Perimenopause and menopause: understanding what changes

Menopause occurs on average around the age of 51 years old. It is confirmed after 12 consecutive months without menstruation, in the absence of another cause.

But the hormonal changes begin well before that. We now know that perimenopause is a transitional period that can last for several years, sometimes up to ten years before the last menstrual periods.

During this period, estrogen levels fluctuate, ovulation becomes less regular, and menstrual cycles may change. After menopause, estrogen levels decline permanently while FSH increases.

So the most common symptoms that appear are: hot flashes and night sweats, sleep disturbances and frequent awakenings, mood changes, irritability and difficulty concentrating, vaginal dryness and gynaecological and urinary discomforts, and changes in body fat distribution.

Up to about 80 % women experience vasomotor symptoms (hot flashes, night sweats) during this transition. In some, these unpleasant signs persist for about seven years or more.

A practical tip: Noting your periods and symptoms in a calendar for two or three months helps you better understand their progression. Some symptoms may be more pronounced before your periods, but they can also occur at any time during the cycle.

Obesity and menopause: what are the health risks?

Menopause does not necessarily lead to weight gain. However, with age, muscle mass tends to decrease and energy needs may change. The decline in estrogen primarily promotes the accumulation of fat in the abdominal area.

This visceral fat, located around the organs, is associated with several metabolic risks. This is fat that can increase waist circumference and worsen already present or emerging abdominal obesity. This fat can harm women’s health during the perimenopause.

In a woman living with obesity, this menopausal transition can also exacerbate certain health problems: the Type 2 diabetes (increased risk of insulin resistance), Cardiovascular diseases (hypertension, dyslipidemia and accumulation of risk factors), Sleep apnea (which can worsen fatigue and sleep disorders), Gynecological health  (increased risk of hyperplasia and endometrial cancer), Muscle health  (progressive decrease in muscle mass and strength, sarcopenia).

Or, obesity can also be associated with more frequent or intense hot flashes in some women.

It is then particularly relevant to pay attention to their metabolic health during this transitional period of menopause, even when weight does not change much.

Obesity and hormonal treatment: what risks?

One of the main hormonal concerns concerns the risk of venous thrombosis, that is, the formation of a blood clot in a vein, which can sometimes lead to pulmonary embolism.

Obesity already increases this risk, especially due to changes in coagulation and chronic inflammation.

However, estrogens taken by mouth to treat menopause can stimulate the production of coagulation factors by the liver. The combination of these two factors can further increase the risk of thrombosis.

That is why the way in which hormones are administered is as important as the choice of hormones themselves in obesity in transition during the menopause.

Oestrogens administered by the skin, in the form of gel or patches, prevent the hormones from passing directly into the liver, which makes them safer to use. Observational studies show that they are associated with a lower risk of thrombosis than oral estrogens.

This does not mean that these estrogenic creams applied by the skin are risk-free, but these estrogenic creams are generally a preferable option for women living with obesity when hormone therapy is indicated.

To better understand the importance of preserving your muscles, read our article on physical activity and muscle mass in the management of obesity.

Bioidentical hormones and menopause: are they safer?

Bioidentical hormones have a molecular structure identical to that of hormones naturally produced by the body.

Among the bioidentical medications approved in Canada are, among others, the transdermal estradiol, such as Estrogel, and the micronized progestin, such as Prometrium.

These treatments can have certain advantages:

The transdermal estradiol is associated with a more favorable thromboembolic profile than oral estrogens.

Micronized progesterone It appears to present a lower risk of thromboembolism than some synthetic progestins.

The approved medicines offer standardized doses and controlled quality..

However, bioidentical does not automatically mean safe. The risks also depend on the dose, the route of administration, the duration of the treatment, and the medical history.

To learn more about bioidentical hormones and the precautions associated with their use, consult the recommendations of the Society of Obstetricians and Gynecologists of Canada (SOGC).

Next, it is also necessary to distinguish these drugs from the so-called «personalized bioidentical» hormone preparations, which have not demonstrated better safety and the absorption or dosage of which may be less predictable.

Can I receive hormone treatment with a BMI above 30?

Yes. A BMI above 30 is not, in itself, a contraindication to hormonal treatment for menopause.

Systemic hormonal treatment remains the most effective treatment for hot flashes and night sweats. It can reduce their frequency by about 75 % and significantly reduce their intensity.

It can also improve sleep when awakenings are associated with vasomotor symptoms.

