The Reality Of Serious Weight Loss

Nov 9, 2013 @ 11:24

Alexandria Symonds spotlights the work of photographer Julia Kozerski:

For Kozerski and many like her, the experience of significant weight loss is much more psychologically complex than the multi-billion-dollar diet industry, with its beaming “after” photos and promises of a new life, acknowledges. After all that work, it can be a disappointing blow to discover that "Self" bodies that have lost 50-plus pounds simply don’t look like bodies that have maintained a steady weight since reaching adulthood.  (While cosmetic surgeries like those detailed here can treat loose skin, stretch marks, and sagginess, they’re also expensive, invasive, and mostly absent from the fairy-tale weight loss success stories we see depicted so often.)

“You sort of feel like someone shortchanged you on the satisfaction of things,” explains John Janetzko, a Harvard grad student who has lost 120 pounds. “I feel, oddly, more aware of everything – [like] when I lean forward, if I feel like I have any stomach fat that’s there. And it’s strange, because I’m like, ‘Well, how did this not bother me before?’ … It becomes this nagging, incessant reminder of, you did something, but maybe it wasn’t enough, maybe you should keep going.”

Beyond just the surprise of a new body that still may not conform to the social standard of how a beautiful one should look, reaching a goal weight often leaves ex-dieters bewildered as to where to go from here – and upset to find that even after this tremendous accomplishment, they still aren’t completely satisfied with their bodies.

(Image: Self from Kozerski’s series Half. More images from the series can be viewed here (NSFW).)

Nov 11, 2013 @ 10:30

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A reader writes:

I am glad you found this piece and are sharing this with your readers.  This is a subject that is as personal and close to me as can be.  Having gone from 425 lbs to 275 without surgery, I certainly expected to feel much better about it than I do."Self"

Make no mistake, I’m proud of what I have accomplished, but the truth is that I still FEEL 425 lbs.  That fact has been incredibly upsetting and frustrating.  More to the point, because the skin is still there, there is a kind of phantom limb feeling that occurs, which reinforces the feeling of still being as obese as I once was.  I too don’t look the way I envisioned when this journey started.  I find that I look like the proverbial 10 pounds of potatoes in a 100 pound bag.

All of this takes an incredible toll on my mental health.  Any happiness at my achievement is immediately mitigated by fact that weight loss was not the panacea for my appearance and mental health that I assumed it would be.  When you lock up your issues in your weight, you assume that shedding the weight will rid you of those issues.  Like an addict who quits drinking or drugs, you feel the initial euphoria (something akin to a sobriety high), but that wears off, and you are left to live the rest of your life in this new way.

That adjustment is hard for addicts – but I would submit that it may be harder for the obese in one way.  Imagine if an alcoholic still HAD to consume some alcohol to live.  Many alcoholics say one is too many, and a million is never enough. Unfortunately for compulsive over-eaters, this approach isn’t an option and leaves you vulnerable to relapse (and would explain why so many people who lose extreme amounts of weight end up putting it back on).

I really hope this can begin a conversation with readers; I feel like this a topic the Dish is built for.

Another reader:

Wow. This really hit home. A couple of years ago, at the age of 41, I finally got around to doing what had been my New Years resolution for 15 years running: I lost weight.  And not just a few pounds, but quite a few – 100 to be exact. I did it without surgery, through a series of different “programs”… juicing, nutrisystem, calorie counting, and yes, a good brisk 30-minute dog walk a day.  It took me about 10 months and I’ve kept it off.  When you do something for 10 months and are regimented about it, it just becomes the norm.  That’s what I tell people that ask how I did it.  Find something that works for you and is sustainable.  Because at the end of the day, it needs to be a permanent change.

But back to the subject of the post. I too was disappointed that my body did not bounce back to look like It did in my youth.  My belly looks similar to the woman in the photo shoot.  It’s disappointing because fully clothed, I can catch myself in the mirror and feel fantastic about my accomplishment and the way I look, but getting in the shower in the morning … well, that’s a different story.

What I’ve learned though, is that while improving my appearance was always the biggest reason behind getting in shape, it’s health that has become of greater importance to me.  When I finally got off my butt to lose the weight, my blood pressure was through the roof, and my blood sugar was firmly into the pre-diabetes range, bordering on full blown type-2.  I was maybe two years from some serious health issues and the type of medications you take for the rest of your life.

So when I’m getting in the shower and I catch that ugly belly and backside in the mirror, I can shrug it off and be content with who I am.  But there was a 15-year period where I couldn’t.


After my last major weight loss and regaining it all and more, I recognized that I was excellent at losing weight, but terrible at sustaining the loss. And I sought to understand why.

