The Hidden Truths of Major Weight Loss

(crossposted on Feministe)

Laurie and Debbie say:

Julia Kozerski lost 160 pounds, exactly the way that fat people are encouraged to. She changed her diet, she built in exercise, she stayed constant. Her goal was to change her body, and she succeeded. She went from weighing 338 (fat women can always tell you the exact number) to about 180. She’s also a photographer, and she has documented the experience extensively.

before and after self-portraits of Kozerski

It’s the wonder-and-dream story of most fat women in America and the western world. But it’s not a whole story. Here’s a full frontal nude of how she looks now.

“Everything starts sagging, and you’ve got stretch marks, and clothes fit differently, you’re kind of panicking, and you’re saying, ‘Am I doing the right thing? Because this shirt doesn’t look right,'” she says. “I was very, very – I don’t want to say depressed, but I would get really down on myself about, like, ‘I’m not doing this correctly,’ or, ‘This isn’t what it’s supposed to look like.'”

As Alexandra Symonds at New York Magazine says:

After all that work, it can be a disappointing blow to discover that bodies that have lost 50-plus pounds simply don’t look like bodies that have maintained a steady weight since reaching adulthood. (While cosmetic surgeries like those detailed here can treat loose skin, stretch marks, and sagginess, they’re also expensive, invasive, and mostly absent from the fairy-tale weight loss success stories we see depicted so often.)

“It’s a fantasy, that when we lose weight, everything wrong in our lives is going to be right — that means our relationships are going to be right, we’re going to feel completely differently about ourselves,” says Geneen Roth, a New York Times bestselling author of books on eating who also leads retreats and workshops, and who herself lost between 60 and 70 pounds in her late twenties. “People are shocked to find out that this thing that they’ve been longing for and waiting for and working for is not what they thought it was.”

Nude of Kozerski from the back

It should go without saying that Kozerski is remarkably brave to put these images out, and not everyone wants to see them or hear about her experience:

Even when talking about her weight loss, Kozerski says there’s no room to share the full experience – like when she went on a popular talk show to share her story. “They’re putting me in Spanx, and I’m like, ‘This is not what I want to talk about; this is not at all how I want to come out,'” she says. “I would rather put it all out there.”

So she’s not just brave; she’s also speaking truth to power. The diet industry (not to mention the weight-loss surgery industry) does not want women (or anyone) to know that they won’t emerge from the surgery with the bodies they see in advertisements. They absolutely don’t want people to know that choosing to lose large amounts of weight is choosing, in effect, voluntary disfigurement. (ETA: by the same kinds of cultural standards that equate fat and ugliness. Since many or perhaps most people striving for major weight loss are striving for conventional beauty, this is something they should have a right to know.) The weight-loss brigade doesn’t want people to know that as long as the weight stays off, the newly-skinnier person will always have to figure out what to do with the volume of the sagging skin. Spandex stops being a fashion statement and becomes a necessity. As Symonds says, “While cosmetic surgeries like those detailed here can treat loose skin, stretch marks, and sagginess, they’re also expensive, invasive, and mostly absent from the fairy-tale weight loss success stories we see depicted so often.”

Sure, if you lose a lot of weight and keep it off, some things will probably improve. For sure, the world will treat you better, especially when your loose skin is held back by Spandex or removed by costly cosmetic surgery. And some worlds may open up to you. Symonds–trying very hard to write a pro-weight-loss article and tell the truth at the same time–says: “Julia Kozerski waxes poetic about farmers’ markets and bike rides.”

But how many women in this time and place, this culture where smooth, unwrinkled skin is valued almost as much as thin bodies, would really choose the weight loss if they knew what they were choosing?

Thanks to our friend Lizzy for the NY Magazine link.

21 thoughts on “The Hidden Truths of Major Weight Loss

  1. A few thoughts.

    Surgery to remove excess skin following weight loss exposes the patient to much-more-than typical risk of infection, another thing the weight loss industry doesn’t want you to know.

    There are things one might gain from losing more than 100 pounds that might make the extra skin worth it: improved mobility, less stress on knees and back (potential for reducing back pain and reducing the possibility of knee replacement surgery), improved blood sugar. As you say, the changes to one’s skin should be widely known so that people can make fully informed choices.

    You write:

    “They absolutely don’t want people to know that choosing to lose large amounts of weight is choosing, in effect, voluntary disfigurement. ”

    That is not a neutral way to phrase this particular physical change in a person’s body. It sounds pejorative to my ear, but I doubt you mean it that way. Can you clarify? I’m finding it hard to believe that with all the work you have both done around body image that _you_ regard this as “disfigurement,” so your choice of wording seems odd to me.