In women with obesity, transdermal estradiol is generally preferred. When the uterus is present, a progestogen or another suitable progestin must be added to the treatment to protect the endometrium from the proliferation of abnormal cells. Therefore, a combined estrogen and progestogen treatment is chosen.

Even so, hormonal treatment can help limit some accumulation of abdominal fat associated with menopause. However, it is not a weight-loss treatment and does not guarantee stable weight loss.

The decision to prescribe is still based on an individual assessment of the relationship between the expected benefits and the risks.

When are hormones not recommended or contraindicated? Let's get a health and safety overview!

Certain situations require special precautions, or even the avoidance of systemic hormonal treatment.

Special attention should be paid to abnormal uterine bleeding, since obesity increases the risk of certain pathologies of the endometrium.

To learn more about the different therapeutic options for menopause, consult the Clinical recommendations from NICE on menopause.

The choice of hormonal treatment must therefore take into account the woman’s overall health, and not just her weight.

Menopause: What non-hormonal treatments are possible?

A contraindication to hormonal treatment does not mean that one has to endure the symptoms without help.

Several non-hormonal treatments can reduce hot flashes and night sweats.

Fezolatinate (Veozah): a new non-hormonal option

Fetzolimod is a recently approved non-hormonal treatment in Canada to relieve moderate to severe vasomotor symptoms of menopause.

It acts directly on the temperature-regulating mechanisms in the brain, without providing any estrogen.

It represents a particularly interesting option for women who cannot or do not want to take hormones.

However, this medication requires medical evaluation and monitoring of liver function with blood tests during the first 9 months of treatment (at 3, 6, and 9 months), due to a rare but potentially serious risk of liver damage.

Other non-hormonal treatments

Other medications have also shown effectiveness against hot flashes:

Some antidepressants from the SSRIs or SNRIs family, prescribed at appropriate doses.

Gabapentin is particularly interesting in certain situations of nocturnal symptoms.

Other options exist depending on the symptoms, medical history, and contraindications.

Cognitive-behavioral therapy and structured clinical hypnosis can also help reduce the impact of symptoms and improve quality of life.

For vaginal dryness, Hydrators and lubricants can provide relief. Low-dose vaginal estrogens may also be considered in these situations where systemic hormones are not suitable, after medical evaluation.

There are therefore different ways to improve comfort and quality of life, even without systemic hormonal treatment.

Why treat obesity during perimenopause and menopause?

This period is an important opportunity to take care of one's weight, body composition, and metabolic health.

An appropriate approach includes several key elements to support:

A balanced diet, With sufficient protein intake to preserve muscle mass.

Muscle strengthening, associated with regular cardiovascular activity.

Attention to sleep, especially by looking for nocturnal hot flushes and sleep apnea.

Behavioral and psychological support, To support lasting changes without blame.

Medical treatment for obesity, When indicated, especially certain medications that act on digestive hormones such as GLP-1 agonists.

To learn more about obesity treatments and their follow-up, read our article on GLP-1 treatments and the importance of medical follow-up.

Why link the treatment of obesity with that of menopause?

Perimenopause and menopause are particularly relevant times for simultaneously acting on hormonal and metabolic health.

When indicated, hormonal treatment can improve hot flashes, sleep, and help limit certain changes in fat distribution. In turn, treatment of obesity can improve several cardiometabolic risk factors, promote a reduction in visceral fat, and contribute to better long-term health.

These two approaches do not replace each other; they complement each other. 

Because health isn’t just about the number on the scales; discover our article too: Liberating yourself from the weight of the body.

By improving sleep, energy, body composition, and metabolic health, joint care can help women navigate this transition in better condition.

That is why a consultation in obesity medicine can be particularly beneficial at this stage of life. At CoAttitude, female hormonal health is an integral part of the assessment. Perimenopause symptoms, sleep, gynaecological and urinary health, and treatment options are discussed when relevant, in a holistic, personalized, and non-judgmental approach.

Which examinations and tests are important for the obesity and menopause treatment team?

Perimenopause and menopause are also opportunities to take stock of one’s preventive health.

Depending on the age, history and risk factors, the doctor may suggest:

• A measure of blood pressure and an assessment of cardiovascular risk.
• A metabolic profile, including blood glucose or HbA1c and cholesterol levels.
• A check of the screening tests for breast and cervical cancer.
• An evaluation of abnormal menstrual bleeding.
• An assessment of bone health and the risk of osteoporosis.
• A screening for sleep apnea when symptoms suggest it.

