Phantom Fat: What Is It And Can It Be Treated?

Phantom Fat: What is it and can it be treated
Self, Health And Wellness

Phantom Fat is a real thing. Not that fat can show up as a ghost, but that we may experience our body as if it is shaped as it used to be (larger) and no longer is. Read on to learn more.

1. What is Phantom Fat (PF)?

PF speaks to the fact that the body can change faster than the mind can adjust. This is true even if the weight loss/body change occurs over the course of a year or more.

With PF, People lose weight yet still see themselves in their former size body.  It is as if the weight they lost is still there.

They will still shop in their former size of clothing, bringing for example larger sizes with them to the dressing room  than they need.  The will avoid sitting in the middle seat in a row of seats on an airplane, because in their former size body they would not have fit.

They often walk around feeling the same  self consciousness as they had in their pre weight loss body, even  when  complimented about how thin or great they look.

2. Could PF really just be people looking for compliments and assurance that they lost weight, rather than a legitimate inability to see themselves accurately?

While it may be tempting for people who have not had the experience of phantom fat to believe there is no such thing, or that it is really simply  assurance seeking or fishing for compliments, it is in fact a real phenomenon. 

People with PF are NOT the people who walk around saying to others, "Im like so fat", anticipating the assurance of "Oh my gosh. You are so not!" 

No amount of assurance for someone with PF eliminates PF. 

3. What are the risk factors for PF?

The more quickly weight is lost, the more difficult it is for the brain to catch up. So one risk factor is rapid weight loss.

Another risk factor is a history of weight cycling, which is when a person has been a lot of different weights, particularly if the weight changes are due to dieting.

A third risk factor is harder to define. It has to do with something I call embodiment, or how much and how accurately someone is aware of and in tune with her body. Activities such as yoga, Zumba, meditation,  and other movement activities can help provide us with more of a sense of belonging in the body and being able to tune into sensation while knowing where we are in space.

Trauma is another risk factor, especially a history of trauma from adolescence or even earlier in life. Such trauma may have overwhelmed the nervous system at the time(s) it occurred, so it gets stored in a way that is not integrated. The result is a sense of shame/disgust toward the body regardless of appearance. 

4. Is PF the same as Body Dysmorphic Disorder?

There is definitely overlap, but they are not the same. In BDD, a person imagines a defect in appearance or exaggerates a slight aberration if there is one.  BDD is often about facial features – such as the size or shape of one’s nose or ears; or a woman’s belief that she has excessive facial hair. With men the perceived flaw may have to do with baldness, or acne scars.

People with BDD do not necessarily have concerns re their weight, nor have they necessarily experienced major weight loss.

 People with BDD who also have an eating disorder, though, are likely to misperceive their body size and shape, but this is not PF. The  body image disturbance for those with a co occurring e.d. is considered part of the Eating disorder.

5. What is the treatment for PF?

I am not aware of any gold standard or recommended treatment. That is one of the reasons I am so thrilled you are doing this podcast and bringing awareness to the very common problem of PF.

In general, cognitive behavioral therapy (CBT) is useful. It helps people learn how to identify distorted ways of thinking. The way CBT does this is by teaching the types of different thinking mistakes, or distortions, that we all tend to make and the ones that people with PF in particular may be prone to make. CBT then teaches people how to evaluate the validity of their thoughts, and how to generate more accurate ways of thinking.

A second component that I have found useful with the patients I have treated with PF is to help decode what the phantom fat may represent. Often, it represents disgust and shame. So, despite weight loss the person still feels a similar amount of disgust and shame about her body as prior to the weight loss. Carrying around shame and disgust is burdensome. Along with a smaller size body there may be an increased sense of vulnerability, especially around being seen and receiving more attention. Teaching people how to recognize and manage their feelings is often associated with a decrease in PF.

A third aspect of treatment is to address  trauma that may be stored and contributing to the PF. 

6. How long does treatment take?

It varies, depending on factors such as a person’s psychiatric history, any co occurring mental health challenges, how much weight was lost and how rapidly the weight loss occurred. Other factors include a person’s readiness to be curious about any disgust or shame that may exist. I like to frame the treatment as a collaboration, guided by curiosity about their own body’s remarkable ways to keep them feeling safe and protected.

If you suffer from Phantom Fat, get help. Everyone, regardless of size or shape, deserves to feel content in their body - from the inside out and outside in. 

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Dr Elayne Daniels is a psychologist in the Boston area providing treatment to men and women with body image and eating disorder concerns. 

This article was originally published at www.beyondbariatricsurgery.com. Reprinted with permission from the author.