    I would say that individual make choices about their bodies all the time that some people might regard as voluntary disfigurement: breast reduction surgery, breast enlargement surgery, any other kind of cosmetic surgery, tattoos, piercings, other kinds of extreme body modifications that are chosen for a very wide range of reasons. How is this different? It is a by-product of a long-term voluntary process, bearing in mind the great social pressure surrounding weight loss and the great difficulty and time involved with losing more than 100 pounds.

    I would also like to note that many people regard being fat as a kind of disfigurement.

    A parenthetical note: at some point, the check box for subscribing to comments on a per-posting basis has disappeared from the blog interface. Would it be possible for you to restore it?

    1. Lisa, that is an excellent point and something we should have said much better. We’ve edited the post to make it clear that it is disfigurement by the standards of the culture, rather than “objective” disfigurement. Thank you! At the same time, I think the difference between this process and the others you list “breast reduction surgery, breast enlargement surgery, tattoos, piercings, etc.” is that with those, no one is keeping visual results a secret (in some cases, the medical establishment is keeping health results a secret, but that’s a different post).

      We’re also checking on the subscribe-to-comments box for you.

      James, see Lisa’s comment above and our response. I don’t consider fat to be disfigurement, but to be one natural way for a body to be, though it is culturally classed as something quite like disfigurement. And the post been corrected to be clear that to the extent the results of the weight loss are disfiguring, that’s a cultural judgment. The difference is that the results are intentionally obscured by the people promoting the change.

      Rebecca and Kelley, don’t thank us, thank Julia Kozerski, who’s the real hero here. We’re just the reporters. At the same time, I’m really glad you found the pictures helpful.

      Laramie,, we don’t know. It would take a number of people as brave as Julia Kozerski, at different stages of weight loss at different speeds, before we could have any real idea.

      Garth and Brian, thanks for your comments.

  2. Julia Kozerski is incredibly brave. On the one hand, I would like to have a coach with the stick-to-it-iveness she has. On the other hand, I would like to offer a solution for having more skin than her current body requires. I don’t have a solution. I want to help, and I can’t.

  3. “It’s a fantasy, that when we lose weight, everything wrong in our lives is going to be right — that means our relationships are going to be right, we’re going to feel completely differently about ourselves,”

    As a hypnotherapist and NLP trainer, probably half of the inquiries I get are about weight loss.

    Any reputable therapist must deal not only with what’s blocking clients from a healthier lifestyle, keeping them in a cycle of obesity, but make it clear that losing the weight will bring new challenges, and will not be the magic cure for all that’s wrong or unpleasant in their lives. Without follow-up, the craving for “comfort food” (and drink!) may return with a vengeance.

  4. Why is the morale of the story not – don’t let it get that far? In my opinion the article is reversing the cause-effect relationship. The disfigurement that the overweight caused is just revealed by the weight loss, it is not caused by it.

  5. What a beautiful and brave lady you are!

    On the strong recommendation of my doctor I am on the long road to weight loss. Since I started my diet and exercise changes this year I have only lost a few pounds (by what the scale says) but I have lost many clothing sizes. My body shape has shifted in the oddest ways possible. My body is changing in ways that I did not think was “right”. Part of me wanted to put the weight back on so that I looked ‘normal’ but that is not a health option I wanted to take, so I kept on track with the plan my doc and I established.

    From your photos, I can see that this is a normal effect of the weight lost. THANK YOU, your sharing has helped me see that this is normal, that this is okay and that I am just fine the way I am.

  6. Hi, this is shocking and yes, it’s very brave of Ms. Kozerski to post these photos.

    I am curious as to whether this result is inevitable, though. What was the time frame of the weight loss? Might the body adjust better if weight came off very slowly? Over a couple years? Several? Spread out over five to ten years?


  7. Since losing 58 lbs, I can hear my belly skin smack on my waist when I run down the stairs. I can also hear skin flapping when I jump or run. Not only did I not anticipate so much loose skin, but I never thought others might have this same experience. Thank you so much for sharing this story with everyone.

  8. As is often true, Debbie’s comment covers most of what I was going to say.

    But I would add, that the most frequent public diet/weight loss conversation is about dramatic loss creating” transformation” rather then modest weight loss (that doesn’t create these problems). Only the magical transformation is viewed as successful. (And left out of that conversation is the 90% failure of most diets within 5 years.)