After 45 years, the symptoms and the course of menstruation are often sufficient to recognize the menopausal transition. A systematic measurement of FSH or estrogens is usually not necessary. Monitoring of hormonal menopause treatment generally relies on symptoms, tolerability, and clinical evaluation, rather than systematic hormone measurements.

What can you do right now?

A few simple steps can help prepare you better for this transition:

• Note your menstrual cycles, your hot flashes, and the quality of your sleep.
• List the symptoms that disrupt your daily life the most.
• Take stock of your metabolic and cardiovascular health.
• Gradually incorporate muscle-strengthening exercises.
• Make sure you get enough protein and eat a variety of foods.
• During a consultation regarding obesity medicine, discuss possible hormonal and non-hormonal treatments.
• Don’t wait until the symptoms become unbearable to consult and take care of your menopause treatment along with that of obesity.

Taking care of your health, beyond weight and hormones

Perimenopause and menopause are natural stages of life, but their impact on health and quality of life deserves to be taken seriously.

Living with obesity may require more caution when choosing hormonal treatments, but that does not mean that you have to give up on them automatically.

Taking care of one’s weight, hormonal health, sleep, and psychological well-being means acting on several essential dimensions of one’s health.

At CoAttitude, we prioritize this holistic approach so that every woman can navigate this transitional period with more comfort, confidence, and serenity.

Every woman deserves an individualized assessment, clear information, and unbiased support in choosing the solutions that suit them.

L’article Obésité, périménopause et ménopause : quels risques et quels traitements possibles pour prendre soin de sa santé ? est apparu en premier sur Clinique médicale CO-ATTITUDE.

How to get through food addiction, compulsions, and hyperphagia

Is food addiction really what explains certain behaviors that are difficult to control? «As soon as I start eating chips, I can't stop.»

«When I'm stressed out, I eat.»

«Doctor, I think I'm addicted to sugar.»

« In the evening, I find myself in the kitchen pantry trying to pick up anything without really being hungry.»

«Sometimes I eat a lot and I feel like I completely lose control.»

These phrases are similar. They all come from stories told by my patients. Yet, they do not necessarily tell the same story, and food addiction is only one of the possible explanations.

Food addiction, compulsion, emotional eating, bulimic hyperphagia, craving, habit… All these words are used to talk about eating behaviors that are sometimes difficult to distinguish.

And when you live with obesity, a question is often asked of me:

« Do I have an eating disorder? »

The answer does not depend solely on what you eat or the amount you eat.

To understand what is happening, we also need to look at what triggers the behavior, what you feel before, during, and after, the degree of control you retain, the frequency of the episodes, and the function that eating has taken in your life.

And it’s important to remember an essential dimension: what happens in the mind when we eat is not solely psychological.

Hunger, satiety, reward circuits, stress, emotions, impulsivity, the foods around us, and learned behaviors all contribute to the equation. The body also sends out signals.

«Doctor, I'm addicted to sugar»

That is probably one of the phrases I hear most often.

However, having a strong desire for a food does not automatically mean that you are dependent on it.

We can seek out a food because it’s pleasant, associated with a moment of relaxation, because we’re very hungry after eating too little during the day, or because it temporarily soothes a difficult emotion. Our brain may also have learned that at 9 p.m., in front of the television, that’s what we do.

The sensation can be very strong, to the point of giving the impression that it is the food that is «ordering».

But the mechanism behind this desire is not always the same.

A strong desire is not necessarily an addiction food

The word craving refers to a particularly intense desire that is difficult to ignore.

One compulsion corresponds more to a push towards behavior: «I need to eat something.»

One habit It can become so automatic that the behavior begins almost before we consciously decide to do it.

Visit loss of control It means something else: once the episode has begun, the person feels that they no longer really have control over what they eat or their ability to stop.

These phenomena can overlap, but they are not synonymous.

That is why a consultation does not begin with:

« Let's eliminate this or that food item.»

but rather by:

«What happens just before you eat this food?»

Compulsion: when «I want to eat» becomes «I have to eat»

An eating disorder can be experienced as an emergency, even when the person knows that they are not hungry.

An emotion, a smell, the sight of a food, a place, an hour, or a situation repeated hundreds of times can trigger it.

The brain learns associations remarkably well. When a sequence is repeated, the trigger can gradually become a habit. guidance towards already known behavior. The behavior takes root. A path has been learned.

