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Lost Weight but Still See the Old Me in the Mirror!
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Lost Weight but Still See the Old Me in the Mirror!

By John M. Adler, PhD


Before she took the step in her life to have bariatric surgery, my patient Jessica was like many women who want to do something to improve her health and appearance. After surgery, she lost 120 pounds, but she quickly discovered that losing weight isn’t a magic prescription to solve all of her body image issues.


You see, even after coming within 30 pounds of her “dream” weight, she was still struggling with her self-esteem and body image. To put it simply, she looked different on the outside, but she felt the same on the inside.


I tell my patients that in some ways dealing with weight loss is like eating food: the results will take some time to digest. Most individuals are so focused on “getting the weight off”, and not so much on how they will adjust psychologically to changes in their appearance. Dramatic weight loss typically results in a variety of psychological challenges. Dramatic changes may occur not only in our BMI, but in how we see ourselves and feelings associated with our new physique.


After dramatic weight loss, many things change. But often, our core personality remains stable. This can be both a blessing and a hurdle. The things that made you a cherished and terrific person before you lost weight are still with you. However, many of your negative self-perceptions are not so easily shed with the weight. Many individuals following weight loss continue to have troubling body dissatisfaction. Although significant improvement in body image typically occurs during the first 6 to 12 months, many patients experience self-image dissatisfaction resulting in more than 50,000 Americans electing for body contouring procedures.


Exploring physical and emotional changes resulting from weight loss can be very helpful either in support groups or with individual counseling. This includes the development of healthy levels of self-esteem and self-confidence after weight loss. Exploration of expectations and realistic goal setting is also essential when looking at changing lifestyle and behaviors associated with food.


Assistance with thinking about one’s changed appearance and sorting out the different components of how one feels is useful. Often our belief of what we look like, especially after weight loss, remains distorted. How we actually appear to others is often different than our beliefs about our appearance. The importance of our physical appearance to others is frequently exaggerated by us (people tend to be more concerned about how they look, not how you look). Maintaining realistic goals and objectives (how I should look, how I would like to look) is useful in developing self-image stability. 


One strategy is to write down the main objectives for your weight loss. This typically involves improved health and mobility, reduced chronic pain, enhancement of social, personal, recreational and family activity. If weight loss has moved you towards these objectives, then take the time to remind yourself it was a successful outcome. Thinking about your attitudes towards achievement and success are relevant, and the development of a benevolent self-attitude is essential.


Develop wellness and self-esteem enhancing pursuits, something that is typically neglected by individuals prior to weight loss. Do things that you previously were unable to, and take note of these new accomplishments. Lest you forget, write down on a little card your pre-weight loss goals and your post-weight loss accomplishments, use it to remind yourself when doubts creep in. It took a lot of courage to undertake the journey of weight loss, as it does to adjust afterwards, so remind yourself that you have what it takes to cope with these new life challenges.