'Skinny dream' burst by weight loss realities

— If thin equals happy, Jen Larsen should be on cloud nine.

Larsen, 36, of Ogden, Utah, was the fat child. The fat teen. The fat adult. Four years ago, Larsen hit a high of 316 pounds and when diet after diet failed she opted for bariatric surgery. By all measures, the procedure was textbook perfect. The 5-foot-7-inch Larsen is now a slim 140 pounds.

Life, she says, is simpler: she has more energy; her knees feel better; her back doesn’t hurt. And study after study shows she has slashed her risk for life-threatening health conditions like heart disease, cancer and diabetes. But a funny thing happened on the way to becoming a size 8: No matter how much Larsen shrank, her troubles stayed the same size.

“It (weight loss) hasn't solved all my problems or made me a better person, just a littler one,” Larsen says.

Despite being a self-described “accomplished fat girl,” with a master’s degree in creative writing from the University of San Francisco, a great job working in the school’s academic library, a slew of friends and a loving boyfriend, Larsen thought her life had hit a plateau. By age 32, she believed she’d be writing a book, “doing something important,” she says. The only thing holding her back, she thought, was weight.

“Not so,” she now says. “The only thing that’s different is the size of my ass.”

Larsen thought skinny came with a mega-boost of self confidence. And a huge dollop of happiness. She thought she’d be dynamic and brave and ready to take on the world, just because she was thin.

“I think fat people are sold a fantasy, and then get no support in the reality, because we’re simply supposed to be grateful that we’re no longer fat,” Larsen says.

Fairy tale clashes with reality
In a culture obsessed with BMIs, the tears and triumphs of “The Biggest Loser,” and the latest-greatest surefire way to lose weight and keep it off, Larsen’s take on her new lean physique sounds like heresy. But weight loss chat rooms, forums and blogs are filled with people who are wondering why their newfound svelte selves and stellar metabolic profiles are leaving them ever-so-slightly disappointed.

And who can blame them? Reality shows, weight loss books, movies, TV shows and advertisements all tell tales of people dropping major poundage and gaining seemingly perfect lives. They find their true selves and their true loves. They go back to school or get promotions. They become social butterflies, the life of the party.

To be fair, some folks who lose weight do wind up doing all these things. It’s well documented that even small amounts of weight loss can improve mobility and energy levels, and also gives a boost to self-image.

“Anecdotally, patients say they feel better and are happier and studies support that,” says obesity researcher Dr. Charles Burant, director of the University of Michigan’s Metabolomic and Obesity Center. “[Weight loss] puts a spring in people’s step. But to say it puts a strut in their step might be going too far.”

All of this hype leads to fairy tale expectations about weight loss. And when those expectations don’t gel with the reality, weight regain may follow. For professionals who deal with obesity issues, helping patients cope with the fact that weight loss didn’t get them a promotion or a date for Saturday night can be difficult.

'The lottery effect'
Though obese men generally have better self-esteem than obese women, both sexes may expect more from weight loss than what it can actually provide.

“I call it the lottery effect,” says dietitian Keith Ayoob, associate clinical professor of pediatrics at the Albert Einstein College of Medicine of Yeshiva University. “People think that ‘if only’ they won the lottery, life would be perfect. People who want to lose weight think the same thing.”

In a small study presented at The
Obesity Society’s annual scientific meeting last year, researchers identified several key elements that lead to weight gain after weight loss surgery. A recurring theme from the study participant interviews and questionnaires was that weight loss could lead to disappointment. In turn, disappointment — whether from the amount of weight lost not meeting a patient’s expectations or that weight loss didn’t fix their problems — can lead to chronic frustration and weight regain, the bugaboo for all folks who have managed to shed pounds.

While the study focused on those who'd had bariatric surgery, the findings can be applied to those who lost weight through diet or exercise as well, says lead author Lee Kern, clinical director for Structure House, a residential weight loss facility in Durham, N.C.

“People expect a lot from weight loss, things that weight loss alone can’t deliver,” says Kern. “People think it just isn’t worth it and relapse all the way back.” And then they learn “the hard way” that success and happiness aren't linked to a number on a scale, he says.

