Medical Examiner
When I looked in the mirror, I still saw my old self.
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The first time I lost nearly 100 pounds, it was a treat to shop at any store I pleased, and to be able to wear a bathing suit without having a panic attack. I could pack for a trip in an hour—before, I’d need a week to try on everything in my closet to see what fit. What I never expected was the mental toll losing weight would take on me.
The weight came off so quickly that it didn’t register when I looked in the mirror. Anyone standing next to me would have seen flat abs, slim thighs; to me, the reflection still showed cellulite and chubby cheeks. In dressing rooms, a size-XS shirt would go over my head instead of entrapping me like a straitjacket. But I tended to buy clothes that were too big. My brain couldn’t quite compute that I had a new body. If I was out with friends and they didn’t compliment my outfit or call me skinny, I crumpled when I came home, assuming they still must view me as the mandatory fat friend. When I did get compliments, however, I couldn’t just say “thank you.” I felt the need to ask for reassurance that they really meant it, or to ask if they thought I was “thin enough,” or launch into an explanation of how much more weight I still wanted to lose.
Then, the weight crept back. It always did. Eventually, I went under the knife. I hoped cutting my stomach down to a sliver with weight loss surgery would not only take away my hunger and excessive eating habits, but also silence that constant chatter and nagging over food, calories, carbs, scales, BMI, and clothes shopping. I prayed it would finally give me confidence and self-esteem, allow me to enjoy my time with my husband and daughter without worrying about my pants ripping open or huffing up a flight of stairs.
I even hoped weight loss surgery would rejuvenate my career and give me the confidence to pursue all the projects I’d always told myself I’d focus on when—if—I was finally thin (again). When you’re thin, you can go for on-air TV gigs instead of hiding as a magazine writer, I’d told myself. Post-surgery, I did nab a few opportunities as a “talking head,” including in pop culture docuseries. Still, I buckled under the pressure of being “seen” by strangers watching—and, surely, judging—me on TV. I’d get my hair blown out too big and put on too much makeup. Even skinny me never felt like I looked good enough to belong in the spotlight.
There are two promises to weight loss: that you will be healthier, and that you will finally love yourself. Yes, my blood pressure shot down to a normal level, my cholesterol (the good and bad) was out of the danger zone, and I was no longer on the verge of being diabetic. Having better self-esteem as the pounds came off—that part never materialized. The nonstop chatter in my brain actually became louder, more aggressive and damaging. I was thin, so why wasn’t I the family favorite? I was thin, so why weren’t my career dreams coming true? I was thin, so why was I still getting ignored, ghosted and—during those times when I got skinny pre-marriage—dumped? I had no answers, just a constant loop of “You’re ugly, you’re fat and unworthy—that’s why!” playing in my head.
If you’ve lived most of your life in a bigger body—and you were told that your bigger body was unacceptable, unworthy, and your fault—just losing weight won’t change that negative self-perception, experts told me. Mary Dobson, a psychotherapist and the CEO of Lift Wellness Group, points out that weight stigma is inflicted by health care providers, schools, workplaces, family systems, and through media. “A visit to the pediatrician in which weight is identified as inherently problematic can plant that seed of shame,” Dobson explains. That was certainly the case for me. I can still remember a pediatrician scowling at my mom during an appointment when I was 9 and handing her a sheet with a diet plan featuring tuna fish, rice cakes, and apples. I’d hide forbidden foods in the garbage can in my bedroom. One morning, my brother spotted an uneaten bagel that I was saving for after school; he ran down the hall waving it over his head. My parents were confused and upset; I was mortified.
Weight shame can involve withdrawal from activities and peers, Dobson explains. As a teen, I dreaded rites of passage like school dances and parties, usually making up excuses like being sick so I didn’t have to go through the shame of being ignored by boys or the stress of shopping for form-fitting dresses that were not available in my size. Social events as an adult were just as traumatic. I’ve declined many invites to weddings of both high school and college friends because I didn’t want anyone from my past to see how much weight I’d gained or how uncomfortable I felt in plus-size formal attire. The impact of being shamed for being overweight can become psychologically inescapable, regardless of whether weight is lost. The relentless messaging, and my negative reaction to it, might have felt like it was controlled by the size of my body. In reality, it was affecting my brain, which held on to the negativity of so many years of shaming even after I got thin.
At a lower weight, other people did start to treat me differently. Family and friends showered me with praise. I became a guy magnet, unsure how to politely turn down all the men who suddenly were buying me drinks or, gasp, wanting to spend the night. It was upsetting to receive so much positive attention just because I was suddenly a size 4. What was so bad about me as a size 14 (or bigger)?
