This story is from The Pulse, a weekly health and science podcast.
Much of how people experience the world is determined by their appearance, particularly how the rest of society perceives and treats them. So, what happens if someone’s appearance changes dramatically in just a few months?
For people who undergo bariatric surgery and experience significant weight loss, navigating those social shifts can be difficult.
Rachel Goldman, a psychologist in New York City and a clinical assistant professor in the Department of Psychiatry at NYU School of Medicine, has been helping patients before and after bariatric surgery for more than a decade.
Most people can only imagine how others would treat them if their appearance changed, but they’ll never really know how other people would treat them if they were taller or prettier or thinner. Goldman’s patients do.
“We try to prepare people as much as we can. But I don’t think people fully understand what the changes are until they’re living it,” she said. “Oftentimes, before surgery, I’ll get clients saying to me, ‘Yeah, sure, OK. That’s not going to happen to me.’”
But for many, the change is startling. After surgery, suddenly, her patients say, they get more attention, according to Goldman. They report that they feel seen in a way they had not before, as if they had been invisible before their surgery. Strangers talk to them. People hold doors for them or help them with their luggage on an airplane. It can also mean navigating a host of new social situations, like flirting and dating.
“There is this weight bias and negative attitudes towards individuals in a larger body,” said Goldman. “And after people lose a significant amount of weight, they really do start experiencing this. People are kinder and nicer. And it’s like they’re no longer invisible.”
The change can be swift. Goldman’s patients might see their appearance change drastically in just a few months. Patients may lose up to 60% of their excess weight in just the first six months after their weight loss surgery, and 77% of their excess weight within the first year post-surgery, according to the American Society for Metabolic and Bariatric Surgery.
Goldman pointed out that all patients are unique. Some, particularly those who were very social before surgery, don’t see such a dramatic shift in their experiences pre- and post-surgery.
But for those who do, the transition can be difficult. The new attention and compliments might feel good in the moment, but they can negatively affect patients’ self-esteem, and make them fear regaining the weight.
“It really affects their mental health, their self-image and self-confidence, trying to understand, ‘How did somebody see them so differently before?’” said Goldman.
To help patients struggling with the many social and lifestyle changes, Goldman said, she tries to have them focus on the things they can control, and on why they decided to have bariatric surgery in the first place.
“It’s very disappointing and very frustrating, you know, for myself as well, being in the mental health field and hearing about these experiences,” said Goldman. “It’s very sad. And this is really why we want to educate the public as much as we can in terms of how harmful weight bias can be.”