And what has been learned can often be observed, interrupted, modified, or replaced.

Emotional eating: eating to change what is felt

Eating is not just about satisfying hunger.

We also eat to celebrate, to comfort ourselves, to distract ourselves, to calm ourselves, or to please ourselves. Food can thus become a way of modifying an inner state: stress, boredom, loneliness, frustration, fatigue, anger, anxiety, sadness, but also sometimes joy or a need for reward.

If eating calms me down, my brain can hold on to: «When I feel this, this solution works.» Repetition then strengthens the behavior.

However, emotional eating is not, by itself, a psychiatric diagnosis.

It becomes especially important to explore when it constitutes one of the main strategies for regulating emotions or when it is accompanied by suffering, a loss of control, or consequences for health.

And ADHD in all of this?

ADHD does not mean that someone will develop an eating disorder or an anxiety disorder.

However, impulsivity, the pursuit of stimulation or reward, and the difficulties in organizing and regulating emotions that may accompany it can influence eating behaviors.

For example, one can forget or delay meals and arrive in the evening with a significant hunger. Internal tension, intense emotion, or impulsivity can also favor the search for relief or a quick reward through food.

A systematic review indeed finds an association between ADHD symptoms and various disordered eating behaviors, with a possible role of negative affect and emotional dysregulation.

Here again, a good question is:

« What are you trying to regulate at that moment? »

Hyperphagic bulimia: when you enter a defined eating disorder

Bulimic hyperphagia disorder (binge-eating disorder) is a recognized eating disorder.

An episode includes, in particular, the consumption, for a limited period, of a quantity of food significantly greater than that that most people would eat under comparable circumstances, with a feeling of loss of control.

One can also eat very quickly, without being hungry, until one feels uncomfortably stuffed, eat alone out of embarrassment, or subsequently feel guilt, sadness, or self-disgust.

To talk about a Bulimic hyperphagia disorder, Episodes must be recurrent, associated with significant distress, and meet specific criteria for frequency and duration. Unlike nervous bulimia, they are not regularly followed by compensatory behaviors such as induced vomiting.

Eating too much on occasion is therefore not synonymous with bulimic hyperphagia disorder.

And living with obesity no longer.

Is food addiction even a real thing?

The question is more complex.

Food addiction is an active area of research, but it is currently not recognized as an independent psychiatric diagnosis.

To study it, researchers developed the Yale Food Addiction Scale, Then the YFAS 2.0.

This tool looks for several characteristics similar to those observed in addictive behaviors: craving, loss of control, a desire to reduce without succeeding, continued use despite the consequences, and distress and impairment of functioning.

It is therefore not simply a matter of asking:

«Do you really like chocolate? Are you passionate about chips?»

It is rather a matter of identifying a an eating profile that, in several dimensions, resembles an addictive behavior.

Food addiction: Can food itself be part of the problem?

This is one of the major current issues.

The research focuses in particular on Highly processed foods, They are often rich in refined carbohydrates and added fats, very appetizing and quickly consumed.

Some researchers believe that these foods could have an addictive potential in some people. Others believe that the analogy with substance addictions should be cautious.

The debate is therefore not completely settled, and it is simply not possible to say «Sugar is a drug» That would be far too reductive.

We never eat in a brain isolated from its history, its metabolism and its environment.

What happens in the head is not just «in the head»

Our eating behavior results from several systems that communicate with each other.

The mechanisms homeostatic they participate in hunger, satiety and energy needs. The mechanisms hedonistic are linked to pleasure, motivation and reward.

Thus, emotions, stress, fatigue, the available foods, our ability to inhibit a response, and our learning all play a role.

A significant restriction can increase the Hunger and food concerns. Stress can alter the search for reward. An emotion or the sight of a food can trigger a learned association.

Because reducing all food difficulties to a lack of willpower doesn’t make much sense.

Schemas learned: when the brain already knows the way

We all have learned behaviors. Some are useful. Others end up trapping us.

Stress → chocolate → relief.

By dint of Repetition, Stress can trigger chocolate even before the person has consciously decided to eat it.

Or also:

Restriction → significant hunger → loss of control → guilt → new restriction.

To understand the scheme, however, one must look not only what the person eats and also What precedes and follows behavior.

What is the trigger? What emotion is present? What thought? What relief or reward is obtained?

This is often where the pattern becomes visible.

So, am I «in the turmoil» of food addiction, compulsion, and hyperphagia?

A few questions can help us understand what is happening:

Do I feel a real loss of control when I eat?