“It’s confusing when, in a smaller body, you hear, ‘Welcome! You look like one of us. You can shop where we shop. You can eat where we eat. You can fit into these chairs,’ ” says Morgan Francis, a psychologist who specializes in the treatment of body image and eating disorders. She says she often helps patients work through the mixed societal messages that come with weight loss. “Some of the attention feels good because you feel like you matter and are being seen. But it also hurts after going through life feeling invisible, ignored, disrespected, and oppressed.”
Healing from that hurt would be hard enough even if weight loss were permanent. That was my expectation of bariatric surgery—permanent weight loss. At first, it was fun stunning nurses into silence as they replaced my presurgery weight (somewhere around 250) in my chart with a number deep in “onederland” (that’s what we bariatric surgery patients call it when the scale finally dips under 200 pounds). Then, on one check-in visit, the scale had ticked up by a few pounds. My surgeon looked at me with great disappointment. I felt like a high schooler who had been caught cheating on a test. Worse, I felt like the practice didn’t care why I was struggling—that they simply wanted me to fix it and keep the weight off so I could remain a worthy option for their before-and-after billboards on the highway. The threat of feeling all that shame and invisibility again was always looming, and I felt like it was my personal responsibility to prevent myself from gaining weight and bringing all of it back.
Brooke Boyarsky Pratt, the CEO of an in-person and virtual weight-inclusive primary care company called Knownwell, describes that time after her own bariatric surgery as her “most miserable and thinnest.” After a lifetime of trying diets, when she started at Harvard Business School she weighed 330 pounds. Then, after getting a gastric sleeve, she dropped to 175.
“I remember being at the mall and a family friend came up to me and said, ‘Brooke, [seeing you thin] makes me so happy because every time I saw you before, it made me so sad for you.’ ”
It was a gut-punch for Pratt to have people articulate how they felt about her previous weight to her face. Further, she had hoped the sleeve would be a “miracle.” But even after losing all that weight, for her height she was still medically considered obese. And, like me, she eventually started regaining some of the weight that the sleeve had helped her lose. Her eating habits had long been a problem, but, now, they became more disordered than ever. “It’s been a long mental journey of: What does it mean to be enough? What does it mean to be healthy in my body?” she says.
Her big aha moment came after meeting with Janine Kyrillos, director of the Comprehensive Weight Management Program at Jefferson Health in Pennsylvania. She looked at Pratt’s chart and only had reassurances. “Dr. Kyrillos told me, ‘You’re never going to be under 200 pounds. Release yourself. You have struggled. You have been so hard on yourself.’ “
It was the complete opposite of what other doctors had been telling Pratt her whole life. It was refreshing to hear someone acknowledge that while her BMI wasn’t, broadly, considered healthy, it was healthier that she maintain her current weight—now much lower than presurgery, but still notably higher than she was at her thinnest—instead of continuing to constantly diet. “It was pivotal,” Pratt recalls. “I was so sick of going to primary care doctors because I was so sick of worrying I’d get ‘yelled’ at during my exams.”
Just being OK where you are—even if it’s not your goal weight—is easier said than done. No matter my size, I’ve never truly gotten the mean voice in my head to shut up, probably because the mean voices around me, the larger world we all live in that punishes fat and rewards skinny, won’t shut up. Even if you somehow can achieve the “perfect body,” keeping it that way is impossible. Focusing on how your body looks is simply a never-ending battle, says Francis, the psychologist who specializes in body image. “Bodies change due to age, stress, grief and loss, medical issues, postpartum and hormones—things we have no control over—and yet we’re expected to be happy all the time and love our bodies.”
Francis has a simple exercise for me: to focus on what my body is capable of. “You tell yourself, ‘My human arms help me hug my babies. They help me to pick up my crying child. My human arms carry my groceries, or give amazing hugs,’ ” she explains. “It moves the focus off of aesthetics and into an appreciation of what your body does for you.” She recommends making that appreciation part of a daily practice, and pairing it with moving your body however feels good to you.
Believing I am valued when my weight is up and my body feels heavy is tough. Relinquishing the hold that food has over me is a power struggle. I’ve tried to turn off the chatter in my head with everything from 12-step programs to weight loss surgery. I’ve blamed my weight struggles on my mom, my doctors, and my genetics. And it’s true—there are a lot of factors that impact the shape of my body. But to truly be happy, I need to feed my mind with compliments, positive affirmations, and love.
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