The unspoken truths about life after drastic weight loss

Those who have been through it warn that major physical transformations can bring about inadvertent mental and emotional challenges

Charlotte Bruce-Alexander started her weight loss journey after her first child was born, but says being left with loose skin made her as if not more insecure. Photo: @farfromfat126 / Instagram

“I thought I was going to lose weight and wake up looking like Jennifer Lopez,” recalls Charlotte Bruce-Alexander after a drastic body transformation in which she lost about 40 kilograms in 18 months.

“I thought I was going to be super-happy. But actually looking in the mirror, I felt very unhappy.”

Stories of extreme weight loss are often predicated on positivity. People go to great lengths, emotionally and physically, to achieve such transformations, and many take years to hit their goals. So when goals are met, it is usually a cause for celebration.

While Bruce-Alexander, 41, was happy about the weight loss, it brought about a host of other issues she couldn't just brush off.

“I had a lot of loose skin. I had very baggy arms, stomach, knees – everything was just baggy and saggy,” she tells The National, adding that she “never really understood that was going to happen”.

“You see these people's weight and they go from being big to being small, and they look perfect. For me, there was nothing attractive about it. I looked like a carrier bag.”

Having spent most of her life overweight, Bruce-Alexander thought she was going to be more comfortable in her new body. Instead, she went back to covering herself up, consumed by even more insecurities.

“Losing a lot of weight, you'd think you're going to have this body where you're out in a bikini or at least out in a top without sleeves, especially after spending 30 years of your life being covered up,” she says.

Reflecting on her mixed emotions, the British expat says she quickly realised how much of a mental exercise it was to cope with a new body reality. “You've gone from being this big person, and you've got all these embedded ideologies about who you are, and what you can and can't wear,” explains Bruce-Alexander.

“Although there's a small person in front of the mirror, inside you are still a big person holding insecurities about yourself. It takes a long time to relearn who you are.”

Dealing with excess skin

There are many reasons people have excess skin after drastic weight loss, ranging from how fast the weight was shed, to genetics and other biological factors such as age and health level.

“If a patient loses weight rapidly like through pregnancy, Ozempic and drastic dieting, more often than not, the stretched skin does not have time to shrink in line with the loss of volume from the body,” explains Dr Maurizio Viel, a plastic surgeon at Cornerstone Clinic in Dubai.

“Other reasons for stretched skin can also be due to genetics – some patients after pregnancies find their skin shrinks back while others are left with excess. Also, patients who carry excessive weight for prolonged periods of time have excess skin on arms, legs and stomachs as the skin has been stretched for a while.”

Three-time Olympian and personal trainer Sarah Lindsay confirms: “Unfortunately there is only so much you can do here.

“I've spoken to a number of doctors and plastic surgeons on this topic, and it seems the common agreement is that you have about six months post-weight loss for the skin to contract back. After that, what you see is likely to be the end result.”

There could be ways to minimise loose skin, though. “Losing weight fast and in an unhealthy way will make loose skin far worse due to poor nutrition, and your body not getting all the vitamins and nutrients it needs,” says Lindsay.

“This is what we’re seeing with those who are taking Ozempic for example, and those who go about weight loss in an extreme, unhealthy manner.”

Body contouring techniques are considered major medical procedures. The most common ones are abdominoplasty, famously known as a tummy tuck, as well as brachioplasty or arm lift and thighplasty or thigh lift.

“In the case of a tummy tuck, the surgeon would remove the excess skin and may also have to tighten the abdominal wall and reposition the belly button,” explains Dr Viel. “In situations with less skin, sometimes only the excess has to be removed, with a smaller scar, similar to a C-section scar, placed discreetly below the bikini line.”

Aside from being expensive (about Dh18,000 in Dubai for a tummy tuck), these procedures involve a lot of emotional and physical toll. For people who don't want to go under the knife for whatever reason, it doesn't help that there “are no specific exercises for tightening skin as such”, says Lindsay.

“Weight training could help,” the British fitness coach adds. “Lifting weights and increasing muscle mass and tone will help give you a fuller or more filled-out appearance.”

After doing a lot of research, as well as talking to friends family about it, Bruce-Alexander decided she wanted to do plastic surgery.

“The first ones I did were arm and breast lifts, and honestly it was the best decision I've ever made – even though everybody thought I was crazy,” she recalls.

“It was such a taboo – 'Charlotte, why would you do that? Plastic surgery is for people who want to look like Barbie or for those in Hollywood, it's not for your average mom',” Bruce-Alexander recalls being told. She agreed with them for a while, but realised it was ultimately her decision.

