Body Image & Weight Loss Surgery: What Is It, & Why Is It Important?

November 4, 2019

When I first met her before weight loss surgery, “Beth” (not her real name) was excited and hopeful that losing 150 pounds would give her a new lease on life. Specifically, she thought that losing weight would improve her self-esteem, give her the self-confidence she’d never had, and make her finally like her body.

Body Image & Weight Loss Surgery

18 months after her surgery, Beth had lost weight and her health was greatly improved, but she returned to my office in despair. “I look in the mirror and I hate what I see,” she said. The extra skin, very common after a big weight loss, made her feel old, saggy, and shapeless. “I miss my curves,” she said tearfully. She had a new boyfriend, but she was too ashamed of her body to be intimate with him. She was disappointed because the hopes she had placed on her post-operative life were not realized. She felt depressed and was thinking about purposely regaining weight to help herself feel “normal” again.

Although Beth’s case is not typical of every patient who has weight loss surgery, losing a great deal of weight causes a change in physical appearance and body functioning. With these changes can also come changes in body image. Sometimes these changes are positive, but sometimes they are not. Most people struggle with body image at some point in their lives.

Body image refers to the way we think and feel about our bodies. It does not necessarily correspond to what we actually look like.

Instead, it is about our personal relationship with our physical selves—our beliefs, thoughts, perceptions, feelings, and actions that relate to our appearance. This can be in terms of our weight, our body size or shape, our beauty, or other physical features. Although body image is only one aspect of who we are, it can influence our self-esteem, self-confidence, our mood, our social life, our relationships, and even our eating habits.

To get a feel for your own body image, consider the following questions:

• How do I talk to myself about my body? What kinds of words do I use? Are they positive or negative? Would I talk to another person the way I talk to myself?
• How does my self-talk about my body affect my mood? How does it affect my eating?
• What behaviors or situations, if any, do I avoid because of my body image?
• What do I appreciate about my body?

Traits of a negative body image can include:

• Feeling ashamed about your whole body, or parts of your body
• Spending a lot of time worrying that your looks are inadequate or unattractive
• Avoiding situations (such as mirrors, pictures, swimming, or social events) because of your weight or appearance
• Linking your self-worth to your appearance

Better body image and self-confidence is one of the top-cited motivations for patients undergoing weight loss surgery. And most patients who have the surgery do report improvements in these areas afterward. However, a positive body image is not a guaranteed outcome. Some patients, like Beth, find the loose and folded skin to be distressing. Others have such a long history of body image dissatisfaction that even losing weight does not change how they feel about themselves. Others shift their area of dissatisfaction to another body part or attribute. Still, others do not lose as much weight as they had hoped and feel frustrated and let down.

Ultimately, it is impossible to predict exactly what the body will look like after losing a significant amount of weight, and having too high of expectations can lead to disappointment. After all of the work you put in to have the surgery and make these permanent lifestyle changes, being disappointed in the outcome can feel devastating. Many patients, even those with a positive body image, describe a “mind-body lag” where their physical body has changed, but in their minds, they still feel bigger for some time after the surgery.

If you are struggling with your body image, even if you are still pre-operative, consider some of the following ways to help yourself feel better.

Tips to Improve Your Body Image

1. Spend some time reflecting on the source of your discomfort. What types of messages have you received about your body over the years? Have you agreed with these messages? If not, why give them so much power? Surround yourself with something more positive.
2. Challenge oversimplified assumptions about appearance. For example, “Attractive people have it all!” or “My life would be so much happier if I were thin!” Research has shown that attractive people are no happier than unattractive people, and persons of average weight have no better body image than persons who are overweight. (Go back and read that sentence again --Yes, it is true!) Your appearance does not prevent you from being happy – your thoughts do.
3. Focus on the things your body can do for you. Your body gives you life and it is capable! Engage in pleasurable activities that rely on your body’s non-appearance functions, such as dancing, swimming, playing a team sport, playing with your children, grandchildren, or pets, doing yoga or stretching, getting a facial or a massage, or take a relaxing shower. Go outside and feel the sunshine on your skin. Ride the roller coaster you’ve been waiting to get on.
4. Senses and abilities. What senses or abilities are you thankful for? What would you miss if it were suddenly taken away?
5. Positive. Make a list of all of your positive qualities that have nothing to do with physical appearance. Ask your partner, friends, and family to add to it. Post it somewhere where you will see it often.
6. Challenge yourself. Challenge yourself to do some of the things you would normally want to avoid. The more you do them, the less fearful they become.
7. Avoid “mind-reading.” It is tempting to assume what other people are thinking about us, especially when those assumptions are negative. It is tempting to attribute others’ behavior to our own personal qualities. We might think the store clerk is rude because we forgot to put on makeup, but in reality, she is rude because she’s having a bad day. We might think everyone in the room is judging us because we are overweight, but in reality they are more worried about themselves. If you do not have any true, factual evidence to support your assumption, let it go.

Sometimes, our feelings about our bodies and ourselves are so resistant to change that we might need outside help. If your thoughts and feelings about your body are seriously impacting your mood, your eating habits, or other aspects of your daily life, make an appointment to talk to a psychologist or therapist. A trained behavioral health professional can help you explore your relationship with your body, and learn ways to become more compassionate towards yourself. You deserve it!

References:

1. Azin, A., Zhou, C., Jackson, T., Cassin, S., Sockalingam, S. & Hawa, R. (2014). Body contouring surgery after bariatric surgery: A study of cost as a barrier and impact on psychological well-being. Plastic and Reconstructive Surgery, 133, 776e -782e.
2. Bertoletti, J., Aparicio, M.J.G., Bordignon, S., & Trentini, C.M. (2019). Body image and bariatric surgery: A systematic review of literature. Bariatric Surgical Practice and Patient Care, 14, 81-92.
3. Cash, T.F. (1997). The Body Image Workbook. New York, NY: MJF Books.
4. Perdue, T.O., Schreier, A., Swanson, M., Neil, J., & Carels, R. (2018). Evolving self-view and body image concerns in female postoperative bariatric surgery patients. Journal of Clinical Nursing, 27, 4018-4027.

ABOUT THE AUTHOR Christina Rowan is a clinical psychologist in the Weight Management Institute at Summa Health. She received her Ph.D. in Counseling Psychology at The University of Akron and completed a post-doctoral fellowship in health psychology with a specialization in bariatrics at Cleveland Clinic. She provides individual and group counseling, assessment, and support services to patients struggling with weight or eating-related concerns. Read more articles from Dr. Rowan!

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