When I was 18, I decided to take charge of my health and began working with a cognitive behavioral therapist to change my relationship with food. After two years working with my fabulous therapist, I had lost 75 pounds and started running and cycling in my spare time. In the four years since I stopped active therapy, I have lost an additional 15 to 20 pounds and gained a great deal of muscle through weightlifting. I love my new life; My whole social circle centers around my gym, and I make more nourishing food choices by default. That said, every single day is still a struggle.
I was inspired to write this post after reading last month’s New York Times article about life after bariatric surgery: the only solution that has been linked to long-term successful weight loss. Bariatric surgery is thought to work not only by restricting the physical size of the stomach, thus limiting what a person can take in, but also by changing the “set point” weight that the body will default back to without conscious effort. This, in theory, makes keeping weight off easier in the long run.
Losing weight without bariatric surgery does nothing to change the body’s set point, but the compromise is that is also doesn’t require an irreversible, major surgery that comes with serious risks to the patient. My weight loss was more gradual and required greater cognitive effort over a longer period of time than the patients in the NY Times article, but six years or so out, I feel the same way as they did: deeply ambivalent.
Doctors, and probably most of the general public, would expect people like us, who have lost the equivalent weight of an adult human, to be ecstatic and grateful, but what most fail to understand is that life doesn’t magically change when the fat comes off. Without undergoing the bariatric surgery that would have reset my body’s weight set point, I fight an uphill battle with maintenance. Having lost around 95 pounds, my body needs less fuel per day than an average person of my height and weight who was never obese, even though I’m extremely active. If I indulge in a rich meal, especially a carbohydrate-rich meal, my fat cells pull energy from the food that I eat. When body fat is lost, the fat cells do not actually go away, but rather deflate. Because of this, if I am meticulous with my food, the number on the scale creeps up to a 225-pound set point, with which I am all too familiar.
Experts also do not have nearly enough conversations about what your body will look like after. Even if weight is lost gradually, excess skin can present as an annoying and uncomfortable problem. I have skin hanging from my abdomen, thighs, and upper arms, and no tightening creams or toning will get rid of it. The only solution is to either accept feeling like a balloon that someone popped with a pin, or undergo a series of major surgeries to remove it. Since I am an avid cyclist and runner, this skin actually gets in the way of my preferred activities, and it gets painfully infected. Despite this, most insurance companies consider skin removal an elective surgery, costing tens of thousands of dollars.
Arguably the hardest part of the post-weight loss experience is how your relationship with yourself and the world around you changes. The subjects of the NY Times article lament that they still had “fat brain.” They still feel like the biggest person in the room and are wary of individuals expressing romantic interest. Fat brain is real, and I don’t think that any amount of weight loss or body transformation can make it go away. Although my body now looks like some sort of hybrid of a mildly chubby 20-something and a serious weightlifter, I still worry about what people will think if they see me enjoying dessert in public. I’m always concerned if my seatbelt will fit or if I’ll knock things over in small spaces. I never think that compliments based on my appearance are genuine, and I’ve only now just started to accept the fact that I might even look a tiny bit athletic.
Despite the physical and emotional difficulties and social isolation that can accompany massive weight loss, I am grateful to have improved my health and my relationship with food. My continued struggle with weight control is what lead me to study public health nutrition, and I have no doubt that my life would be different without this experience. I wish I had more fully understood what my body and mind would look like years down the line. I hope that this post has been educational for anyone out there who is thinking about making this kind of major change.
Have you experienced major weight loss? What was your experience? Share below.