The physical changes experienced after weight loss surgery happen in such a rapid manner that we often fail to see the difference in our own appearance.
This coupled with the lifetime of knowing oneself as a certain ‘type’ of person.
The labels that not only society has given us, but ones we have all too readily stuck to ourselves.
The FAT one. I'm... Overweight, obese, ugly, worthless and unhealthy.
Having spent close to 3/4 of your life both being and feeling fat will have undoubtedly shaped your opinion of yourself.
No doubt emphasised and cemented by a multitude of unfortunate social interactions that shape those thoughts and feelings; “…but you’ve got such a pretty face”, “… No Fat chicks”…. “going to need a bigger boat!”. (and unquestionably more cruel and hurtful remarks than these.)
Through the weight loss process (a process that has become one of the largest parts of your identity) that shame and unhappiness, more often than not transforms into fear.
We, never ,never, never want to be FAT again, and that can be a powerful motivator to stay the course.
The unfortunate aftermath of these fears and labels is that they not only shape how we feel, but they also shape how we view ourselves, for a long time after "being fat" is no longer the reality of our condition.
I have made the statement before and wish to emphasise it again, that there is not enough attention given to the credibility of obesity as a mental health issue or its need for the same kind of multi-modal intensive support required of those with diagnosed eating disorders. Disordered eating or Eating disorder? talks about this further.
In many cases this mental image of ourselves may lead us into an unhealthy preoccupation with body image, and then into the realms of Body Dysmorphia.
There is no denying that there are strong and sound correlations between being overweight, unhappiness with our physical appearance and our psychosocial outcomes (i.e. how well we do in social or professional life).
This negative body image having a profound impact not only on pre-operative outcomes but also post-operative outcomes.
Body Dysmorphia is characterized by the unrelenting preoccupation with a perceived “defect” or “flaw” in your appearance. For example: Seeing yourself as obese when you possess an athletic figure.
People with body dysmorphia can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach, and when it relates to weight loss surgery, every square inch of loose skin and place of previous excess weight.
It is an unrelenting state of mind where you constantly compare yourself with others, check yourself in the mirror, avoid social situations or photos and despite meeting all indicators of health, wellbeing and good body weight/body fat ratio, continue to see yourself as fat (or in need to lose “just a bit more”)
This is why I am so very passionate about the equalization of the importance of mental health and nutrition after weight loss surgery. There is (and will always be) so much more to the puzzle than merely losing weight to meet a surgical standard of weight loss.
Our first endeavour after embarking on this courageous and remarkable journey should be that of discovery and re-establishing a kind supportive relationship with the self. We are all our own worst critics. We are the one and only person in our lives that can both simultaneously think the best and worst of us; and the cruellest part… we allow it.
We need to start being realistic and honest with ourselves. There is NO WAY that after 50kg(100lbs) of weight loss that you are the same as you were, so why are you berating yourself as if you were (or worse!)
It is because you cannot see the difference… yet.
What can you do to help you recognise your success?
How can you make it more tangible and real and retrain your brain?
Its about knowing the difference between “being Fat” and “feeling fat” . Something I have written about before.
The feeling is undoubtedly a more powerful motivator than just physically being 'f a t' . Being “fat” is merely a physical attribute, whereas “feeling” fat, brings with it those perceptions of being unworthy, unhappy, unsuccessful, unattractive and goals that are unattainable.
Too many un-words and negatives in my opinion.
We know that our thoughts and feelings have a huge impact on our perceptions. We have associated and intertwined weight with unhappiness and as a by-product have hated ourselves for being such. They say not to 'fat shame' but we have done it to ourselves.
Despite weight loss surgery being an amazingly successful tool for weight loss, it fails long term for many... why?
We don't change our perceptions of ourselves in the process.
After 70, 80, 90....150 lbs down, even within normal weight ranges and measurements, we still perceive the fat person, and this can cause unhealthy relationships with numbers on the scale... or create physiologically unattainable goals.
It seems as though those darn scales are all the stand in the way of finding happiness in your new shell.
So can I jump on the scale?
Yes of course they can be used to monitor your weight ,BUT it’s what we think and do with the numbers afterwards that is important.
- Will we dwell?
- Will we simply observe it as an objective measure?
