At her highest weight of 263 pounds, Leah K. didn't think she could be more unhappy with her body. The 33-year-old had been battling her weight her entire adult life. And despite her best efforts to exercise and eat healthfully, the weight wasn't budging. Not only was she suffering from chronic physical health problems, but the years of dieting had also taken a toll on her mentally. Her self-esteem was rock bottom and she spiraled into an eating disorder. Finally, she made the decision to try bariatric surgery. It wasn't a choice she made lightly. But it seemed her best chance to regain her health, inside and out.
After the surgery, she quickly lost 100 pounds and at first was delighted with her new body. But she discovered that while she looked different on the outside, she felt the same on the inside. The weight loss didn't magically cure her self-hate or the eating disorders. "I began to recognize that shaming, blaming, and hating yourself doesn't work to lose weight, and losing weight doesn't work to fix those feelings," she says.
Leah isn't alone in her post-weight-loss mental struggles. Many people do see an improvement in their self-esteem and body image after losing weight—but some find the opposite is true. (Like this woman who was less happy after reaching her weight-loss resolution.)
"In our current era of 'reality-based' cosmetic surgery television and over-the-top air-brushed social media, many weight-loss patients may hold unrealistic expectations of what they will look like and what their life will be like," says Ryan Neinstein, M.D., a board-certified plastic surgeon at NYC Surgical Associates, who has treated many patients in this situation. If you hold on to that unrealistic ideal—thinking that once you get down to your goal weight that everything will be perfect and you'll suddenly love your body—you may discover that you still have body image issues even at your "dream" weight, he explains.
For Leah, she also discovered that the weight loss caused her to hyperfocus on other "problem" areas like the loose skin on her stomach and arms. Anna K., 29, had less weight to lose but says she experienced similar feelings. After working hard for a year to drop 15 pounds, she says she expected to feel fabulous but she didn't.
"I'd counted every calorie and never missed a workout and it had worked," she says. "Except it hadn't. Before, I'd hated my stomach. And while my stomach was now flat, all I could see were my thighs. They seemed so big in proportion to the rest of my body. I transferred all my hate to them."
There are many other ways this post-weight-loss depression can manifest. Some women say they still "feel fat" even when the scale says otherwise. Others report being angry at people who ignored them when they were heavier but are now kind or attracted to them at their lower weight. Still others say they feel like an imposter in their own skin or they're worried that people will be disappointed or won't love them if they gain the weight back. These issues are as real and as painful as any physical problems, but treating them can be tricky.
Self-image is a very complicated issue and is affected by a variety of factors, not just weight, says David Greuner, M.D., surgical director at NYC Surgical Associates. One key factor is the person's mental health history. A majority of obese people report symptoms of depression and anxiety, according to a study published by JAMA. And while weight and mental health are intertwined, simply losing the weight isn't enough to resolve mental illness. You need to treat both conditions, he says.
"I find that past emotional trauma can distinctly have an effect on someone's perception of their physique, regardless of their true appearance," he says.
He recommends getting professional help to resolve mental health and body image issues. A therapist specifically trained in body image issues can help you resolve lingering feelings. In addition, building a solid social support network, with friends and family who love you and are willing to listen, helps a lot as well. Your loved ones can help you see your true beauty by reminding you of what they see in you. Lastly, he encourages people to focus on the positive aspects of weight loss that aren't related to appearance.
"I try to have patients focus on the overall benefits of their weight loss, such as better mobility, athleticism, and heart health," he says. "I also try to help them understand that what they have accomplished took a significant amount of discipline and effort to achieve. It's easy to forget how far you have come once you have reached a more favorable situation. But by taking a second to appreciate your achievements, you will often feel much more satisfied and fulfilled."
Leah, with the help of her therapist, was finally able to turn her feelings around. "It takes years of unlearning to get rid of those negative thoughts," she says. Her mental shift included ditching her old disordered dieting behaviors. While she still does many of the same things—eating healthfully and exercising—she says she now does them as a way to love and nurture herself, rather than as a punishment.
And this time it's sticking. Even though she's regained some of the weight she originally lost, Leah says she's never felt healthier or happier with her body. "I can honestly say now that I love myself and it's such a great feeling."