Are the episodes occasional or recurring?

Am I eating a very large amount of food in a relatively short time?

Do I sometimes eat in secret?

Major distress, shame or guilt—is that what I’m feeling?

Do I eat primarily to satisfy an emotion?

Do certain foods almost systematically trigger a sequence that is difficult to interrupt?

Does my diet affect my health or my quality of life?

And above all:

Does this behavior make me suffer?

These questions do not replace a clinical evaluation. They allow us to understand why two people who say «I eat too much» may need very different support.

And what if several mechanisms were present at the same time?

It’s common.

A person may eat when they are anxious, have very ingrained habits, be particularly sensitive to certain foods, and experience episodes of loss of control. ADD/ADHD, anxiety disorders, sleep difficulties, or other factors can also be involved.

Looking for a single cause therefore risks missing part of the story.

Understanding before dealing

For a long time, the difficulties related to weight were reduced to a too simple equation: We eat too much and we don't move enough.

The eating behavior is much more complex.

Metabolism and hunger count. The reward circuits, emotions, food, and our environment also play a role. Sleep, stress, attention, impulsivity, and our learning history can also play a role.

This does not mean that every food difficulty requires psychotherapy, that every intense craving is an eating disorder, or that all emotional eating constitutes a disorder.

Before trying to eliminate a behavior, it is especially useful to understand What it serves and what keeps it going.

The question then becomes less:

«How can I get this person to stop eating?»

and more:

« What triggers and maintains this behavior in this person? »

And sometimes, the first change consists simply in replacing:

«What's wrong with me?»

by:

«What's going on in my house?»

L’article Suis-je dans le trouble, docteur ?  est apparu en premier sur Clinique médicale CO-ATTITUDE.

What do you know about what should be monitored when taking a medication from the GLP-1 family?

You will certainly answer: the weight. Perhaps also the digestive side effects, such as nausea or constipation.

But what about your diet, your muscle mass, your level of physical activity, your hunger, your satiety, the thoughts around food, your old eating habits, and even the way you live through the sometimes rapid changes in your body?

Treatments that act on the GLP-1 pathways, such as semaglutide or tirzepatide, as well as new molecules that broaden the treatment options for obesity, are not simply intended to bring the number on the scale down.

They profoundly alter the food experience of some people.

Hunger can decrease. Satiety comes more quickly. Portions naturally become smaller. The incessant thoughts about food, sometimes called food noise, Some foods become less appealing and behaviors that previously seemed difficult to control may lose some of their strength.

So, when everything seems to be working well, a completely legitimate question arises:

« If I lose weight, eat less and feel good, why would I still need follow-up care?»

Precisely because the monitoring is not just used to measure your weight loss.

It allows to check How your health evolves during treatment, what the medication actually improves and what still deserves your attention.

And what if the conclusion is simply that if Everything is fine, It is also an excellent therapeutic result.

What does a treatment with GLP-1 actually do?

GLP-1s are hormones produced naturally by our body. Drugs that replicate or amplify some of their actions act, among other things, on the brain and digestive mechanisms involved in appetite and food intake.

They can thus:

• reduce hunger; ;
• increase satiety; ;
• enable you to be satisfied with smaller quantities; ;
• reduce certain food cravings; ;
• reduce the incessant concerns about food, often called food noise.

In some people, this produces a new experience:

«I can finally stop eating without having to fight against myself.»

This change is important.

It also reminds us that certain behaviors that were once easily attributed to a «lack of willpower» were strongly influenced by the biological mechanisms of hunger, satiety, and reward.

And the compulsions or eating habits?

It’s quite complex.

Some eating behaviors are built over time. They are learned, repeated, reinforced, and then sometimes become almost automatic.

The path can look like this:

stress → desire to eat → food → relaxation

Or, more simply, associated with a habit:

evening → television → desire to snack → pleasure

Through repetition, the brain learns this association and a habit is created. The context itself can eventually trigger the desire to eat, sometimes even before we have actually made the decision to do so.

By reducing hunger and the desire and interest in food, GLP-1 treatment can reduce the force that maintains this loop. The behavior then becomes easier to interrupt.

But not all food difficulties are the same.

One person may eat because they are actually hungry. Another may eat to calm down after a difficult day. Someone may feel a loss of control in front of certain foods. Some people experience true hyperphagic attacks, with a large amount of food consumed and the impression that they can’t stop eating.

