Sometimes, appearances can be deceiving.
Across the United States, people are shedding pounds more rapidly than ever before, thanks to popular obesity medications such as Wegovy and Zepbound. Currently, about one in eight American adults are using these GLP-1 drugs to help them lose weight.
However, some individuals are experiencing an unexpected psychological effect alongside their physical transformation.
This phenomenon has been dubbed “ghost fat” by experts. It describes a situation where individuals who have lost a considerable amount of weight still perceive themselves as being larger than their current size.
This is somewhat similar to phantom limb syndrome, where individuals experience the sensation that an amputated limb is still present, functioning, and sometimes even in pain.
At its core, ghost fat reflects a disconnect between the brain and the body. A person’s internal self-image — shaped by years of emotional memories, body dissatisfaction, trauma, stigma and other factors — can lag behind physical reality.
“We see this not only with weight loss but with other body-altering procedures. It takes the brain time to catch up to the new appearance,” Dr. David Sarwer, director of the Center for Obesity Research and Education at Temple University’s Barnett College of Public Health, told Medscape.
“In rhinoplasty, for example, it may take patients a while before they become accustomed to looking at their new face in the mirror after decades of looking at a more prominent nose.”
Researchers believe ghost fat may be more prevalent among people who lose weight rapidly, like through bariatric surgery or GLP-1s, compared with those who slim down more gradually.
One study of 40 women who were 18 to 30 months post-bariatric surgery found that nearly two-thirds still perceived themselves as obese despite having lost a substantial amount of weight.
That disconnect can affect behavior in surprising ways.
Someone struggling with ghost fat might automatically reach for a larger clothing size than they need or choose a wider seat out of habit. They may also instinctively turn sideways when walking through tight spaces, even when there’s plenty of room.
Others continue avoiding mirrors or photographs, conditioned by years of dissatisfaction with their appearance.
The feeling of still being in a larger body despite significant weight loss can take a real emotional toll, fueling low self-esteem, anxiety, depression and a sense of disconnect from one’s own self-image.
For some, it leads to social withdrawal. Others become preoccupied with their appearance, constantly checking the mirror or seeking reassurance from those around them.
Adding another layer of complexity, many people who lose a significant amount of weight are left with loose, sagging skin. Those folds can look and move in ways that closely resemble body fat, making it difficult for some to recognize just how much their bodies have changed.
Fortunately, in most cases, the brain eventually catches up, and a person’s self-image begins to align with their new physical reality.
Experts say several strategies may help speed the process along.
“For my weight-loss patients, I have started to recommend cognitive behavior therapy,” Dr. Fred Pescatore, a physician who has experienced ghost fat himself, told First For Women.
“I truly believe this can help them navigate their ‘new world.’ They have to learn to align their inner thoughts with their body image,” he continued. “It takes time to overcome the stigma of your weight.”
Mindfulness practices such as meditation, body scans and breathing exercises may also help people pull themselves out of their heads and reconnect with their physical selves.
Experts also recommend shifting attention away from appearance and the number on the scale.
Instead of focusing solely on how you look, it can be helpful to celebrate achievements that reflect improved health and fitness — whether that’s climbing a flight of stairs without getting winded or lowering your cholesterol levels.
For some people, the solution can be surprisingly simple: spend more time looking in the mirror.
Take Sandra, a GLP-1 user who lost 41 pounds over six months but continued seeing her pre-weight-loss body staring back at her.
Normally, she avoided her reflection. But for one week, she challenged herself to stop and really look.
The exercise initially made her anxious. By the end of the week, however, she said she was already beginning to feel more comfortable in her new shape.
“It’s not that I forgot what my previous body looked like,” she told Psychology Today. “It’s more like I finally started seeing what felt like me in the mirror instead of a stranger.”