You lost the weight. Yup, you finally freakin' did it, and you're proud. And you're scared. And you're happy and you're confused. Maybe it was through bariatric surgery, GLP-1 medications, lifestyle changes, or some combination of all three. The outside transformation is obvious. Clothes fit differently. Strangers compliment you. Maybe even loved ones treat you differently.
But inside? You feel unsettled.
If you thought the hardest part would be losing the weight, you’re not alone. Many people are surprised to find that the emotional and relational shifts that follow weight loss can be just as challenging—sometimes even more so.
Research backs this up: a 2016 review in Obesity Reviews found that psychological support is one of the key predictors of long-term weight maintenance. And yet, most people never receive that support. They're left to navigate major body and identity changes on their own.
So what does therapy actually do to help you keep the weight off?
Understanding the Deeper Roots of Weight Gain
Let’s be clear: weight gain is not a personal failure. It’s often an adaptive and intelligent response to chronic stress, trauma, or unmet emotional needs. Obesity is a chronic illness, much like any other illness. And it requires constant treatment and adjustment to maintain remission, in my humble opinion. I should know, I've gained and lost 180+ pounds on average over the course of my adult life time. In fact, for the past two years I've lost 94 pounds and counting, and now I'm in the final stages of losing the weight and will enter maintenance again. For the millionth time.
I see you. I know you. I am you.
From a biological perspective, the body is wired to protect you. In the face of a perceived threat—whether that's emotional neglect, abuse, burnout, or even consistent invalidation—the body responds. (I always say the body doesn't know if you're actually being chased by a tiger in the woods or not. The human brain designed to keep you alive, not happy.) And sometimes, that response includes holding onto weight.
There's even a bit of nuance here to be discussed around how food in developed countries, like the US, has changed over the last 100 years. Ultra-processed foods, which are cheap to make and cheaper to buy, use your body's natural tendency to seek out salt, sugar and fat, in order to increase your appetite and decrease the likelihood of you starving. We know that processed food isn't good for us, but we also know that the brain and body are primed to ensure survival right now, not a few hours, days or weeks from now. Hence, the choosing of foods that are 'easier' in the short term, but the debt they accrued in the long run is massive. (Moss, M. (2014). Salt, sugar, fat: How the food giants hooked us. Random House.)
In fact, studies show that early life trauma is strongly linked to obesity in adulthood. A 2012 study published in Pediatrics found that adverse childhood experiences (ACEs) increase the likelihood of obesity, particularly in women. Why? Because trauma affects the hypothalamic-pituitary-adrenal (HPA) axis, which regulates cortisol, metabolism, and hunger signals.
Caveat here: I don't want you to go buy another stupid cortisol regulating 'cocktail' from another influencer online. Health and wellness influencers who claim a lemonade flavored drink will 'regulate' your cortisol are LYING to you. They are the modern day snake oil salespeople. Don't fall for it. You can regulate your stress responses with the old fashioned shit that I am recommending in my therapy office all the time: time outside, reducing workloads, spending moments with loved ones, laughing more, getting enough sunshine, eating foods that are nourishing and tasty, etc. Those things actually regulate your hormones.
And here's the kicker: your brain doesn’t distinguish between emotional famine and physical famine. Emotional neglect, loneliness, chronic stress? The brain can interpret these experiences as threats to your survival. In response, it may signal the body to slow metabolism, increase fat storage, and drive cravings for high-calorie foods.
Weight, then, becomes a form of safety. A buffer. Seriously, I saw my weight as an armor against the world for a long time. It was the perfect excuse to not truly show up in my life as well.
Also, there's very little good research about how hormone disruptions, thyroid conditions, autoimmune issues and the old calories in-calories out model and how it keeps people stuck, because it doesn't include the whole picture!
Your body adapts as you lose weight, and it can take years to reach a new setpoint. Don't believe me? Check out this interesting research here: "A weight loss of 10-15% leads to a 20-25% decrease in thermogenesis (a fancy word meaning fat burn/calorie expenditure) over time. (Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. Int J Obes (Lond). 2010 Oct;34 Suppl 1(0 1):S47-55.).
If you're reading this and thinking, "Holy Shit.... this is why weight loss is so hard to maintain," you're right! You are pushing a giant boulder uphill metabolically, emotionally and societally. So it behooves us to get our emotional ducks in a row so we can enter and stay in maintenance for life.
This is why addressing trauma is essential to sustaining weight loss. If the original emotional wounds remain unprocessed, the body will continue to look for ways to protect itself—even if that means regaining the weight.
What Therapy Can Offer After Weight Loss
1. Therapy Helps You Understand the Emotional Roots of Weight Gain
Significant weight gain often doesn’t come out of nowhere. It can follow a period of trauma, grief, burnout, chronic stress, or emotional neglect. Food may have served as comfort, protection, or numbing.
