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Factors contributing to high rates of cosmetic surgery in Utah

Factors contributing to high rates of cosmetic surgery in Utah

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SALT LAKE CITY -- Numbers and anecdotal evidence suggest that a high proportion of people, particularly women, in Utah are having cosmetic surgery done; an analysis of 2010 statistics, for instance, showed that Utah is ranked eighth in the country for the number of plastic surgeons per capita.

These statistics inevitably lead to questions about “why”: Why would a state known for its conservatism have these kinds of numbers? And with a population that is said to be more than half members of The Church of Jesus Christ of Latter-day Saints, how do LDS religious beliefs and practices (divine worth, modesty, etc.) mesh with the practice of aesthetic surgery?

Plastic surgeons suggest that the reasons have much to do with the level of education of Utahns, who are thus more open to undergoing elective surgery, and with the high birthrate, meaning that women who have had more children would notice more changes in their bodies from pregnancy and would be more interested in restoring their bodies to how they looked pre-pregnancy. Doctors say that their patients just want to feel better about themselves.

Plastic surgeons suggest that the reasons have much to do with the level of education of Utahns, who are thus more open to undergoing elective surgery. However, therapists who work with the LDS community point to issues with self-worth and body image as significant contributors to the trend.

However, therapists who work with the LDS community point to issues with self-worth and body image as significant contributors to the trend. Body image itself in our media-saturated culture today can be influenced in part by the media and its portrayal of women in general, a topic that is being addressed as more researchers talk about the idea of “media literacy.” Counselors also point to the low senses of self-worth and negative self-image that are apparently too frequent in the LDS community.

Little concrete research has been done to show how LDS women in particular feel about themselves and how they look. But one study published in 2007 by researchers at Brigham Young University noted that LDS females (of college age) had a more positive body image than non-LDS females generally, although LDS females in Utah had less positive body images than LDS females residing in other states.

Other researchers who provide counseling to Latter-day Saints have indicated that there is a high prevalence of conditional self-worth among the community, meaning that individuals base their self-esteem on “arbitrary external conditions or requirements being met,” as BYU-Idaho professor John M. Rector, Ph.D., put it in an article called "Origins of Human Worth."

“If these conditions are not met,” Rector writes, “(an individual) will perceive a drop in overall sense of worth, which is likely to set off a dramatic chain of events: feelings of inadequacy, self-loathing, despair or anger, which can lead to self-defeating behaviors of all kinds.” Rector says his goal is to help his clients work toward having a sense of their “unconditional human worth,” which can then free them from feeling those negative reactions whenever their set expectations are not met, and lead them to be able to halt or limit self-defeating behaviors.

Ashley Johnstoneaux, a therapist who works through Utah Valley University's Turning Point, a resource for personal, educational and professional improvement, observes that there seems to be a real sense of inadequacy felt in the women he counsels. He says that through the lens of attachment theory, these women just “want to be wanted, to belong.” Those needs to feel wanted and to belong are exhibiting themselves in issues of body image, of eating disorders or turning to cosmetic surgery so they can more easily be “wanted” or "belong" from how they look.

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A recent documentary examines these same issues. Created by Joylin Namie, Ph.D., a professor at UVU, the documentary, “Drinking Gold: the Normalization of Cosmetic Surgery Among Latter-day Saint Women,” looks at a number of facets of this trend among LDS women in Utah.

As an anthropologist, Namie was particularly interested in the concept of “transparency,” or “the ability of media, in this case body image ideals that come from the culture, to map on to existing beliefs and values,” as she says in the film.

To some, it could seem not to make sense that the conservative LDS culture, which stresses modesty and divine worth, is adopting the image consciousness of the larger culture, which values youth, immodesty and almost impossible standards of beauty.

Namie, who is neither from Utah or a member of the LDS Church, finds it interesting that the church states explicitly in its For the Strength of Youth pamphlet, “Do not disfigure yourself with tattoos or body piercings.” But women who are active members of the church seemingly find nothing inconsistent with avoiding tattoos while having their breasts augmented surgically with implants, for instance. Johnstoneaux, who is LDS, also said he finds this “incongruent.”

Several subjects in Namie’s documentary and therapists interviewed address the role of women in the LDS culture. The culture delineates very clear gender roles, and regardless of whether the church’s doctrine or statements from general leaders explicitly state particular concepts, many women may end up tying their self-worth to the role of being a wife and mother, rather than finding satisfaction in other personal pursuits or, as mentioned previously, being able to value themselves solely on their innate worth as human beings and children of God, speaking doctrinally.

Rector says, “My own personal perceptions suggest to me that affluent LDS women are particularly likely to be susceptible to such pressures because — again, in my view — LDS culture provides limited avenues for women to enhance their sense of self in a tangible way, marriage and children (including grandchildren) representing the bulk of it.”

It makes a lot of sense that some women would choose to focus substantial energy on enhancing their physical appearance as a tangible means of enhancing her sense of self.

–- John M. Rector, Ph.D.

“The pursuit of righteous living, while certainly beneficial, represents a much more personal, ‘inward’ development which doesn’t provide the same sort of ego stroke,” Rector continues. “Because identifying oneself through an outside-the-home career or other avocation is generally not considered to be a viable path toward self-esteem for Mormon women, it makes a lot of sense that some women would choose to focus substantial energy on enhancing their physical appearance as a tangible means of enhancing her sense of self.”

Investigating the phenomenon of high rates of cosmetic surgeries in the Utah community is much like opening a set of Russian nesting dolls. There are multiple layers of complexity relating to the causes of these high rates, including all the issues addressed so far (and in much greater detail relating to each issue) and many others. One individual’s motivations for choosing surgery are “likely based on two or three factors salient to the particular person (e.g., chronic personal dissatisfaction with some aspect of their physical appearance, pressure from a significant other to undergo surgical change, low overall self-esteem, etc.),” as Rector notes.

Then when looking at a whole group of individuals, each with her own varied motivations, the phenomenon becomes very complex indeed.

Perhaps much of the concern about the rates of people who are having surgery done is not with the idea of surgery itself, but with the seemingly high rates. If one or two individuals in a large group decided to have an enhancement or restorative surgery, it wouldn’t draw much attention. But when a larger number of people in a community decide that they all need to have surgery, that is what concerns the average person who is looking in on the phenomenon without being a participant.

Contribute to the discussion
This article is part of a continuing examination of the prevalence of cosmetic surgery in Utah. The author is seeking input from those who have personal experience with surgery, either those who have elected to have cosmetic surgery, those who have considered it, those who have opted not to have aesthetic surgery and/or those who know someone who has had surgery.
Interviews will be arranged at your convenience, and published quotes will not feature full names and identifying details. The author would like to provide an in-depth look at this issue from varying points of view and allow an open and thoughtful dialogue. If you have interest in contacting the author to contribute, please email her at

Dr. Brian Brzowski noted in a previous story that the strong community connections in Utah more efficiently spread the word about cosmetic surgeries, putting in place what therapists consider to be “social influence.”

As Namie says in the “Drinking Gold” documentary, the “structural factors in Utah, including a larger concentration of plastic surgeons per capita, lower prices for cosmetic procedures coupled with the impetus to marry and have children at younger ages, set the stage. LDS ideals related to appropriate gender roles (etc.) accomplish the rest.”

As Namie concludes, “A group of women admonished to be in the world but not of the world becomes very worldly indeed."

Cathy Carmode Lim is the founder of, a website that reviews books and gives them ratings according to content.

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