Does body image improve after dramatic weight loss?

Do you believe that the fatter you are, the worse your body image? The Huffington Post, November 16th, spoke with David Sarwer, an associate professor of psychology and a weight and eating disorders specialist, about the truth of common assumptions about weight loss and body image.

 
Assumption 1: “The fatter you are, the worse your body image.” According to Sarwer this assumption does not hold true. There’s a very slim relationship between how you think you look and how you actually look. Those who are the most attractive sometimes have negative thoughts about how they look and those less attractive may show little body image distress.

Assumption 2: “Losing weight is the best way to boost body image.” Following weight loss, many people, including bariatric surgery patients, still have a lot of body dissatisfaction. One of things Sarwer tells patients when they come in for body-image counseling is: "Your goal isn't necessarily to learn to love your body as much as it is to learn how to tolerate it and not have the distress significantly impact your daily life."

Assumption 3: “Gastric bypass surgery cures body image woes.” With all bariatric surgery procedures (gastric bypass, the sleeve, the banding procedure), the average weight loss is somewhere between 25 and 35 percent of initial body weight within the first 18 to 24 months after surgery. As patients lose weight in the first three to six months, they report significant improvements in body image. But after weight loss, many patients complain about loose hanging skin, which is why more than 50,000 Americans every year turn to plastic surgery following massive weight loss.

Assumption 4: “Liposuction, tummy tucks and other shape-altering surgeries transform body image.” After surgery, most people report improvements in physical appearance and body image. But in some cases, patients may be dissatisfied because of complications or scarring or because they had unrealistic expectations. Between five to 15 percent of patients who suffer from body dysmorphic disorder are preoccupied with a relatively slight defect in their appearance and typically don't report improvements in body image after undergoing cosmetic surgery.

Assumption 5: “Breast implants boost body image.” Surprisingly, seven studies worldwide have shown a rate of suicide two to three times greater among women who have undergone cosmetic breast augmentation. About these statistics, Sarwer comments that it's likely these women had preexisting mental illness and is not a result of having surgery. One of the strongest predictors of a subsequent suicide is a history of psychiatric hospitalization.

Although weight loss and plastic surgery are not surefire guarantees of good body image, if you are obese, weight loss will certainly improve your overall health. For the rest of us, after improving appearance as much as time, money and good judgment will allow, the biggest challenge is to accept how we look.