She says she learnt from “some mistakes along the way”, including what to look for in surgeons and “how to find the right doctor for you”.

“It's so important to understand that one person is not the same as the other, so even if you go to the best surgeon in the world, you are not necessarily going to heal the same way as somebody else.”

Post-surgery care also matters, she adds, from following doctor's orders of not smoking or drinking, for example, to using compression garments. “There's so much more that goes with skin removal surgery,” she says.

“It's also super-expensive, so it's so important that you don't get yourself into debt over it, and do your homework because you don't want to have to repeat it.”

Bruce-Alexander eventually followed the procedures up with a tummy tuck. “My upper body looked great, but the bottom didn't match the top,” she recalls. “It was like wearing mismatched clothes, like there were two different people in one body.”

Bruce-Alexander was aware of the implications of her decision to go for another major procedure, as people criticised her for being “addicted” to plastic surgery. “But this was not about anybody else,” she says. “It's never about that. It's always been about me being happy in the skin I was in. It's about me feeling comfortable in my own body.”

She adds: “If you're bigger and you're happy, absolutely amazing. If you've lost weight, got loose skin and you're OK with it, amazing. I was not. I was very uncomfortable and probably more insecure at my smallest than I was at my biggest.”

'I've learnt to love my loose skin'

For Abu Dhabi resident Suzi Curtis, loose skin is a “marker of an achievement I have created”.

“The bulk of my loose skin is on my belly and around my legs,” she tells The National. Curtis, 42, lost about 70 kilograms in a span of two years and has since maintained her weight in the range of 65 to 75 kilograms. Her drastic weight loss also resulted in loose skin, but she says: “I have learnt to embrace it. I'm actually quite proud of it.”

Curtis admits looking at plastic surgery to deal with her excess skin, but she's been holding it off because of plans to have children.

“If I decide to have that plastic surgery, it probably won't be until my mid- to late 40s, when I know that the chances of my having kids is slim,” she says.

In the meantime, Curtis, who left a corporate job to be a fitness instructor, has learnt to love herself in the body she's in – an advocacy she is passionate about as her clients rely on her for fitness inspiration. “If you're not loving yourself the way that you are now, how are you going to love yourself when you're the brand-new version of you?”

It helped, she adds, that being in the fitness industry meant meeting people who are on the same path. “I realised that I'm not the only one who has loose skin. There are post-partum mothers, for example, who deal with it too. Or everyday people who, for instance, can't afford plastic surgery.”

Curtis acknowledges that she's one of the more fortunate ones whose excess skin can be masked with the right clothing.

“My arms look perfectly fine, and if I'm in the right pair of pants or leggings, you can't even tell I have loose skin around my thighs. Same with my belly, if I'm bent over, you can see the loose skin, but I'm standing up nice and tall with correctly fitted pants, you can't tell,” she explains.

Like Bruce-Alexander, Curtis believes body transformation boils down to genuinely loving oneself, regardless of whether or not plastic surgery is on the cards.

“I want to educate more people to love the body they're in before even thinking about modifying it,” she says. If people decide to undergo cosmetic procedures, Curtis says it can't come from a place of societal pressure.

“Whatever happened to the day when we couldn't get things such as Botox done, for example? Most of us loved ourselves the way that we aged, and that's what I want to people to feel.”

Weight loss is an emotional fight too

While weight loss is, on surface, a physical challenge, much of it also takes a toll on mental health.

“Significant changes in appearance can impact us and our lives at many levels, in both positive and negative ways,” says Dr Victoria Mountford, a specialist in eating disorders and the lead psychologist at Sage Clinics.

Bruce-Alexander says for her it was about “relearning” who she is. “I never thought I would be able to do this in a million years,” she says of her journey. “I'm big-boned. This is just how I'm made. This is who I am. I'm never going to be that person.”

She had to get past these thoughts, and admits “it took years” to finally be in a head space where she's accepted her new reality.

Today, Bruce-Alexander has lost more than 60 kgs since 2012. She has since had three children and has kept up her dedication for a healthy lifestyle. She also hopes to pass on the things she's learnt along the way.

Internal emotional battles aside, body transformations also have an impact in people's relationship with others, says Dr Mountford. “The social impact of extreme body transformation is significant. It may lead to praise and admiration, which may feel rewarding at first, but could also mean mounting pressure.”

As Bruce-Alexander puts it, a weight-loss journey is just that, a journey, and those going through it are going to need a lot of physical and emotional strength to come out of it thriving. “I'm happy to say I feel comfortable now,” says the mum-of-three, who notes she has a “very supportive” husband and family, for whom this was “a big change too”.