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‘Phantom fat’ can linger after weight loss

Losing the weight is just the first step. Next comes shedding the heavy burden of a larger-than-life self-image. Even after dramatic weight loss, some are plagued by lingering  "phantom fat."
Duane Hoffmann /

Even though Kellylyn Hicks has lost about 85 pounds over the last year and a half, and gone from a size 24 to a tiny size 4, she still worries she won't fit into chairs.

While out shopping, she fears that she’ll bump her hip into a shelf and break something. A few years ago when she was heavier, she accidentally knocked over and broke a wolf figurine and had to pay $60 for it.

And every morning when she looks in the mirror while getting ready for the day, she sees her former, heavier self. “My brain says, ‘Yep, still fat.’”

“It's been really hard to change my self-image,” says Hicks, 37, of Chesapeake, Va. “I still feel like I'm this enormous person who takes up tons of space.”

While many people are thrilled when they lose excess weight, not everyone is as happy as they expected to be — or as society assumes they surely must be.

Body-image experts say it’s not uncommon for people, especially women, who have lost a lot of weight to be disappointed to some extent to discover that they still aren’t “perfect.” The excess fat is gone when they reach their goal weight, but they may have sagging skin, cellulite or a body shape that they still deem undesirable. Like Hicks, some even continue to see themselves as though they are overweight.

Some specialists use the term “phantom fat” to refer to this phenomenon of feeling fat and unacceptable after weight loss.

“People who were formerly overweight often still carry that internal image, perception, with them,” says Elayne Daniels, a psychologist in Canton, Mass., who specializes in body-image issues. “They literally feel as if they’re in a large body still.”

Daniels and other experts suspect this may happen because the brain hasn’t “caught up” with the new, leaner body, particularly for people who were obese for many years and then experienced rapid weight loss.

“Body image is a lot harder to change than the actual physical body is,” Daniels says.

'Waiting for the other shoe to drop'
Another contributing factor, especially for yo-yo dieters, can be fear of regaining the weight, says Joshua Hrabosky, a psychologist at Rhode Island Hospital who studies body image and counsels obese people undergoing bariatric surgery.

“They’re still in the back of their minds maybe waiting for the other shoe to drop,” he says. People who’ve gained and lost and gained again may be less likely to embrace a new image that they worry won’t last.

Hrabosky co-authored a research paper in 2004 that discussed the notion of a phantom fat phenomenon. “We were kind of playing on the concept of phantom limb,” he says, in which people who’ve lost an arm or leg feel like the limb is there and even causing them pain or itching.

In his study, published in the journal Body Image, Hrabosky and colleagues questioned 165 women who were grouped into three categories: those who were currently overweight, formerly overweight (and at an average weight for at least two years) and never overweight.

Both the formerly overweight women and currently overweight women were more preoccupied with weight and had greater “dysfunctional appearance investment” — telling themselves, for instance, that “I should do whatever I can to always look my best” and “What I look like is an important part of who I am” — than women who were never overweight.

Still focused on the fat
The findings suggest that “people who undergo major weight loss may experience improvements in satisfaction in appearance, though still not necessarily as much as someone who was never overweight,” Hrabosky explains. “But they are also still more invested or preoccupied with appearance than someone who was never overweight.”

Though she’s lost 50 pounds, Nell Bradley, 25, of Atlanta, says she’s more weight-conscious now than five years ago when she weighed 200 pounds.

“I’m so afraid of being that size again,” says Bradley, who exercises three to four times a week and watches her diet to keep her weight in check. She’d like to lose about 10 more pounds.

Even five years later, she still hasn’t shaken the image of her heavier self. “Now I’m down to 155 to 160 and I still feel like I'm at the weight that I was before,” she says. “It's weird because sometimes I'll shop and immediately look for clothes in my size when I was nearly 200 pounds. I always have problems seeing myself in the mirror or in pictures.”

Experts say part of the problem in our body-obsessed culture is that many women — and increasingly more men — have highly unrealistic expectations of what weight loss can do for them. Too often, they think hitting their ideal weight will make them look like a swimsuit model in a magazine, and they’re disappointed when that’s not the case.

People who expect perfection can “get stuck in dichotomous thinking that you’re fat or you’re perfect, and there’s no gray area in between,” says psychologist Leslie Heinberg, who counsels bariatric patients at the Cleveland Clinic. “So if you’re not perfect, you’re ‘fat.’”

'Blind spot' about own body
Heinberg says a lot of her patients who’ve lost large amounts of weight know they have a “blind spot” when it comes to their new body, so they really have to work at believing they look the way others see them.

“It can take years after surgery, after losing weight, for people to really buy that,” she says.

Think of getting a dramatically different hairdo and then doing a double-take upon seeing your reflection in a store window, Heinberg says. “Losing 80 pounds is much more of a cognitive shift than getting new highlights,” she explains.

Some people will adjust naturally and more quickly to the weight loss than others, experts say.  But it’s time to get help when people are experiencing significant distress, sadness or depression, they say, or their feelings are interfering significantly with their normal activities (such as not going to parties or children’s events, always looking in the mirror or avoiding intimacy with a partner).

Counseling may involve challenging distorted ways of thinking about one’s appearance (by studying before-and-after photos, for instance, or bringing out the “fat pants” and seeing the difference in the mirror), learning how to think about oneself in a more positive manner, and working to engage in activities one’s been avoiding.

“You have to look at retraining your brain and understanding that you have been reinforcing this negative image for probably a long time,” says Adrienne Ressler, a body-image specialist and national training director for the Renfrew Center Foundation, which has several eating disorder-treatment facilities around the country.

“We become numb to how mean we’re being to ourselves,” Ressler says.

“We need to learn to appreciate our bodies,” she says. “If we could all look in the mirror and say, ‘Hello, Gorgeous!’ I just think the world would be a better place for women.”