Shani lost 101 pounds with gastric sleeve surgery. Michele lost 50 pounds with the GLP-1 drug Mounjaro. Both are happy with their weight loss, but both also went through some emotional ups and downs along the way.
For some people, the ups and downs can be serious, even life-disrupting, especially if they lost the weight quickly and without enough emotional support. (Shani and Michele asked WebMD to use only their first names for privacy reasons.)
And for a lot of people, weight loss is the beginning of a journey, not the end. Changing your body size won't solve all of your problems, and it may even create some new ones. Negative feelings after weight loss are real and valid, experts said. Seeking assistance, if necessary, can help you to deal with them before they become severe.
Why Weight Loss Doesn't Always 'Fix' Body Image
"Like many others, I thought all of my problems would be solved and life would be great once I lost weight," Michele said. "While I do feel more self-confident, and I am thrilled about my results, I would not say losing weight was a magic bullet that made life perfect."
Losing weight can improve some health conditions such as diabetes and high blood pressure. But some people have new problems. For one thing, it can take time to start feeling at home in your new body. And that can sometimes be uncomfortable or even upsetting.
In addition, weight loss often changes how other people see you. Many people think they want others to appreciate their appearance, but sometimes even positive comments about your body can trigger unexpected – and unexpectedly negative – feelings. And if you've been bullied or shamed for your weight in the past, that hurt may remain even after the weight is gone.
When It's Hard to Accept a New Body Size
Changes in body size can also bring unresolved issues to the surface.
Significant weight loss can leave marks on the body, including loose skin, stretch marks, and a loss of muscle and curves. Not everyone goes through all of these, but for people who do, the new changes can understandably be distressing.
"I remember walking down the street and seeing a reflection and realizing it was me, and it's not matching the idea that I had of myself," Shani said.
If you lose weight, especially if you lose it quickly, your self-image may lag behind the image in the mirror. You may still feel fat, even if you're significantly thinner. Researchers call this "ghost fat" or "phantom fat."
In one study of women who had bariatric surgery, researchers found it took 18 to 30 months after surgery for patients to stop identifying as obese. Shani's experience reflected this. After the surgery, she lost 101 pounds over the course of a year. It took about a year more for her body image to catch up to her new body, she said.
Michele expressed similar feelings. "Sometimes, I still feel like I am 'fat' although I'm not!" she said. "The more difficult thing for me is that all of my clothes are too big and falling off of me, and I look frumpy unless I wear a smaller size or something tighter."
Shani added: "There's definitely an adjustment required to being a smaller person in the world, taking up less space."
Managing Body Image After Weight Loss
"Being fat gives you a kind of invisibility," Shani said. "People look at you differently, or don't look at you at all. When you're a smaller size, I think, especially for men, there's more attention, awareness. … That can be alarming to people."
"This is part of the weight loss journey that doesn't get talked about a great deal," said David Sarwer, director of the Center for Obesity Research and Education at Temple University. "Finding your space back in the social world and feeling comfortable in your new body in relationship to other people can be really unsettling for some."
It can also be unsettling when people treat you differently – and not always in good ways.
Roberto Olivardia, a clinical psychologist and lecturer in the Department of Psychiatry at Harvard University Medical School, described an experience of one of his patients. "In spaces where people didn't know her when she was in a larger body, she said, 'I feel like people are talking down [to me], like I'm a kid.' She also said, 'I think people are thinking I'm dumber.' "
A significant weight loss may also affect your intimate relationships.
"Intuitively, we would think that if one partner loses a large amount of weight, that person's going to feel better about their body," Sarwer said. "They're going to be more interested in sexual behavior, and their partner's going to be more interested in sexual behavior. However, we know that even in healthy relationships, the level of sexual intimacy establishes itself. If all of a sudden the dynamic changes, such as with a large weight loss, and suddenly one person is now more engaged, that can throw that relationship off. Sexual intimacy is about the individuals, but it's also about the partnership."
