Many people who lose weight, whether through diet and lifestyle changes, medication, or bariatric surgery, recognize their body has changed.
Some patients experience a phenomenon referred to as “phantom fat,” “ghost fat,” a dissatisfaction with their body change.
A subset of people who lose weight remain dissatisfied with their body image, including their shape.
Such body dissatisfaction of people who lose weight may be long-standing, predating the weight loss, or may be new because weight loss can catalyze a host of previously unaddressed psychosocial issues.
A lingering self-perception of being obese vs being ex-obese, In patients who had undergone bariatric surgery reported being unable to see the difference in their size and shape 18-30 months following their procedure, despite the presence of substantial weight loss.
Being habituated to one’s former appearance may play a role: As it takes the brain time to catch up to the new appearance.
In addition, it may also take time for people to overcome years of enduring the stigma of obesity.
Body image develops within a societal context and is influenced by the person’s ethnic, racial, and cultural heritage.
Adolescents are vulnerable to body dissatisfaction, and this is compounded in those with obesity, who often experience weight-based victimization and stigmata, compared with adolescents with lower weights.
Weight stigmata often takes the form of teasing and bullying during childhood and adolescence can continue into adulthood and persist throughout the lifespan.
The stigmatizing experiences can affect one’s subjective body image, even after the weight has been lost and the person’s body is objectively thinner.
Genetics may contribute to people’s self-perception and body dissatisfaction:measured by polygenic risk cores are significantly associated with both phenotypic BMI and body dissatisfaction.
BMI itself accounts for much of the link between genetic risk and body dissatisfaction.
Experiencing sexual or physical abuse, may also account for body dissatisfaction after weight loss.
Childhood maltreatment can also be associated with body image disturbances in adulthood.
Sexual abuse is common among patients with obesity.
A chart review of patients revealed that 60% of those who reported a history of rape or sexual molestation were ≥ 50 pounds overweight vs only 28% of age- and sex-matched controls without a history of abuse.
Excess weight can be a self-protective mechanism that prevents sexual advances by potential romantic partners or abusers.
After weight loss, repressed memories of a sexual assault surface as a result of the newer, attractive appearance.
Feeling vulnerable to their thinner bodies, they may regard themselves as overweight to return the feeling of protection.
Weight loss may also trigger memories, flashbacks, or nightmares, as people return to a weight at which they were abused.
Dissociation is another mechanism that links prior trauma with post-weight loss body dysmorphia as people with a history of depression, anxiety, or posttraumatic stress disorder have higher levels of body dysmorphia, both before and after weight loss.
A study found that patients undergoing bariatric surgery who had some type of psychopathology and other psychological risk factors were significantly more likely to report body image concerns 3 months after the surgery.
Body image concerns were also more common in patients with preoperative depression, psychotropic medication use, and a history of outpatient psychotropic therapy.
Depression, anxiety, and trauma play a role in how one sees and carries themself.
A Body Image Quality of Life Inventory assesses how and to what extent the perceived body image affects the person’s quality of life.
Cognitive behavioral therapy (CBT) as an evidence-based intervention for body image issues, including those following weight loss.
CBT can modify irrational and dysfunctional thoughts, emotions, and behaviors by self-monitoring, cognitive structuring, psychoeducation, desensitization, and exposure and response prevention.
Weight loss can also reveal questions about self-worth, when receiving compliments about one’s improved appearance, so that to be acceptable or validated is by losing weight, suggests that they need to continue losing weight.
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