  9. I know from my mother in law who went from about 400lbs down to 120 that the loose skin IS mentally very hard to deal with. She lost the weight slowly, over about 3 years, so I don’t think the issue was how quickly the weight was lost. It took 3 doctors and 2 years to convince her insurance company that the surgery to remove the extra skin around her waist wasn’t “cosmetic elective surgery”. She’d already had both hips replaced and was looking at having one of them redone, and her mobility is severely limited. The extra skin made her unbalanced and prone to falls. I know that were I to lose weight the way Julie did I’d have the same issues, and it doesn’t thrill me.

  10. I wonder if extremely slow weight loss makes a difference with this problem?

    I reached a lifetime high of about 255 in early 1996. I started loosing weight a few pounds a year at that point. I weigh about 45 pounds less now. My main exercise is walking so while I do have a slightly saggy gut and upper arms, I’m reasonably comfortable by how my body is. I have high BP/cholesterol so any weight I lose is a win.

  11. I lost a lot of weight rapidly (almost two years) on Medifast. There were a lot of changes that frightened me as I lost weight. Adjusting blood pressure meds so I wouldn’t feel dizzy; terrible backache as my spine realigned, hair loss, skin folds. Terrible skin folds that would not go away. Those pictures are accurate. I lost almost 90 pounds. Most of it around my belly. I still could not get into size 16 pants because of the skin around my gut. I did not have supportive help after the weight loss and it almost all came back on. I’m not sure I want to do it again, I know the results. I am 56 now, my skin is even less flexible than it was when I lost weight at 40. I know it will help my knees, but I’m never gonna lose that gut or extra skin. My counsel would be never to get that way to begin with. It’s far far too late for me, but maybe someone else will see this and can benefit.

  12. Woah, a lot of these comments are way scary for a body positive blog. Don’t get that way in the first place? Diet stories? Argh! Good on you, Julia, for your courage in being photographed. As an artist, I find your body beautiful now. All those lovely flowing lines. But, I would have found it beautiful before as well. xxx

  13. Laurie,

    Appreciate your thoughts and your story.

    That’s a good question. This is an area where there way too many unanswered questions.

    Kryss and Judy,

    Thanks for sharing your stories. All these stories are information that folks really need. And Judy _thanks_ for your bravery in telling yours.


    We’re a body positive blog and we welcome everyone where ever they are on their journey.

    I appreciate your thoughts for Julia.

  14. I’m a consultant by trade and travel to work in my customer’s offices. After losing 160 lbs, I was at work one day and noticed that my client was too distracted to work effectively with me. The “bat wings” under my biceps were hanging out of my short sleeved shirt. A brachioplasty corrected that but that was self-pay since it is considered cosmetic. On the other hand, my only other option would be to wear long sleeved shirts which, when working in Florida, makes you stand out for other reasons, or else change careers.

    The other recommended surgeries include a complete circumcision of the skin around the waist, then pulling the skin of the legs and lower abdomen up like a pair of pants and reconnecting it all. There is also one where the skin over the legs which is vertically sized correctly after the whole-waist tuck, but can be reduced horizontally to make up for skinny thighs. There are others to remove a flap that hangs down over the genitals, butt tuck, and removal of excess skin of the breasts and chest. All of that is self-pay, of course. Without it you absolutely look like a freak at the beach, in the bedroom, etc. Then if you regain weight, there’s no elasticity left in the skin and it causes the skin to become very thin and prone to injury.

    Also, after the brachioplasty, my arms were numb around the incision, regaining most feeling gradually over 2 years, and this is considered normal. The same loss of sensation would be expected after any of the other surgeries I mentioned, potentially losing feeling over large areas of the body. There’s an element of danger there in that if you injure yourself you might not feel it, as I discovered the hard way while clearing brush in the back yard.

    After losing the weight, I got rid of my sleep apnea, asthma, edema, knee pain, back pain, shortness of breath, high blood pressure (mostly), and fatigue. Since I’d avoided the pool and the beach and now appeared slim, people started inviting me to those places, not knowing that below the clothes I looked like the male version of the photos above. It’s a journey from living “out” at the far right of the bell curve for weight, to looking typical when dressed but shockingly abnormal in beach attire or in the bedroom.

