Body image distortion after weight loss is common for GLP-1 drug users, experts say. It takes time to accept the body's changes.

• Weight loss injections like Wegovy and Ozempic have yielded fast results for many patients.
• But one unexpected side effect is a distorted body image, patients told Insider. 
• It takes time to accept the body’s changes after rapid weight loss, experts said. 

Samantha Casselman has avoided her reflection for as long as she can remember. But the behemoth mirror in her in-law's dining room is one she takes special pains to dodge every Thanksgiving.

"I didn't want to look at myself," Casselman, a mother of five battling obesity, says. "I would do whatever I needed to do to avoid that mirror, because it made me feel so bad."

But after losing 80 pounds (and counting), the 35-year-old cardiac tech from Oklahoma can't wait for this year's Thanksgiving Day dinner. 

"I feel this year it's going to click, and I feel really excited to see their reaction," Casselman says. "It's going to be the best day of the year for me."

Like so many people rapidly losing weight with GLP-1 agonists like Mounjaro, Ozempic, and Wegovy, Casselman, whose doctor prescribed her Mounjaro to treat obesity and stave off its associated deadly diseases, is working to accept her new body, reconcile it with her former, larger body, and integrate it into her sense of self. 

Four months into her weight loss, the bespeckled brunette says she's happy that her co-workers compliment her, and she can see that her scrubs are hanging off her body, but when Casselman looks in the mirror, there's still a startling disconnect. 

"I can't see it," she says of her new physique. "Why is everyone saying how good I'm looking when I look exactly the same now as I did two or three months ago?"

It's a conflict that many people who are experiencing astonishing weight loss are struggling to resolve: Their old, enduring body image vs. the new frame they're carrying throughout the day.

"We have definitely seen more of this kind of disconnect in our non-surgical population since the increase in popularity of the GLP-1s," says Kelly Fanty, a clinical social worker at Mount Auburn Weight Management Center in Waltham, MA. This disconnect is specific to patients taking GLP-1 medications, Fanty says. "Weight loss rarely happens fast enough through diet and exercise alone to cause this." 

Casselman's dilemma is another aspect of the ways these agonists, which experts say are on track to become the most profitable drugs of the 21st century, are impacting social, personal, and economic life in America.

It can take time for the mind to catch up with changes in the body.

Dr. Roberto Olivardia, a clinical psychologist and lecturer in the Department of Psychiatry at Harvard Medical School says that while appearance is factual, measurable, body image is personal and emotional – a learned response based on each person's own history and experiences. 

"Body image could be that I'm too short or my height is fine," Olivardia says. "There's a lot of subjectivity to body image."

A disconnect between mind and body

Michelle, a 49-year-old IT director, was prescribed Mounjaro in April after being diagnosed with type two diabetes, class III obesity (formerly known as morbidly obese), hyperlipidemia, and primary hypertension. She is keenly aware of this subjectivity, so she's employing tech to help her mind catch up to the reality of her new, changing figure. Michelle, who asked Insider not to use her last name because her friends and family do not know she is using GLP-1 drugs, is using a 3D modeling app called ZOZOFIT and gets regular DXA scans to track her physique. 

"I'm a nerd," says Michelle, who also uses "a thousand spreadsheets," to predict when she'll reach her goal of attaining a healthy body mass index. (According to Michelle's calculations, that's June, 2024.) 

ZOZOFIT requires Michelle to don a stretchy $90 bodysuit covered with black-centered white circles. Michelle positions her phone at the correct angle, steps back and lets the app take pictures while she turns a full 360 degrees. 

"It's not a picture of you," says Michelle, who likes to compare the 3D images side by side when she takes a new one, which is every two weeks. 

"It's a grid image, like in the movie Tron, and somehow that makes it more helpful."

Dr. David Sarwer, the Associate Dean for Research and Director for the Center for Obesity Research and Education in the College of Public Health at Temple University, says it's not unusual for people to say they only notice a change in appearance when they see a static image of themselves.

The mirror, he says, is almost too familiar. 

Michelle is still critical of herself when she looks into a mirror. "I see that overweight spot. Or that tire," she says. "But if I'm looking at a screen, it's way easier for me to see the definition I have around my waist, or see how much slenderer my thighs are."

Sarwer says this isn't uncommon. "Oftentimes, patients will say that seeing that kind of image is what not only motivates them to lose weight, but can also be what tells them that their body has started to change as they lose the weight," he says.

In addition to her so-called "Super Suit" app, Michelle also gets a DXA, or DEXA, scan every three months to measure both bone density and body composition, such as body fat and muscle mass. She bought a package of 12 scans for $399.

"I'm very concerned about doing this in a way that is healthy for me, not just my relationship with gravity represented by a scale, but my actual physical body composition," she says. "The DXA scans helps me understand my body composition in a way that reinforces positive behaviors in terms of gaining muscle. I feel so much stronger now because I'm doing weight-bearing exercises and I'm eating a ton of protein."

Olivardia says this more compassionate inner dialogue is key. "You can both accept your body as it is and say, 'I have worth and I have value, and I'm going to work towards being healthier.'"

The struggle both Michelle and Casselman are experiencing adapting to their new and changing bodies isn't private. Both are subject to how others perceive them. 

"Whether we'd like to admit it or not, our appearance matters," says Sarwer. "We have a tremendously large body of social psychological research that tells us that individuals who are perceived as being more attractive are seen in a more favorable light by others and receive preferential treatment in situations across the lifespan."

A struggle for acceptance

For people experiencing body image adjustment issues, it can take time to adjust, experts say. "We look in the mirror every day," Sarwer says. "When we see ourselves from a different perspective like in a photograph (or a scan), that can be when we really notice a change in our appearance."

According to experts, body image is a mental representation of what our body looks like combined with how we feel about it, and what our culture says about it.

After months of disbelieving her own eyes, Michelle says she's finally starting to think more positively about her changing body. "I feel more attractive," she says. "At my highest weight (285 pounds), I struggled to identify myself in my physical being. I lived in my spirit and in my intellect. My body was just this meat that carried me around as an unwelcome inconvenience." 

"How we feel about our appearance is an important part of who we are and how we interact with the social world around us," says Sarwer. 

With her health issues caused by or exacerbated by obesity, Michelle says her body felt like something "other" that was out of her control.  

"With Mounjaro, between the weight loss and the health improvement, I feel like I am able to connect to my physical self."  

After months of being unable to see her weight loss, Casselman says she's ready to confront the in-laws' mirror and begin to begin to accept her new, changing body.

"I'm hoping this year when they set us around the table that I can sit right in front of it and I can smile when I look at my reflection, feeling so good about myself because each day is a struggle," Casselman says. "Because I've avoided the mirror for so long, now I'm trying to stare more into it, stare more deeply and see that reflection and let it catch up to my brain."