs and mortality.

Researchers used databases of hospital discharges across the United States to identify every adult hospitalization with a surgical site infection from 1998 to 2011, and tracked local temperature with data from the National Oceanic and Atmospheric Administration. The study, in Infection Control & Hospital Epidemiology, included more than 55 million hospitalizations in more than 2,500 hospitals.

Compared with January, the risk of being admitted to a hospital for a surgical site infection rose steadily from 9 percent higher in February to 21 percent higher in August. Then the risk declined in each month through December. After controlling for many other variables, the researchers found that for every five-degree Fahrenheit increase in average monthly temperature, the risk of hospital admission for a surgical site infection increased by 2.1 percent.

Why this happens is not clear.

“There are other skin and soft tissue infections that are seasonal,” said the senior author, Dr. Philip M. Polgreen, an associate professor of medicine at the University of Iowa, “and there have been reports that the bacterial colonization of the skin may change from season to season. But we need more investigation to help us understand the mechanisms.”

Understanding body image

Our body image is the perception we have of our bodies, as well as how we perceive others perceptions of our bodies. Psychological in nature, perceived body image is not based on fact, but influenced by self-esteem, imagination, emotions, and physical sensations of and about our bodies.

It’s fluctuating, as with changes in mood, environment, and physical experience. In childhood we appreciate our own uniqueness and beauty without question, and as we grow this conception will change and develop in part by what we see are the standards of our society.

Public attention, media and growing distortions

Images women are presented with by the media that represent feminine beauty seem inhumanly flawless, and there is the tendency to hold media and celebrity standards as ideal. The message emphasized by movies, magazines, and television programs, is that meeting this ideal of appearance is not only important, but rewarded for both women and men.

Current studies indicate that only one in five women are satisfied with their body, and that 47% of 5th-12th grade girls reported wanting to lose weight after looking through magazines. Advertising for the summer season has, over the years begun to promote an unrealistic and unhealthy standard for women to achieve the perfect bikini body, which is represented as being very tan, thin and toned.

When Seventeen was first published in 1944, the average model was about 5’7” and 130 pounds. Today’s model is roughly 5’10” (taller than most American women) and her average weight of 115 pounds gives her a BMI lower than that of many women in impoverished, developing countries.

Rejecting the hype

It can be a challenge to remember when looking at these images alongside the headlines that the model pictured doesn’t even look like that in real life. Today all photos, television and film are retouched; and nearly all the appearances of women we see are digitally enhanced to strip away any of her natural flaws.

The sensationally airbrushed photos of models and buzzwords like “summer diet” or “bikini-ready abs” are used to hype attention for campaigns, ultimately out to make money. The weight-loss industry alone brings in at least $55.4 billion in revenue per year.

Just as the media isn’t responsible for how people individually perceive their bodies, they also have no accountability for accurately representing what is important for women’s health or well-being. As consumers it’s essential to have a critical eye and recognize negative and distorted messages for what they are.

Make a positive change

As individuals, we decide how to experience the media messages we encounter, which doesn’t mean it’s time to give up all fashion magazines, television or films for being digitally enhanced. Have a discerning outlook of what’s positive and enjoyable versus what triggers insecurity or promotes an unhealthy standard.

By recognizing that having the “perfect body” isn’t the ultimate source of happiness, and appreciating your body for all it does, you can begin to change the script about how we define a healthy summer look.

Behind all the hype generated about a woman’s appearance, summer is about getting out in the warm weather, enjoying swimming or boating without being dampened by fretting over insecurities. Having a positive body image is about respecting your health and well-being, and that of others.

Every Body Is Different

Begin to notice as often as you can (and in a complimentary way) how different people are; we come in a variety of shapes, sizes and colors; develop an appreciation for diversity and celebrate it.

Surround yourself with supportive people and encourage dialogue and critical thinking in response to negative messages when you encounter them. Find your unique voice to promote healthy body image in social media by following, sharing and encouraging a more diverse and encompassing view of what beauty is.

These are some of the ways we can take our power back and do with our summer what’s really important- enjoy it!

Summertime blues

It’s summertime, and the livin’ is easy. At least that’s what you’ve been led to believe based on songs and film—and your friends’ Facebook Pages. But for some, summer isn’t quite the funfest it’s cracked up to be.

In fact, it turns out plenty of people don’t find bliss during summer. The hot, bright, long days turn them into gigantic grump buckets or make them genuinely sick.

From vacation envy and arm-flab anxiety to actual summer-onset seasonal affective disorder (yes, it exists), here’s what may be dragging you down during the dog days of summer.

