Mental Health, Body Image and Major Weight Loss

Losing a large amount of weight does not automatically change how you feel about yourself, and for some people it brings new difficulties. Depression and binge eating disorder are more common among people seeking weight-loss surgery, and body image often lags behind the scales. Support is available, much of it free or Medicare-subsidised.

This topic is also in our free guide, Health Checks and Support. Get it emailed to you

If you are in crisis or thinking about suicide, call Lifeline on 13 11 14 (24 hours), text 0477 13 11 14, or call 000 in an emergency.

How common are mental health conditions?

A meta-analysis of 59 studies, covering 65,363 people, found that depression (19%) and binge eating disorder (17%) were the most common mental health conditions among people seeking or having bariatric surgery (Dawes et al., JAMA, 2016). They are a reason for screening and support, not a reason to be excluded from treatment.

There is no single standard screening tool. Self-report questionnaires suit screening, while an interview with a clinician is better for diagnosis (PMC review). If you want a private starting point, the InsideOut Institute offers a free, confidential online eating disorder screener.

Binge eating and emotional eating

Binge eating disorder is more than overeating. It involves regular episodes of eating a large amount with a sense of loss of control, often followed by distress. It is a treatable condition, and a Medicare eating disorder plan can fund psychological and dietetic care (see below). Emotional eating that does not reach that threshold still warrants attention; mindset and emotional eating covers practical strategies.

Body image after weight loss

Many people expect to feel completely different once the weight is gone, and are unsettled when they do not. Excess skin is a common reason. In a Swedish study of people after bariatric surgery, 91% of women and 67% of men said their body looked unattractive because of excess skin; for women the upper arms were the most common area of concern and for men the abdomen (Obesity Surgery, 2013). The Obesity Evidence Hub also identifies excess skin as a source of body dissatisfaction after weight loss (Obesity Evidence Hub).

Other common experiences include still seeing your former size in the mirror, discomfort with comments from others, anxiety about regaining weight, and changes in relationships as routines and roles shift. These are normal responses to a large change and are worth talking through with a psychologist, particularly if they affect sleep, work or eating.

Skin surgery can relieve physical problems such as rashes, chafing and difficulty with clothing and exercise, but it is not a treatment for depression or an eating disorder. Being psychologically ready is part of being ready for surgery; see when is the right time for skin removal?

Getting support through Medicare

  • Mental Health Treatment Plan (Better Access): up to 10 individual and 10 group sessions per calendar year, via your MyMedicare practice or usual GP (Department of Health, Disability and Ageing).
  • Eating Disorder Treatment and Management Plan: covers binge eating disorder, bulimia nervosa and other specified eating disorders; up to 40 psychological and 20 dietetic services over 12 months for eligible people (Department of Health, Disability and Ageing).

Your GP is the starting point for both. Working with your GP explains how to raise it.

Support services

  • Butterfly Foundation National Helpline: 1800 33 4673 (1800 ED HOPE), 8am to midnight AET, seven days, plus webchat, email, support groups and body-image programs (butterfly.org.au).
  • Weight Issues Network (WIN): an Australian charity offering peer support, community meetups and advocacy for people living in larger bodies (weightissuesnetwork.org).
  • ANZMOSS: the Australian and New Zealand bariatric society keeps a directory of psychologists who work with people before and after weight-loss surgery (anzmoss.com.au).
  • GetHealthy NSW: free phone health coaching on 1300 806 258 (listed by healthdirect).
  • Lifeline: 13 11 14, 24 hours, for crisis support (lifeline.org.au).

When to seek help urgently

Contact your GP promptly, or Lifeline on 13 11 14, if you notice any of the following. Call 000 if you or someone else is in immediate danger.

  • Thoughts of suicide or self-harm.
  • Low mood or loss of interest lasting more than two weeks.
  • Episodes of binge eating, vomiting, laxative use or fasting to control weight.
  • Rapid or unplanned weight loss, fainting, or being unable to keep food down.

Some weight-loss medicines also carry warnings about mood changes. If you notice low mood or troubling thoughts while taking one, speak to your prescribing doctor (healthdirect).

Where to next

When you feel settled in your weight and in yourself, and loose skin is the main thing left, the readiness assessment is a good next step, or you can book a consultation with Dr Kumar.

All surgery carries risk. Individual results vary. Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).

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