I once climbed Mt. Rainier, which, at 14,411 feet, requires that you breathe in a methodical way as you ascend to help your body adjust to the decrease in oxygen in the air. Every breath and every step must be done consciously in tandem to prevent altitude sickness. It requires a level of focus that becomes all-consuming. I don’t remember much about the view during the ascent, but I remember that breathing ritual.

That was my experience as well during weight loss. The focus required is total. Nothing passes your lips without also passing the gauntlet of calorie count, nutrient type, whether it is a “good” or “bad” food, eaten in the right quantities, pairings, settings, company, platings, etc., etc. ad infinitum. The step from healthy attention to unhealthy obsession is a short one, and downhill. The cultural obsession with body image is right there, with its hand on your back the entire time.

A function that is natural and necessary to life, becomes stilted, judged and twisted. And if it works, and you lose the expected weight, it becomes a life sentence to maintain it. Ask a dieter how much of their day is spent planning or anticipating the next tightly monitored meal. How much of their workout is spent staring at the fatuous “calories burned” indicator on the exercise machine readout. It is shocking.

I consider it one of my healthiest decisions to reject the very idea of weight loss as a goal. It took me years to purge myself of the toxic ideas of the diet-and-exercise industrial complex and the self-blame and self-hatred those ideas cultivate and profit from. I consider it malpractice for physicians to prescribe an approach that will be unsuccessful in the long term for 95% of the people who attempt it. What a choice: you can be fat or crazy.

Pinning all your hopes on an unattainable body image (with ever-moving goal posts) and placing the authority on what is best for your body on late-night infomercials is a so sad and so wrong and such a waste. I wish I could put Kozerski’s pictures on every billboard nationwide in hopes of breaking the cultural fever and dispelling the illusion of the perfect body attainable forever through diet and exercise. What we could do with all the brain power being wasted!

I am healthy despite my weight. I eat well, I enjoy moving my body and breaking a sweat. I do not own a scale. I am at peace.

(Image: Self from Kozerski’s series Half. More images from the series can be viewed here (NSFW).)

Nov 13, 2013 @ 1:40pm

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A reader writes:

One aspect of substantial weight loss that hasn’t been brought up in your discussion thread is the effect it has on your sex life. Yes, once the euphoria has worn off, you have to come to terms with the disappointment that your new body is not what you envisioned. But you also have to face the fact that even a modest amount of excess skin may actually make you less physically attractive than before. Those who have not found love or a secure relationship may see weight loss as a key to finding new social and romantic opportunities. This was certainly true for me, but I was shocked to discover that my body after weight loss appeared to be more repulsive to potential lovers than it had been before. I have experienced the look of disappointment and shock on the face of a new lover – even after I had been open and honest about my body. For me, the realization that I may never again be physically intimate and experience the joy of being held, caressed, and loved is actually worse than the health and social problems of obesity.

The above photo from Julia Kozerski is entitled “Lovers Embrace”, from her (NSFW) series Half. Another reader:

It’s been over four years since I started getting my life and weight under control. I joined a support group and the weight just slid off. It’s been three years now since I lost the last of 170 pounds. Those first months in my “new” body were disconcerting. I carried a photo of the “old” me around to show people I met. I was telling them they weren’t really talking to this normal-looking person, but rather that fat guy. It took a long time for me to shake that habit.

The second thing I remember was a feeling of instant vulnerability. Having been used to being the biggest person in any room, I never felt physically threatened. Ever. Suddenly I was 200 pounds, not 370. A guy I used to outweigh by over a hundred pounds now had be by 40 or 50. What would happen if he turned on me? I’d never feared that in my life.

Hugs are strange too. That bulk I carried around was a great barrier to keep people away. Now they’re RIGHT THERE.

Lastly … intimacy. I’ve been 100 pounds overweight since adolescence. Needless to say, I didn’t get a lot of attention from women. I went my entire thirties without a single sexual partner. Now women check me out regularly. It’s still weird. I wish I could say I’m getting used to it, but I’m not.

Reddit had a great discussion a month or so back on weight loss and the struggle to quiet the inner fat guy/girl. I saw myself in a lot of it. Thanks as always for the discussion.

Nov 14, 2013 @ 7:32am

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Readers continue the thread:

One of your readers mentioned that he/she is “excellent at losing weight, but terrible at sustaining the loss” and attributes it to being unable to maintain razor sharp focus. I think it’s important to point out that this phenomenon is more physiological than mental. Tara Parker-Pope wrote a fantastic article about this in the New York Times called “The Fat Trap.” It should be read by everyone who wonders why people lose a lot of weight and gain it all back.

