Significant weight loss is becoming more common and has novel psychological side effects.

Phantom obesity reflects a discrepancy between self-perception and the physical body.

Although phantom obesity can resolve itself, multiple evidence-based treatments can help.

Sandra couldn't understand it.

Through a combination of GLP-1 medicine treatment, dietary changes, and a regular walking program, Sandra had lost 41 pounds over the last six months. Her scale confirmed it. Her clothing displayed it. Her doctor recorded it. Even her friends routinely lauded her for it.

But Sandra couldn't see it. Instead, when she looked in the mirror, Sandra still saw her pre-weight-loss body. She still instinctively reached for larger clothing sizes and looked for larger chairs.

The hardest parts of all, however, were emotional. She expected to be happier. To feel more confident around others and to enjoy the sincere compliments about her weight loss. Instead, it all felt surreal, as if she was living in someone else's body. Intellectually, Sandra knew she was physically changing. But her self-image remained stuck in the past, and she worried that something was wrong.

What Sandra didn't realize is that her experience is increasingly common in the modern era of GLP-1 weight loss treatments. Millions of people are now struggling with the same strange emotion that arises when the brain and body register different realities. This phenomenon is sometimes called phantom obesity or phantom fat.1-2 Here's why it happens and how to respond.

Working as intended. Why phantom obesity is normal, not pathological

Weight loss is framed, in our culture, almost entirely as a physical event. The number changes. The body changes. Our mental story, presumably, updates itself automatically and on the same schedule.

What this cultural framing leaves out, however, is that the self is not a passive mirror of physical status. The self is........

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