In therapy, you can gently explore the "why" behind your eating habits—not with shame or blame, but with compassion and curiosity. When you understand the emotional drivers of past behaviors, you're more empowered to choose differently moving forward.
This might look like:
Processing the grief of a past loss that triggered emotional eating
Using EMDR or Somatic experiencing to help you reset your patterns and identify what your body really needs instead of food.
Identifying childhood patterns of using food to self-soothe, or how your family treated food as love or a way to celebrate.
Recognizing how high-stress environments led to disconnecting from your body’s hunger and fullness cues
2. Therapy Builds a New Identity Beyond the Scale
Weight loss makes you question your identities. Maybe you were always the "funny fat friend," the caretaker who always focused on others, or the girl no one wanted to date. Now, attention feels different—sometimes welcome, sometimes deeply uncomfortable.
Therapy helps you redefine your sense of self, explore who you are now, and process any discomfort that comes with being seen in a new way. It's not just about adjusting to your new body—it's about adjusting to the way your soul has shifted as well.
You may:
Explore your relationship with visibility and attention
Unpack discomfort around sexuality, desirability, or dating post-weight loss
Rebuild your sense of identity outside of your body size
Redeem yourself and your view of what 'you can do' now that your body is different and identify any area where you might be holding yourself back.
3. Therapy Helps You Navigate Shifting Relationships
You might notice people treating you differently. Some are more supportive. Others become distant or jealous. Some may offer backhanded compliments or fixate on your appearance.
Therapy offers a space to process those shifts, set healthy boundaries, and develop communication strategies that align with your values. It can also help you grieve relationships that no longer fit.
In the therapy room, this may include:
Exploring fear of rejection or abandonment in relationships post-weight loss
Practicing scripts for handling comments about your body, your eating habits, or your exercise routines. ("You're not going to lose too much weight, are you?" or "I feel like all you care about now is your weight and eating healthy and exercising. What about just living life? Why have you changed so much?") I know you've heard statements like this before.
Processing resentment toward people who only value you at a certain size
4. Therapy Strengthens Your Grit
Knowing what to eat or how to move your body isn't usually the problem. But stress, overwhelm, and emotional dysregulation? Those can derail even the best intentions.
Therapy teaches you how to find routines that actually work, identify solutions to dumb problems like "I hate brussel sprouts but I should eat them because they're healthy." (Y'all, no, just say no to foods you hate. I don't care how healthy they are.) and create new habits that are flexible and creative,—so your choices come from self-connection rather than survival mode.
This might involve:
Redefining what exercise means to you, and how you can create emotional safety by physically moving your body
Working with your window of tolerance to handle big emotions without numbing
Creating rituals of self-care that replace old coping mechanisms
Figuring out how to shift behaviors you hate (like overeating or food 'pickiness') and accommodate them while you're in the process of changing.
5. Therapy Heals the Nervous System, Not Just the Mind
Our bodies carry negative experiences. When you've lived through chronic stress, neglect, or emotional pain, your nervous system adapts to keep you safe—often through behaviors that disconnect you from your body.
Therapy can include somatic practices that help you reconnect with your body in a safe, supportive way. This can be a critical step toward sustainable wellness and a more peaceful relationship with food, movement, and self-care.
Practices may include:
Noticing sensations in the body without judgment
Using gentle movement to build safety and agency, like toe yoga (a legit thing!) or bilateral swaying (I call it "the mom holding baby in church sway").
The Brain-Body Connection: Why This Work Matters
Your brain's number one job is to keep you alive. If it learned at some point that extra weight meant extra safety—whether from starvation, assault, or rejection—it will do whatever it takes to maintain that safety.
That’s why therapy is about so much more than mindset. It’s about safety. Connection. Integration.
You’re not just unlearning old beliefs. You’re retraining your nervous system to understand:
“I am safe. I am fed. I am allowed to be well.”
This takes time. It takes support. And it takes a compassionate, attuned approach that honors both the trauma and the triumph.
The Bottom Line
Maintaining weight loss isn't just about willpower. It's about doing the inner work that makes outer change sustainable. Therapy provides a compassionate space to unpack the emotional layers of your journey and build a life that supports the healthiest, most authentic version of you.
If you're in the "after" phase of your weight loss journey and feeling lost, disoriented, or emotionally raw—you're not alone. And you don't have to figure it out by yourself. If you're just being super proactive and want to start working on these things regardless of weight loss, I'm here for that, too. I'm on your team. I want you to succeed.
You deserve support for this chapter, too.
Interested in exploring therapy that honors your full journey? Book a consult with me here!
Take Exquisite Care of Yourself,
Megan