'You can be fat ... and pretty darn happy'
Jennette Fulda knows all about being successful. And happy. She was both at 372 pounds. Fulda, of Indianapolis, was a national merit scholar, her high school class valedictorian, and graduated with highest honors from Indiana University’s School of Informatics. “You can be fat, accomplished and pretty darn happy,” Fulda says. “I think people forget that.”

Over the last several years, the 5-foot-9-inch Fulda, now 29, whittled her weight down to 180 pounds through diet and exercise after having surgery for obesity-related gallbladder disease. “It really was a wake-up call to do something about my weight,” says Fulda, author of "Half-Assed: A Weight-Loss Memoir.”

Although she battled episodic migraines for years, they became daily occurences in 2008. Then she regained 50 pounds, mostly due to inactivity brought about by the headache pain. Although she believed she was realistic about what weight loss could and couldn’t do for her, Fulda thought a “leaner bod” meant no more health woes, which “just goes to show that being thin doesn’t guarantee perfect health,” she says.

And she is surprised that despite her monumental weight loss she still has what she calls a “skewed” relationship with food.

“I eat when I’m bored, when I’m sad, and that’s not something that went away with being less heavy,” she says. “I guess we all really think that losing weight gets rid of our issues. But in so many ways we’re still the very same person, not that skinny woman we dreamed about.”

'I thought I was going to live the skinny dream'
You don’t have to tell that to Darliene Howell, 55, of Las Vegas. She’s been dieting off and on since she was just 6 years old. She’s tried “every diet on the planet” and has counted calories, points, carbs and proteins “until I thought I was losing my mind,” she says. She lost 100 pounds on a liquid diet.

“I’ve weighed 150, 250 and even 300, and each time I lost weight I thought I was going to live the skinny dream,” she says. “My life was supposed to have changed. I thought I was supposed to be more popular, more attractive, if only I were thinner. Well, that didn’t happen.”

It’s not like Howell didn’t try to spread her wings. About 20 years ago, when she was at her lowest weight of 150 pounds, she took dance lessons, and went out with friends to local dance clubs. “For one solid year I did everything I thought I was supposed to do,” says Howell. “And then I realized I was not who I thought I would be. I was still me. It took me a while to realize that was OK.”

That kind of self awareness is vital to good health. “The first thing I always ask people is why is this the right time for you to lose weight?,” says Madelyn Fernstrom, professor of psychiatry, epidemiology and surgery at the University of Pittsburgh School of Medicine and author of “The Real You Diet.”

“If they say they’re happy with their lives, but have hypertension, great. If they are losing weight just to be happier, then we’ve got to talk. Happiness isn’t a size 2. And weight loss isn’t just about eating, activity and behaviors. It’s really about getting in control.” And when people come to that realization, better health behaviors follow.

The message is straightforward: focus on the positive aspects of weight loss, such as health and mobility improvements and increased energy. “It’s the benefits over time that are important,” says Structure House’s Kern. “The dream life is fantasy, whether you’re fat or skinny.”

These three women know that, now. Howell is finally at peace with her body and herself. She now focuses on being healthy, not on how much she weighs. A few years ago she was 300 pounds. Now’s she’s 240 pounds, dropping 60 pounds by “listening to her body,” she says. She swears she’ll never diet again, but will keep on dancing.

Jennette Fulda, the author of “Half-Assed” who battles headaches, is training for a 10K run. She’s determined to stop fretting about the weight gain. “Instead, I’m going to focus on all the things I can do, instead of my appearance,” she says.

And Jen Larsen, the Utah woman who shed more than 170 pounds yet felt disappointed, is finally writing her book. She’s calling it “Stranger Here,” “a story about me, a fat person living in a skinny person’s body.”

And, despite the emotional roller coaster that followed Larsen's dramatic weight loss, she has no regrets about undergoing surgery, except one — or two. “I miss my breasts,” she says, laughing. “When I was fat, they were magnificent.”