- Will we start to take stock of how we feel?
- Will we start working on changing our perceptions?
See, its not the scales that determine success and happiness, it is the combined collaborative effort of your biggest fan and your biggest critic… it is you.
You make the daily decision to deem the number on the scale as objective or subjective, a success, failure or tool.
You have the choice to remain in your pre-op headspace or recognise that, just like the need to buy smaller underpants, the elastic on your thoughts, feelings, habits and perceptions may be a bit worn too and in need of replacement.
Changing perceptions... what can you do?
1. Recognise your true presence.
Start taking photos with friends and family, and not just any friends and family, the ones who you have always perceived as healthy weight. (those who you wanted to be like or admired) You need to see how different you look now. No more sticking out like a sore 'fat' thumb.
2. Make tangible connections.
Get the measurements of one of your old pairs of pants and cut a piece of string to match the waistband, do the same for your current size and stick them up on the wall, the difference will amaze you. Or simply keep an old pair and lay them on the ground with a new pair over the top, take a picture and keep it on your phone.
3. Success is a STATE OF MIND.
When you jump on those scales and they register a ‘success’, STOP, take stock of how you look and feel. That is the feeling you want every day without a number dictating it. That feeling is how you should feel EVERYDAY, a pound up , two pounds up, even 5 pounds up WILL NOT change how you look and does not make you a failure. It does not make you FAT and does not mean you will go back to square one. Look at the number objectively. “ok, 5lbs up. I know I have been fudging my nutrition lately, and my portions are a bit large, so I will use this as an indicator to follow my plan, or get help, or be more mindful to my intake”
4. Stop setting goals that MAY NOT BE PHYSIOLOGICALLY POSSIBLE!
You are different in so many ways from others, you will not look and feel the same at the same weights but picking a number out of the air and attaching "I will be happy when…”, means you probably won't. How do you feel?
If you "will be happy when.." , you may not need to lose physical weight, but rather emotional weight that is skewing your perceptions.
Sometimes I have to ask, are you merely setting the bar to impossible levels to avoid the fear of what comes next after you no longer have the weight loss to define you?
5. Recognise that you are not your neighbour.
“Julie” may be the same age as you, and same height as you and weight 150lbs while you sit comfortably at 170lbs. “Debbie” might be 2 inches taller and weigh in at 140lbs.
Do you know what this means? Diddly Squat!
There are too many physiological variables that determine what one person weighs as opposed to the other… want some examples?
· Muscle mass
· Bone density
· Water retention/ hydration status
· Faecal matter (yes how much you have ‘waiting’)
· Fat mass
6. Take the time to discover the New You. You are no longer the same person (or won’t be for long), and you simply cannot continue with the same attitude that got you to the table (both surgical and dining). Don’t be scared to let go of possessions, feelings and even relationships. This part of your journey is about you and you need to provide yourself with all the love and support you can to truly recognise how amazing you are and the wonderful, fantastic, brilliant, amazing, phenomenal ….. achievement you have accomplished.
So here are some more of those un-words for you.
Understand that your achievements are unbelievably under estimated.
The Balanced Macros Program, Fresh Start Reset, and all Holistic Plans are built on a foundation of the recognition of mental health as a success factor in weight loss.
 Song, A.Y., Rubin, J.P., Thomas, V., Dudas, J.R., Marra, K.G. and Fernstrom, M.H., 2006. Body image and quality of life in post massive weight loss body contouring patients. Obesity, 14(9), pp.1626-1636. https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2006.187
 Rosen, J.C., Orosan, P. and Reiter, J., 1995. Cognitive behavior therapy for negative body image in obese women. Behavior therapy, 26(1), pp.25-42. http://web4.uwindsor.ca/users/j/jarry/main.nsf/032ecd0df8f83bdf8525699900571a93/aa9ed943e56182bf85256abe005bc3f6/$FILE/Rosen%20Orosan%20&%20Reiter%20(1995).pdf
 Anxiety and Depression Association of America https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd
Mental nutrition is BioME Integrative Nutrition's
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Carrie Ross: Clinical Nutritionist | BSc Nutritional and Dietetic Medicine | Nutritional/ food Behaviour Counselor |Bariatric Health Coach | Social Trainer |Author