Reality television shows and glossy magazine covers would lead you to believe that major weight loss makes your life better in every conceivable way. (And that it can happen practically overnight, at that.)
But the fact of the matter is, the reality of weight loss, and all the changes that come with it, is much more complicated than that. Significant weight loss not only affects the body, but the mind and spirit as well, and navigating the world throughout the process can be quite complex.
In order to get a clearer picture of what major weight loss is actually like, we spoke to health experts and someone who experienced this life-altering transition firsthand.
What is Considered Significant Weight Loss?
Like any health-related matter, what is considered significant varies from patient-to-patient and—as obesity medicine physician-scientist Dr. Fatima Cody Stanford of Harvard University explains—which modality of weight loss therapy is used.
For instance, if a person has lost weight through behavioral, medication, or surgical therapies, “the expected outcomes would vary,” she says.
Dr. Stanford, who co-wrote Facing Overweight and Obesity: A Complete Guide for Children and Adults, says that for behavioral therapies, the medical industry considers significant weight loss would be considered 3-5 percent of total body weight, while medication is 5-10 percent and surgery is 25-30 percent.
“Everyone has a different response to a certain treatment course,” Dr. Stanford says of losing weight and maintaining it for the long-term.
What Happens to the Body After Significant Weight Loss?
What happens to the body after significant weight loss will again be different for each individual, including the matter of loose skin. Dr. Stanford explains that this issue, in particular, depends on the elasticity of one’s skin, which is genetic. So, while one person may lose 200 pounds and not deal with loose skin, a person who loses just a fraction of that may not have the same result due to their skin’s elasticity.
If you do have loose skin as a result of significant weight loss, Dr. Stanford notes that the only effective treatment in mitigating it is plastic surgery intervention. But, this can only be done after six months of maintaining a stable weight after the initial loss.
Weight loss, Dr. Stanford explains, is a hormonal shift, so the body will undergo changes as a result. Because the resting metabolic rate drops drastically during a significant weight loss, the body will try to get back to its set point. This is why, Dr. Stanford notes, diets typically fail, as your body is designed to go back to its highest number.
For those who do maintain long-term success in terms of weight loss, some of the ways health and the body can be affected, include improved fertility rates and increased energy and sex drive, among others.
However, because of biases against patients with mild, moderate, or severe obesity, health problems that are blamed on weight can go misdiagnosed and under-evaluated for years, she explains. For instance, while weight loss can aid with issues related to osteoarthritis, the same cannot be said for rheumatoid arthritis.
This is why it’s so important to see a weight-inclusive practitioner whether you have a larger body or if you have lost significant weight, explains New York City-based psychologist Dr. Alexis Conason.
What Happens Emotionally After Significant Weight Loss?
Just like physical changes can fluctuate by person, so can the mental and emotional after-effects of weight loss.
San Diego-based therapist Dr. Marianne Miller says that getting to the root of why the weight was lost in the first place can explain the underlying emotions attached.
If a person has lost weight due to illness or an eating disorder, their emotional and psychological changes may differ from someone who lost weight for cosmetic reasons.
As Dr. Conason points out, “we live in a fatphobic culture” and, in turn, some people who lose significant weight experience sadness or anger when they see how biased and unjust the world can be to marginalized people.
“Literally doors are open that were closed before,” explains Dr. Conason. This means that experiences that may not have happened while living in a larger body—being able to fly on airplanes, getting new job opportunities, and yes, strangers opening doors for you—can become the norm after weight loss. “You have to adjust to being in a world that treats you and sees you differently…it’s a huge psychological transition.”
This can be an eye-opening and exhilarating for some, while others feel upset about these newfound experiences. “Our society presents weight loss as a positive thing, and it’s not always the case,” Dr. Miller adds.
What Happens Mentally After Significant Weight Loss?
When it comes to anxiety and depression and weight loss, Dr. Miller says that while these two health problems “can often accompany disordered eating patterns,” it all ultimately comes back around to the underlying emotional, psychological, and physiological issues associated with weight loss.
In some cases, the oft-vicious cycle of long-term weight loss maintenance and coming to terms with body image or self-esteem problems can make anxiety and depression worse. One example of this, Dr. Conason notes, is after the honeymoon period of weight loss when the world seems new and great, and then depression and anxiety reemerge.
For some, there’s been a longstanding idea that losing weight will fix everything (career, romance, and even mental health) and when that facade is shattered or expectations set by society aren’t met, it can be devastating.
When it comes to depression and anxiety, all of the experts agree on finding a therapist who specializes in both disorders, as well as weight-related body issues. Support groups can also be helpful for those going through this experience. “You don’t have to go through this alone,” assures Dr. Conason.
Dr. Miller reinforces that weight loss and body image does not define your value as a person either. As she puts it: “Society tends to reduce women’s value to their appearance, which is a way of marginalizing and oppressing them. We have big, beautiful brains, and huge hearts, and wonderful spirits. We have courage and tenacity and compassion. That does not change if your appearance changes.”
One Woman’s Experience With Weight Loss
Everybody responds to major weight loss differently, and not just when it comes to their bodies. One woman who knows that firsthand is Jean, a 32-year-old who lost almost 150 after a vertical sleeve gastrectomy and what she calls “a seriously intense diet” that had her eating only 800 calories a day.
While Jean says her physical transformation was almost immediate (she lost about 75 pounds in the months after her surgery), she admits, “I don’t think my brain ever caught up with the physical transformation my body had undergone.”
“On the one hand, I feel like people started to see me the way I’d always seen myself, but on the other hand, I truly didn’t feel that much different,” she says.
Jean admits that while it was great to be able to shop for clothes in “regular” stores after the weight loss, she says it’s hard to enjoy victories, as she was always thinking about her next goal. “I don’t think I spent enough time really appreciating the effort I’d put in and how much I liked how I looked.”
In the nearly 10 years since her surgery, she says she’s gained a good deal of the weight back, a figure that doesn’t bother her. “I am quite tall and broad no matter what I weigh, so I will never be considered ‘small,’ whatever that means.”
She says, ultimately, she is grateful that her body confidence journey and the weight loss have provided her with a different perspective on how others viewed her, as well as how she views herself.
Though she is not necessarily “happy” with her weight, she acknowledges, “I don’t know that anyone who’s ever struggled with their weight will ever reach a size where they feel like they reached their end goal and feel content.”