Summer-onset SAD

If circadian rhythms are messed up it can mean trouble—even if it’s just a few less (or more) hours of sun each day. Norman Rosenthal, MD, and colleagues at the National Institute for Mental Health discovered seasonal affective disorder (SAD) and realized there’s also a summer version. Summer SAD shows up as agitation rather than winter’s lethargy. If you’re not yourself and are too jittery to eat, sleep, or follow your usual routines, you may want to talk to your doctor about SAD.

Summer solution:

Your doctor may want you to stay out of the bright light and heat and/or take antidepressants. While summer SAD is relatively rare, it can be dangerous and lead to feelings of suicide. If summer makes you manic, don’t ignore it.

Understanding Summer Depression

Why do some people feel more depressed in summer? Here’s a rundown of reasons.

Summertime SAD.

You’ve probably heard about seasonal affective disorder, or SAD, which affects about 4% to 6% of the U.S. population. SAD typically causes depression as the days get shorter and colder. But about 10% of people with SAD get it in the reverse — the onset of summer triggers their depression symptoms. Cook notes that some studies have shown that in countries near the equator such as India summer SAD is more common than winter SAD. Why do seasonal changes cause depression? Experts aren’t sure, but the longer days, and increasing heat and humidity may play a role. Specific symptoms of summer depression often include loss of appetite, trouble sleeping, weight loss, and anxiety.

Disrupted schedules in summer.

 If you’ve had depression before, you probably know that having a reliable routine is often key to staving off symptoms. But during the summer, routine goes out the window – and that disruption can be stressful, Cook says. If you have children in grade school, you’re suddenly faced with the prospect of keeping them occupied all day, every day. If your kids are in college, you may suddenly find them – and all their boxes of stuff – back in the house after a nine-month absence. Vacations can disrupt your work, sleep, and eating habits – all of which can all contribute to summer depression.

Body Image Issues.

As the temperature climbs and the layers of clothing fall away, a lot of people feel terribly self-conscious about their bodies, says Cook. Feeling embarrassed in shorts or a bathing suit can make life awkward, not to mention hot. Since so many summertime gatherings revolve around beaches and pools, some people start avoiding social situations out of embarrassment.

Financial worries.

Summers can be expensive. There’s the vacation, of course. And if you’re a working parent, you may have to fork over a lot of money to summer camps or babysitters to keep your kids occupied while you’re on the job. The expenses can add to a feeling of summer depression.

“This summer, we have worries about the economic crisis layered on top of everything else,” says Cook. “People are feeling more financially strapped. They’re wondering, ‘If I go on vacation, will the job still be there when I get back?’”

The heat.

Lots of people relish the sweltering heat. They love baking on a beach all day. But for the people who don’t, summer heat can become truly oppressive. You may start spending every weekend hiding out in your air-conditioned bedroom, watching Pay-Per-View until your eyes ache. You may begin to skip your usual before-dinner walks because of the humidity. You may rely on unhealthy takeout because it’s just too stifling to cook. Any of these things can contribute to summer depression.

Consider these five tips for a healthy summer season:

Get moving.

Try a new activity find a yoga class for relaxation, go dancing with friends or play volleyball on the beach with the goal of finding joy and connection with yourself, others and nature, not losing weight. Identify physical activities that make you feel good physically, emotionally and spiritually.

Find your happy.

If achieving a healthy weight or getting stronger is your goal, you’re more likely to be successful and less likely to develop an eating disorder if you are nurturing your emotional health as well. For those people who struggle to disengage from the strong seasonal pressure to lose weight, consider this studies suggest a correlation between a positive emotional status and healthy body weight.

Take time to “stop and smell the roses.”

It’s easy to get so caught up in our physical appearance or the appearance of others that we forget to enjoy the moment. At the beach, don’t worry about how you or others look in a bathing suit. Instead, focus on the sun’s warmth on your skin (protected by sunscreen, of course!), the salty sea air smells and the sounds of crashing waves and kids laughing as they build sand castles.

Stay hydrated.

The simple act of drinking sufficient water throughout the day supports overall health. In fact, research suggests a connection between proper hydration and a healthy body weight. And, adequate hydration allows us to engage meaningfully in summertime activities.

Make time to check in.

Especially for adolescents and young adults, summer brings changes to the standard routines. Make time to talk to the young people in your life and discuss feelings related to seasonal changes and milestones, such as fear, anxiety, depression or a perceived loss of control. Identifying unhealthy coping strategies early means you can get help early.

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