    Finally, it really *is* a deliberate choice of disfigurement. Nobody sits down and says “you know, I’m gonna make myself fat.” But to transition the other way is usually a deliberate choice and when losing a lot of weight the result is not to look good but to go from one type of disfigurement to another. Although I personally gained all the health benefits, I was not prepared for the negative psychological effects. I was sometimes embarrassed but never ashamed of my size and it wasn’t something I tried to hide. Five decades of my learned coping behaviors are geared to dealing with my appearance head on since I could not deny it. What I find now is that the difference between my clothed appearance and my actual appearance, and the constant desire to hide that, is what I’d always interpreted as shame. I didn’t feel disfigured before. I do now. Every day I weigh the cost and benefit of having lost the weight and on bad days it seems to not have been worth it. For me, on the whole, I’m glad I did it. But for some the result is worse and that can be psychologically devastating.

    Much love to Julia for having the guts to post those photos.

    1. T.Rob, this is a gut-wrenchingly honest post, and I especially love how you can see both the positives and the negatives of your experience. I hope when you are sending love to Julia for having the guts to post those photos, you are saving some for yourself for having the guts to make this post.

  15. Thanks, Debbie. I wanted to respond to the comment that “voluntary disfigurement” is not a neutral phrase. I can’t speak for Julia but I would imagine it was intended to be non-neutral. It’s a choice we either make with eyes wide open, or we get to the other side and are surprised. Either way, there are serious negative aspects to deal with and finding a neutral phase would do the reader a disservice.

    But James’ comment “Why is the morale of the story not – don’t let it get that far?” should be addressed as well. The question echoes the popular myth that obesity is a character flaw. It buys into the stereotype that fat people are lazy, weak-willed, evil, or otherwise of undesirable character.

    In my case, my blood work showed my leptin levels at 20 times the high end of the normal scale. Leptin is a hormone manufactured by fat cells that suppresses appetite. Lose weight your leptin levels decrease, you put weight back on. Gain weight, your leptin levels rise your appetite diminishes, you drop back down. That’s a bit simplified but in essence, leptin is like a thermostat that holds body weight steady.

    People whose bodies don’t make leptin are those children you see that are 100 lbs or more at 5 years old. Without leptin, their appetite takes over their waking thoughts and compels them to eat, just as your limbic system compels you to breathe. Hold your breath long enough and your body overrides your conscious directive. For these kids, not eating is not an option. However, now that we understand the role of leptin, we can screen for it and replace it using an infusion pump and these kids quickly return to a normal weight. This is very much like Type-1 diabetes where the body doesn’t make insulin and it must be replaced.

    The problem I have is more like Type-2 diabetes where the body makes insulin but it isn’t effective. My body makes lots of leptin but it doesn’t suppress appetite. Unfortunately, we don’t yet have drugs that work on leptin receptors the way we do with diabetes drugs and insulin receptors and so for the first 40 or so years of my life I never had a waking moment when I wasn’t thinking about food. Either trying to find some, or else doing the nutritional equivalent of holding my breath until my limbic system overrode my conscious desires and threw me into binge mode. I had some freedom of choice in individual moments but without a working thermostat and my body in a runaway positive feedback loop, there was no avoiding a gradual upward trend over time.

    And leptin issues are just one of a very many medical conditions that we absolutely know mess up the metabolism and lead to obesity. That anyone would assume obesity is a character flaw is understandable – we’ve been telling them it’s one of the 7 deadly sins for a few hundred years, after all. But it’s a fundamentally flawed interpretation that boils down a complex variety of interlocking biological systems to a simple but false assumption that obesity = character.

    It’s easy to blame obesity on character. It gives fitter people who choose to do so a group of people they can see as inferior. Even as we begin to tolerate sexual preference in society, obesity remains as one of the last acceptable social prejudices. We either actively mistreat the obese or we tacitly approve of such behavior when we see it and say nothing. But the people making these judgements really know nothing about the character of an obese person based only on appearance. They do however reveal their own character in their words and deeds and often it isn’t pretty.

    So, no, there is no reason the moral of this story should be “don’t let it get that far” because we don’t yet understand the biology of obesity and cannot assume every case is one of poor character. Until we do gain that understanding, there will always be some people in that upper percentile of weight distribution for whom the moral of the story is “where do I go from here?” If having that discussion in public makes someone uncomfortable then perhaps it’s an opportunity to consider what that reveals about or own character. If this is an opportunity to improve the overall level of compassion in the world, the only possible change we each can make is in ourselves. It isn’t about what someone’s obesity says about them. It’s about what our reaction to it says about us.

