December 20, 2023

BDD is less about appearance than anxiety about it.

Some people who have lost weight have trouble embracing their new, slimmer shapes. They may still perceive themselves as very heavy, even when the reflection in the mirror reveals a much smaller person.

This phenomenon is sometimes called “phantom fat” or “phantom fat syndrome.” The medical term is body dysmorphic disorder. The disorder can involve other aspects of a person’s self image, not just weight.

When people have body dysmorphic disorder, they are preoccupied with something about their physical appearance they perceive as a flaw, even when that ‘flaw’ is not observable to others. This preoccupation might include repeatedly checking a mirror, seeking reassurance from others, or mentally comparing themselves to other people. An example of this might be a body builder who never sees himself as big enough, so he works out constantly to address this perceived flaw in his appearance.

Image vs. reality

Why would people who have lost weight still perceive themselves as very large or heavy?

While weight can be quantified by a stepping on a scale, a person’s self-image is a more abstract thing. Our beliefs, past experiences, relationships, cultural context and behavior all play a part in how we think and feel about ourselves. If some of those areas haven’t changed despite the weight loss, a person might still feel the same way about themselves as they did when they were heavier.

The people most likely to experience body dysmorphic disorder, or BDD, are those with depression or obsessive-compulsive disorder. They tend to zero in on imperfections and perceive them as major flaws.

The seeds of the problem are present before weight loss. The disorder has more to do with psychology than with a change in size. It’s a rare experience, affecting perhaps 3 percent of people who have lost a great deal of weight, though there may be more who don’t talk about it or seek help.

Body dysmorphic disorder somewhat resembles eating disorders in which women, especially, view themselves as too fat when they may be at a normal weight. Unlike anorexia or bulimia, body dysmorphic disorder affects men and women equally. But eating disorders do not appear to be a risk factor.

Signs of body dysmorphic disorder include:

  • Repetitive behaviors, such as compulsive grooming or constantly checking the mirror.
  • Seeking frequent reassurance from other people about appearance.
  • Constant anxiety stemming from thoughts about size and appearance. This is a particularly strong symptom of body dysmorphic disorder. If an individual becomes consumed with thinking about weight, shape and perceived flaws, it could detract from the ability to focus at work or school or engage in normal daily activities.

How to rid oneself of ‘phantom fat’

It’s difficult to bring self-perception and reality into alignment.

Some people might need to deal with a relationship in which the person’s weight played a key role, or with past experiences of being bullied or shamed. Others may need to practice telling themselves different messages about their size.

Working on viewing oneself as a whole person with varying parts, interests and facets – as opposed to over-identifying with and/or attaching so much importance on the physical self – could also be helpful.

A therapist can help. Antidepressant medications are a common treatment. If you’re unhappy with your appearance even after reaching a healthy weight, it’s time to seek counseling.

how to keep your new years resolution

Help for those trying to lose weight

Keeping off excess weight is a challenge. People who have maintained their weight loss have many positive things in common. Keeping the kitchen stocked with healthy food always helps. If you’re just starting your weight-loss efforts, exercise is probably one of your goals. Start an exercise routine that’s manageable and not too intense at first.

Vanderbilt Medical Weight Loss