To summarize, in order to maintain your newer, thinner body, you have to be far more disciplined than a person of the same size who was never fat. Not only does your resting metabolic rate (the number of calories you burn if you lie in bed all day) decrease, your body becomes more efficient during exercise (formal or informal). As a result, compared to a person who has always been thin, you have to do about 2500 calories worth of extra exercise to maintain your weight. That’s the equivalent of running 5 miles every week day. No wonder 97% of people who lose a significant amount of weight gain it back within five years.


As a physician I am dismayed by one of your readers quotes “I am healthy despite my weight”.  That’s the equivalent of saying I’m healthy despite my heart disease or I’m healthy despite my colon cancer. I agree that there is a problem with how this society views fitness/beauty. Six packs and stick figures are not attainable healthy for the most part. The problem is we use the mirror as our tool for judging weight loss. Being overweight or obese lowers our self esteem and weight loss improves it. If you are lucky enough to be one of the few people who doesn’t hitch their self-esteem to their outward appearance, then congratulations. Unfortunately this does not help you or the very real health consequences of being overweight, or worse, obese.  I could list all the things, but it would take forever. There is not a single thing that being overweight/obese does not effect. In my opinion it is the single biggest roadblock to excellent medical care. We certainly don’t all have to be skinny, and we’d do better to try and separate the superficial from our feelings of self worth. But we as a society need to realize that obesity is a disease that will shorten your life.


I am a 32-year-old male. This past January while lounging around at 285 pounds I decided to make a change. I started to track my eating and doing a lot of cardio activity. Today I am down 65 pounds and everyone is amazed at my weight loss. What I see is different and was illustrated on Saturday morning when my wife commented on all my extra belly skin, I was defensive and told her it’s fat, because in my mind I have not changed in the ways I thought I would change. Losing 65 pounds is great and my doctor really loves it, but in the mirror I still feel like I weigh 285 pounds.


Those who have written in about the sagging skin resulting from their extreme weight loss should look into and seriously consider surgical removal and reconstruction surgery.  There should not be any shame attached to doing so, but only consideration of the risks and pain involved. Obesity can damage joints and arteries – we all see repairing those as necessary and attach no shame. The skin is another organ. It should not be seen as vanity to seek to repair it if it has been damaged.  If it can be repaired through surgery to give those who have lost the weight better mobility, comfort, and self-image, it is just as legitimate as a hip or knee replacement, in my opinion.

Nov 15, 2013 @ 10:30am

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The thread continues:

Excess skin is also a reality for most women after pregnancy – even if you didn’t experience excessive weight gain. I am trim and fit otherwise, but my stomach and breasts are saggy and loose and covered in stretch marks. It definitely affects intimacy. My husband says he doesn’t care; that he doesn’t even notice, but I care and I notice. I have a hard time relaxing during sex and I find myself contracting away when my husband touches my belly. My youngest child is almost 15 years old and I still feel shame and embarrassment about my post-pregnancy body. The feelings haven’t gotten any less intense, even after all this time.

Dec 12, 2013 @ 4:45pm

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Reviving the thread, a reader sighs, “I should have set a timer for how long it would take a physician to tell me my weight will kill me”:

My original letter prompted this predictable response:

As a physician I am dismayed by one of your readers’ quotes: “I am healthy despite my weight.” That’s the equivalent of saying I’m healthy despite my heart disease or I’m healthy despite my colon cancer.

It is that global belief, which is quickly being undermined by research, that puts doctors outside the reality of the lives of their patients. Recent studies have shown that in the absence of heart disease, diabetes, high blood pressure or other chronic illnesses that can correlate with obesity, but do not always, obesity itself may not be the risk it is assumed to be. The blunt instrument of weight, or the specious BMI, as an absolute indicator of health does not square with the actual experience of many people. The prescription to lose weight – a “losing” proposition in the long run for most people – does not recognize the reality that doing as prescribed – eating healthily and exercising regularly – doesn’t always result in weight loss, but it may result in health.

Another is more blunt:

By insisting on continually recommending weight loss to their fat patients instead of emphasizing healthy habits for all, doctors like your reader do real harm. In fact, studies have shown that many health professionals have a bias against fat people, finding them disgusting, lazy, noncompliant, etc. Largely because of this bias and its effects, fat people are less likely to go to the doctor. And when they do go, they get substandard care, with symptoms of serious health problems often ignored and attributed to fat rather than the underlying condition.

I’m not saying doctors shouldn’t talk about good nutrition and exercise and other health habits with their fat patients. They should talk about all these things with all their patients, all the time. But as anyone who has ever been to a doctor like your reader knows, most of the time conversations about health habits are ignored in favor of pointless and harmful scolding about weight loss.