  16. Debbie, thanks SO much for that link! I had not seen that article but it is a nice summary of all the various research I’d been following and a few more. Someone recently on Facebook commented “the comment section is where hope for the human race goes to die.” No exception here. I died just a little the moment I realized the article was finished and the scroll bar wasn’t yet 25% down the page because I knew what came next – an outpouring of people revealing their character. A longer version in a similar vein is Gina Kolata’s “Rethinking Thin.”

    Going off on a tangent for a moment, the more exciting discovery on that page (for me anyway) was the reference to the author’s book “Us and Them: The Science of Identity.” Figuring out who the hell I am has been *the* major theme of my life and I’ve had five different identities over the years, only one of which was of my choosing. (T.Rob was not my choice but I eventually acquiesced.) Along the way I came up with the idea of “The Big Us” which is a method and philosophy of social change based on reversing standard manipulations of us and them. A book that combines these two themes? And I’ve managed not to find it in five years? I have no idea yet if it’s any good but if the essay you linked is any indication, I may be forever in your debt.

    Apologies for the detour but I needed to give thanks for what I hope will be a significant find for me. Please return to your regularly scheduled commenting. (I’ve attempted to link in the text to my blog post explaining The Big Us, and also the link in my handle of this comment.)

  17. Hey, the link worked! Here’s another. The BBC documentary “Why Are Thin People Not Fat?” took 10 skinny people, fed them massive numbers of calories, restricted their exercise, and sequestered them in a house so they could be monitored. Interestingly, one of the subjects gained more than 8% of his body weight but only 2% was body fat. The remainder was muscle mass and it increased his basal metabolic rate by a whopping 30%.

    Those people who claim it’s all thermodynamics – calories in vs. calories out – are both correct and horribly wrong. Yes, we gain weight when energy input exceeds output. What this argument fails to account for is that the body exerts an incredible degree of control over the efficiency of both input and output. We are very good at measuring caloric content of food but fail to measure how efficiently we metabolize it so two people eating the same food can have very different caloric intake. By the same token two people of the same weight will use the same number of calories in doing the work of moving x lbs over y distance, but the calories burned in excess of the work energy expended depends on individual metabolic efficiency which differs greatly across individuals. A trained athlete will have greater oxygenation, use different muscle (fast vs. slow twitch), and even move more efficiently than a non-athlete.

    So we can count calories in but don’t know what percentage of those are actually absorbed without measuring residual energy in feces, urine, gasses, skin oils, etc. We can estimate calories out based on charts of calories per hour but these are at best rough estimates unless we measure basal metabolism, oxygenation, heart rate, etc. If you look at the margin of error for any one of these measures, it exceeds the few hundred calories a day nutritionists tell us makes the difference between maintaining or gaining weight. Combine them and it’s clear that “eat less, exercise more” only applies if you can offset the margin of error by an order of magnitude or more, in which case you will have eliminated other variables and reduced the equation down to thermodynamics but only through extreme diet or exercise which for most people isn’t sustainable.

    Anyway, thanks for the response. I’m off to go buy that book and will stop hijacking your thread now. :-)

  18. I lost about 70 lbs. gradually over the course of a couple of recent years. (Approximately 1-2 lbs. a week as recommended.) After nearly 20 years of being an obese adult, I changed my eating habits and started exercising. The reality of one’s body after weight loss was a rude awakening for me. I feel far more uncomfortable naked now than when I weighed over 200 lbs. (I’m a 5’9″ tall woman). As someone who has participated in swinging, public kinky play, etc., it is still hard to deal with feeling less attractive after something society has always sworn was going to make me more attractive. Still, I’ve worked on maintenance for 2 years now and done well. The health benefits are worth it to me but I find the situation still less than ideal. I’ve toyed with ideas of cosmetic surgery.

    And then unfortunately, I’ve hit a bad health patch and had three surgeries over the month of November 2013 (2 for sinuses and one emergency brain abscess surgery) which each resulted in appetite loss – so for the first time in my adult life I’m concerned that I’m getting bony and dropping 10 lbs at once may actually be bad for me.

    Not to mention all the sick time I had accumulated that’s now gone and means cosmetic surgery isn’t really an option as I can’t even take the paid time off, let alone get insurance to pay for the surgery. Plus, I’ve had enough of surgery for a long time. So for now I’m going to stick to trying to embrace myself. Julia’s photos are very helpful to show that this is NOT an unusual result of massive weight loss. I just wish I had known beforehand. They really do hide these facts.

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