Body Dysmorphia After Gastric Sleeve Surgery

Oh, the joy of seeing the numbers on the scale drop and your body shrink following gastric sleeve in Mexico! After years (or perhaps a lifetime) of being overweight or obese, it’s truly thrilling to feel normal…healthy…even sexy. Some VSG patients, though, still see a much larger person in the mirror than what’s actually there. It can be disconcerting to have your eyes and your mind at war with each other—not to mention the stress it can place on relationships if it becomes serious. If it’s affecting you, please know that you’re not alone and that help is available.

What is body dysmorphic disorder (BDD)?
It’s most often associated with feeling fat even when you’re not, but BDD encompasses any perceived physical “flaw”—believing that a perfectly lovely nose is huge, for example. For our purposes, however, we’ll restrict it to body size, as that connection is most pertinent to our patients.

BDD is related to self-image, which isn’t always (or even mostly) rational. Says Jordan, “When I look at my (recent) pictures, I’m like, ‘Wow!’ But then when I look in the mirror, I see the same old me.” Her experience is common. Self-image is associated with how you feel about yourself, whether the medical charts say you’re overweight or lean. Many formerly obese patients, understandably, go into vertical sleeve gastrectomy with a poor self-image. Years of teasing or straight-up bullying takes its toll on how you feel about yourself, and that mindset doesn’t simply vanish in the weeks and months it takes your body to become healthy. Conversely, perhaps you worked so hard to accept yourself when you were overweight that now a healthy weight doesn’t seem like the “real you.”

The truth is that BDD is a mental health issue, and, like other mental disorders, it can occur in mild to severe forms. For the vast majority, it’s mild. Maybe the changes you see in your body aren’t quite as big as what others tell you they see, or perhaps you’re still trying on size XXL in stores when you’re now a size medium. In those cases, your mind will eventually catch up, likely without professional intervention. But when you’re convinced that your now-healthy body is still obese or become fixated on physical “flaws” more than ever before, you might need the help of a professional.

Is it a problem—and what’s the solution?
After significant weight loss, there’s often a fine line between normal behavior and true BDD.
• Checking yourself out in a mirror is normal. Doing so compulsively and not liking what you see is not.
• We all like compliments. But it’s not healthy to require constant reassurance that you’re not fat, ugly, etc.
• Everyone feels anxious about their appearance at times, but if anxiety about your body is interfering with your ability to concentrate at work or preventing you from enjoying social engagements, it’s a problem.

For mild cases of BDD, studies suggest that tossing oversized outfits (even baggy clothes in your new size) can work wonders. Fitted shirts and dresses not only “force” you to see your new shape, but they can help you feel good, too. After all, how good do you feel when you’re wearing a tent? Countering invasive thoughts with a mantra—”I’m not fat; I’m at a perfectly healthy weight”—can also retrain your brain over time. For more severe cases of BDD, the help of a mental health professional is critical. Therapy, perhaps combined with medication, can help you see yourself as the uniquely beautiful person you are, inside and out.

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“Changing lives…one sleeve at a time”.