Recent Dish on doctors’ bias against fat patients here. Another reader brings mental health into the equation:

The physician who e-mailed you is surely saying what is decreasingly popular to say out loud: obesity is a health risk. But the implication in that e-mail that the numbers on the scale are of paramount importance overlooks the mental health aspect of living and dying by the scale.

I have lost about 70 pounds, from a high of almost 250 to a low in the 170s. I am lucky that I never hit the point of stretch marks or damaged skin, so I saw the changes in the mirror and gained the promised confidence, but for a long time, I frequently weighed myself. When I lost weight, of course it felt good, but at some point, the urge to step on the scale at every opportunity became overwhelming. If my weight was up, I would enter a cycle of self-hatred, sometimes culminating in the use of laxatives (which I have never told anyone – I may have an undiagnosed eating disorder). All this over five pounds or less. For perspective, a person’s weight can fluctuate by 10 pounds over the course of a day.

This happened over and over and over again until I put my scale away so deep in my closet that I have forgotten where it is. I may have lost it in a move by now. I am so much happier, even if I’m not hovering around my all-time lowest weight.

Dec 13, 2013 @ 4:00pm

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A reader writes:

I read with some consternation the reaction of one of your readers to the admonition by a physician that there is no “healthy obesity”.  It is worth pointing out that contrary to your reader’s unsupported assertion, clinical data does not support the idea that obesity in the absence of metabolic abnormalities (high blood pressure, high cholesterol, diabetes, etc.) is as safe as being normal weight.  Specifically, a recent systematic review and meta-analysis (that is, an analysis that looked to combine data from multiple independent studies) appeared in the Annals of Internal Medicine (here is the link to the abstract). The study combined eight studies that looked at 61,386 people in all and found that otherwise healthy obese individuals had about a 25% increased risk for death or cardiovascular events (heart attacks and strokes) compared to healthy normal weight individuals.  To quote the conclusion: ” Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight.” [emphasis mine] Here‘s a NYT blog entry on the study.

I am very sympathetic to your reader’s assertion that eating healthily and exercising regularly doesn’t always result in weight loss, and the reader is certainly correct that doing those things will result in health independent of whether it affects weight loss.  I also cringed at the way the physician reader’s tone.  But he is also correct; all else being equal, an obese person is at increased risk for bad health outcomes.

Another reader is much more blunt:

That obesity is tied to many terrible and debilitating physical aliments is not merely opinion, and to point to the very few healthy exceptions to this norm is not an argument worth a damn.  And unfortunately, too few doctors even bother to make the recommendation to lose weight to their patients anymore, opting instead to prescribe drugs like statins or insulin, or surgical therapies, like gastric bypasses.  Why some overweight people think taking a palmful of drugs with potentially dangerous or even deadly side-effects or having part of their guts chopped out is more desirable than losing some weight through managing their eating habits and exercising regularly is mind-boggling.  Weight loss is not a complicated process, but it does mean the dieter cannot continue to eat like a spoiled child.  It means denying oneself everything one wants to eat, yes, okay, so suck it up or accept the fact that you are making a trade off: chose self-indulgent eating or health, mobility, and extended lifespan.

But I sigh because for anyone to claim obesity doesn’t matter or isn’t the health burden it actually is is ludicrous.  My own health has been greatly improved through weight maintenance and regular exercise.  I have been able to reverse my strong family history of heart disease – my father, who did not exercise or watch his weight, had a triple bypass by my age whereas my current risk of heart disease is rated extremely low.  Meanwhile, one of my siblings who disregarded proper weight management and regular exercise has also had a triple bypass. Sorry, but obesity and sloth make a huge negative impact on one’s health and anyone who argues otherwise is just nuts.

Another looks beyond health problems:

People who are obese may not have the issues that are often correlated with it, but there’s something to be said about the social impact and your ability to be mobile. I’ve lost 120lbs in about two years so far and I’ve seen both sides of this issue. The fact was, I was getting winded going up two flights of stairs. People wouldn’t sit next to me on the bus. Jokes were made at my expense. I could barely sit in seats and booths at restaurants. So if I didn’t have diabetes, heart disease, or high blood pressure, all of this would be okay?

After my weight loss I’m seeing doors open up to me. I’m getting solicited by men, and at my job I am getting more recognition for my hard work. They’re even talking about letting me travel; something they’ve never brought up to me before my weight loss.

Whether this is right or not is certainly a discussion, but at this moment it is the reality. Why artificially limit yourself in these ways because you want to convince yourself being obese is healthy somehow? It sounds like surrender.