Don't Let New Flaws Become the Focus
If you've been bullied, judged, or rejected because of your weight, you may still carry that pain after the weight is gone. You might find that you're sensitive to comments about your weight, even compliments.
"Hearing people comment about your weight and size can be a bit of a raw nerve," Sarwer said. "And so even if people are trying to say something to the positive, that still might just feel uncomfortable."
You might also feel resentful of positive attention, Sarwer said. "You might think, 'But wasn't I worthy of your attention when I was heavier?' "
Olivardia recalled another patient's experience. "She noticed increased attention from people, from men, and her initial thought was, 'They're mocking me. They're making fun of me.' Because she'd had those traumatic experiences throughout her life."
The Role of Trauma
Weight loss can also bring more serious issues to the surface.
"The body is a canvas on which trauma can get manifested," Olivardia said, adding: "When the body changes, sometimes those feelings get unearthed."
Trauma isn't always at the root of obesity, but it comes up often enough for scientists to take notice. Sarwer estimated that about 70% of people with obesity have had at least one adverse childhood experience.
When you hear that term, you might think about violence, abuse, or neglect. But the term also refers to witnessing violence; losing a family member to suicide; going through homelessness or instability; food scarcity; having an incarcerated, substance-abusing, or mentally ill household member; family separation; and more. All of these things can have lasting effects on your life and health. People with adverse childhood experiences are at greater risk of suicide, certain cancers, heart disease, depression, and, yes, obesity.
The CDC estimates that 64% of Americans have had an adverse childhood experience.
"For some people with unresolved trauma, extra body weight can serve as a shield, deflecting unwanted attention from their bodies," Sarwer said.
Once this protective shield is gone, people may feel a new and frightening vulnerability.
Physical Markers of Weight Loss
Along with the body changes noted above, significant changes to your body size can result in so-called Ozempic face, a hollowness in the cheeks that comes from fat loss. This can also be upsetting.
"Women will sometimes say, 'Boy, you know, I kind of miss some of my curves, and now I have this loose, hanging skin on my thighs, on my arms, and I'm not happy with that,' " Sarwer said.
If appearance was one reason you sought weight loss, it's understandable that you might be disappointed in new physical flaws. But rather than focusing on flaws, it's important to think about your health gains.
"It isn't lovely," Shani said of her loose skin. But her original goal was physical health, and she's achieved it.
"All of the problems that I'd had, like huffing and puffing up the stairs in my three-story row house, all of those problems were gone, and my bloodwork was all normal."
Support Is Important
Weight loss isn't just about your body. When treating obesity, it's important to treat the whole person before, during, and after their weight loss.
"What are we doing to make sure that, as people lose weight and become healthier, that they're prepared, in this toxic food environment, where food is readily available, to make sure that this intervention is the one that leads to lifelong success?" Sarwer asked.
Shani has kept her weight off for nearly nine years and said her program's psychological and behavioral support before, during, and after surgery were key. Michele's program didn't offer this type of support, but she did seek out advice from others who were taking Mounjaro.
"I think a dietitian's support would be helpful, especially since you need to develop healthy eating habits even while on the medication," Michele said. "If you stop, it's easy to regain the weight if you can't continue to follow a healthy diet and limit portion sizes."
When to Seek Help
Olivardia recommended going easy on yourself during and after your weight loss journey. "Be patient with yourself and know that your body is doing what it needs to do," he said.
You should also be mindful of your self-talk, he said. "This is who I am today. I'm worthy of love and respect, and I'm going to do the best I can today to get where I want to go." He added: "We can accept where we are at the moment, and work to improve our health."
When should you seek help for negative feelings after weight loss? According to Olivardia, it's when these feelings cause distress or get in the way.
Sarwer also recommended checking in regularly with your weight loss team and, if you need to, taking advantage of support groups and mental health referrals.
