Maybe youve heard about body dysmorphia its a mental image many victims of anorexia nervosa have that tells them they look fat, even when they are emaciated. Bariatric patients can suffer from body dysmorphia as well.

When we were morbidly obese our emotional coping mechanisms kicked in and many of us were able to convince ourselves we really werent that big. It is emotionally kinder to avoid body criticism, the whole issue seems hopeless. In fact, many morbidly obese patients will say they see themselves normal sized. That is until a rude moment reminds them they are not normal sized: a skinny chair, a turnstile, a bathroom stall, a flight of stairs, a photograph. This false perception is a subconscious coping strategy to protect us from the brutal truth, the truth about how big morbidly obese really is.

My sister and I were clothes shopping one day with our morbidly obese mother. She tried an outfit and complained to us, but it makes me look fat. And gently we told her, Mom, you are fat. Intellectually my mother knows she is morbidly obese, but the emotional issues run over reason and she doesnt see herself fat. She is in serious denial that is preventing her from getting the help she needs bariatric surgery to save her life.

After surgery, there is a tendency for the body dysmorphia to reverse. Before surgery we denied how big we were, after surgery we judge ourselves critically like the anorexic and fail to see an honest reflection. One woman, down from size 24 to size 10 wrote, I feel fat daily. I never felt this at 248 pounds I saw a thinner person in the mirror than I see now. I look at my size 10 jeans and they look like tents. I dont feel as attractive as I did when I was heavy. I dont understand it, she continued, but I think it has to do with learning to accept yourself fat so you didnt see all the fat. Now I just have to learn to accept myself as thinner.

Many patients report hyper-judging their figures after weight loss. It seems the thinner you get the more judgmental of your body you become. To this day, the first thing I see in my reflection in my pudgy tummy I think its enormous. I dont see long slender legs or a tiny waist or trim arms. I see a Buddha belly. Ive even apologized for my chubby tummy to others when they compliment my new figure. The apology usually goes, Yes, but I cant get rid of this stomach. I say this while pointing to my "flaw".

That is wrong and brutally unfair to myself. I am working daily to keep this hyper-judgment in check, reminding myself the days of belittlement and self-loathing are over. Now is the time when I love myself.

Patients report universal success when they do one thing in the face of body dysmorphia: dress to impress! Get rid of the flowing camouflage clothes and wear a smart, well fitted outfit. Gentlemen, tuck in your shirts in. Ladies, wear a fitted skirt with a waistband. Small sized fat clothes do nothing for body image dump that style and get something that flatters your new size. Enlist the help of friends you trust to find flattering clothes. Sometimes you have to force yourself to see your body as it is, a great fitting outfit will certainly do the trick.

Extreme cases of body dysmorphia after gastric bypass weight loss may be treated with counseling and psycho-therapy.