obesity and the search for self-love: why weight loss won't solve everything
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as glp-1 medications for weight loss become more widely available and affordable in pill form, there’s an important distinction says sandra elia, shown here with her daughter sofia, 15. “medication treats biology. medication does not treat body image. and it never will.”
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sandra elia grew up in the ’80s when thinness wasn’t just a look; it was coded as desirability, intelligence, discipline, even virtue. she was never able to achieve it and, like many teens, she decided she didn’t have those virtues at a point in life when brains aren’t fully formed and youth are like “sponges” to the environment.
that internalized shame took a long time to unpack.
“there was only one idea of beauty and it wasn’t me. i was a short, curvy young lady. and at that time, it was very tall, very blonde, very blue-eyed. i would like to think it’s changed. but that doesn’t mean that it hasn’t left a mark on a lot of people,” says elia, whose career direction came from her own struggles with weight.
in her 20s, she lived with severe obesity and now realizes she lost a decade of her life to self-negativity. any kind of behaviour change needs a strong “why,” and for elia, in her 20s, that “why” was “i want to be skinny. i want to wear a bikini.” that never sustained her.
elia is a food addiction counsellor in toronto and leader of a food addiction recovery program integrated in medical clinics across canada. she is also board chair and director of education and patient advocacy for obesity matters, the national patient advocacy group for people living with overweight and obesity.
what she knows intimately, and shares with others, is that confidence, self-image and the relationship we have with our bodies change during a health journey, especially when it comes to weight.
“i’m very happy because i have a 15-year-old daughter and she does have examples of people living in different body sizes who have happy, full, beautiful lives, as we all should have,” elia says.
now her “why” is her daughter. “if i want her to make her health and happiness a priority, i have to show her how by doing it,” she adds.
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shame of obesity affects all aspects of life
“but for so much of my life, the bigger i was, the less i was worth. and when you internalize that shame, it shows up everywhere in your life. it shows up in your relationships, in your circumstances, in your career, everywhere, right? so it is something that we have to look at.”
as glp-1 medications for weight loss become more widely available and affordable in pill form, there’s an important distinction elia points out: “medication treats biology. medication does not treat body image. and it never will.”
she agrees that glp-1 medication is important because it sends the message more clearly that obesity is a chronic disease that requires intervention and it offers one that’s proven.
but she cautions people who think that reaching their goal weight will answer all their problems, because it won’t. “i equate it to the lottery effect. people who win the lottery think that all my prayers have been answered; i don’t have any more problems because i have all the money i want.” but research shows that about a year after people win the lottery, they go back to baseline happiness, the same happiness they had before they had all the money that was supposed to solve their problems. the theory is called “hedonistic adaptation,” sometimes referred to as the hedonistic treadmill.
‘medication does not treat body image’
she speculates that weight loss likely has a similar curve. people in her food addiction program who reach their goal weight say they thought they’d feel different, but they don’t. then old patterns return, old emotions come back, and they don’t have a sense of their identity—who they really are.
elia experienced a huge relapse in her own life. she went to her lowest weight and then regained 70 pounds. looking back, she understands that she wasn’t measuring anything else but the number on the scale, “this stupid, inanimate object on the floor. that was my only measure of success. the fact that i ran a half marathon, didn’t care. the fact that i had done spiritual retreats, didn’t care. the fact that i was advancing in my career, none of that mattered. it was just that number. and then all of a sudden, i’m watching that number go up, up, up and my self-worth is going down, down, down.”
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there’s another issue about glp-1s that isn’t talked about enough and needs to be, she says. there are people who are strong responders with dramatic results, but typical responders may have 15 per cent weight loss. these results translate to better blood tests, organ function and mobility. but there are also people who do not respond at all, which is difficult to grapple with for those living with obesity.
“we are a very vulnerable population. many of us have tried and failed, tried again, failed again, over and over, because all we had in the past was diet culture. but now we know 97 per cent of all diets fail. the diet was never going to work. it was never your fault.”
now there’s safe, effective medicine to treat obesity, but for some people, it just won’t work. that’s the way it is with every drug, so it’s not your fault. that’s important to discuss because otherwise that person will feel like a failure again, she adds.
another key message is that people on weight-loss medication will likely experience a plateau. one of elia’s clients lost 90 pounds on medication but felt really discouraged because she hadn’t lost any additional weight in four months. “that’s part of everyone’s journey, a plateau. but people often perceive plateaus as failures. and then they may even abandon their medication because it’s not working anymore.” she explains that the medication is indeed working and if you stop taking the medicine, as with any other chronic illness, it stops working.
obesity is a complex and relapsing chronic disease.
options to address skin changes of weight loss
dr. jennifer salsberg is a toronto dermatologist at avenuemd who spoke about weight loss transformation with elia at a recent obesity matters summit. as someone who promotes a natural, refreshed look for her patients, she wants people to navigate the changes that can happen to the facial area with weight loss—and know they have options to address anything they’re concerned about.
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she’s noticed more people coming to her clinic who have experienced significant weight loss, a growing number who’ve benefited from weight-loss medication as it becomes more commonly prescribed.
“alongside that journey comes the possibility of a journey of facial change that some patients anticipate, others do not anticipate at all and don’t necessarily realize may be in the cards for them,” she says.
“sometimes they’re of the mindset, ‘i never thought that this would be the sort of thing that i would be embarking upon. however, now that i’m seeing what i’m seeing as a result of these changes, i’m compelled to want to do something about it.’”
dr. salsberg explains that fat pads naturally provide structure and support under our skin, so if we lose some of that structure and support, there can be a certain degree of volume loss, hollowness or more of a gaunt-looking appearance. fat loss can also affect overall skin health that’s noticeable on the skin surface where patients describe their skin as dull and looking more aged and lax.
while there are surgical options, there is a whole host of non-surgical, non-invasive options for the face like injectable treatments to help restore volume loss and stimulate support structures, and laser-based treatments to improve the skin surface. “it’s a very personalized treatment plan, depending on what a patient is seeing and what we think is going to be the best,” she adds, noting that misinformation online is rampant so consulting a professional is best.
“we’re doing these things that just really allow them to continue to feel like themselves, but to feel like the best versions of themselves.”
self-love and embracing change
the core message about transformation in weight loss comes down to self-love and accepting yourself for who you are as a person. as elia says, “two things can be true at the exact same time: i can love and accept myself and want to change something. we need to give women permission to want to have both. it is a natural desire to want to flourish, evolve and change.” that can involve an aesthetic procedure or a career change, for example.
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“i think the real work is actually to love and enjoy the body i have today because i’m never getting today back.”
how do you help people build positive self-image at any size?
elia readily admits that it takes courage to be able to look in the mirror and have that acceptance. “we all have that voice in our heads who can be really mean to us. there’s always those trolls on the internet that throw mud and hate. who wants to be that person? don’t be that person to yourself either.”
self-love can be a challenge for anyone, given the lengthy list of must-haves that society measures for success and happiness. but it’s also foundational for navigating weight management.
“it’s very hard to have behavioural change when motivated by guilt, shame or self-hate,” says elia. “so, if you’re starting a new journey filled with guilt and shame, and you have this inner voice that’s so hateful, telling yourself you’re not going to make it, that’s not going to work out. love is energizing, always.”
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