Monitoring is precisely what allows us to understand What's happening at your place, Rather than assuming that all food difficulties have the same origin.

The GLP-1 follow-up: eating less is not enough

When appetite decreases sharply, a new problem may arise: no longer eating enough or no longer eating well enough.

It can become more difficult to achieve adequate intakes of protein, fiber, vitamins and minerals, or even simply energy.

Weight loss also does not only involve fat mass. Part of the lean mass can also be lost.

Monitoring therefore allows us to focus on the quality of the diet, proteins, hydration, digestive tolerance and, when necessary, micronutrients. Current data They also encourage looking beyond just weight loss and integrating nutrition, physical activity, body composition, and maintaining physical function into the follow-up.

The question is no longer simply:

« Am I eating less? »

but rather:

« Am I feeding my body enough? with what I eat now?»

Physical activity: protecting what we don’t want to lose

During significant weight loss, preserving strength and muscle mass becomes particularly important.

Moving around daily is important, but muscle strengthening also plays an important role.

It’s not about exercising to «burn off» what you’ve just eaten.

The objective is different: maintain a functional, strong body that can accompany you during and after weight loss.

How do I know if I still need to be accompanied?

This is probably one of the most important questions in follow-up.

You are losing weight. Hunger is less present. You think much less about food. Your clothes are getting too big and your friends and family begin to notice the changes.

Everything seems to be going in the right direction.

And that might indeed be the case.

But the weight only tells us part of the story.

Some questions allow us to see what is happening behind the figure displayed on the balance, And that is also what obesity medicine is all about.

Has my relationship with food really become easier?

Do you need less control over what you eat?

Do you think less often about food?

Can you stop eating when you are full?

Can you have certain foods in the house without them constantly occupying your thoughts?

If you answer yes to these questions, it is a real benefit of the treatment.

Your relationship with food may simply have become more free.

Do I still sometimes have the impression of losing control?

There is a difference between wanting to eat and feeling like you have to eat. no longer able to stop.

Some people say:

« Once I start, I have a lot of difficulty stopping.»

«There are certain foods with which I still lose control.»

« I almost no longer feel hungry, but I still have episodes of hunger.»

This information is important.

Treatments that act on GLP-1 can reduce some food cravings and some behaviors of losing control. But if these episodes persist despite the treatment, they deserve to be explored rather than simply being masked by a good result on the scale.

Do I still sometimes eat for something other than hunger?

We do not eat only because our body requires energy.

We can eat to reward ourselves after a difficult day, reduce our stress, distract ourselves when we get bored, comfort ourselves, accompany a moment of relaxation, or simply because a behavior has become automatic.

So, ask yourselves this question:

When I am stressed, sad, angry, alone, or exhausted, what am I doing now?

You may have naturally found something else: walking, calling someone, listening to music, tinkering, reading, going out, getting active or resting.

You then found new ways to meet the needs that might previously have been hidden behind certain emotions.

But other people discover instead:

«I don't eat anymore, but I have nothing to eat instead.»

Food may have previously served a function of pleasure, reward, or comfort that has quickly disappeared.

This could become something to explore during the follow-up.

What can bring me pleasure now?

This question may seem unrelated to obesity medicine.

It’s not that bad.

If eating was previously one of your main sources of pleasure, comfort, or reward, and that interest is greatly diminished, it becomes interesting to look at what is gradually taking its place.

For some people, this change happens spontaneously.

For others, food no longer interests them much, but they have not yet found a way to make it work.’Other sources of satisfaction.

This does not automatically mean that there is a psychological problem.

But this can be an opportunity to actively build a life in which pleasure, relaxation, and reward no longer depend primarily on food.

My body has changed. Has the image I have of myself changed?

A significant weight loss can sometimes be much faster than that.’adaptation of our body image.

You may have lost 15, 20 or 30 kilos and still instinctively choose clothes that are too big. You are surprised by your reflection in the mirror. You still feel like you take up more space than you actually do.

On the other hand, you may be delighted with your new figure and appreciate the compliments:

«You really lost!» «That changes things for you!»

And that is perfectly correct.

Monitoring does not consist of turning legitimate satisfaction into a psychological problem.

It simply allows to check that The perception you have of yourself gradually comes to accompany the changes in your body.

What place did the balance and the perspective of others take with GLP-1?

At first, watching the scale go down is often very motivating.

Compliments can also be very helpful, especially after years of struggling with weight.

But gradually, another question becomes interesting:

How will I manage the days when the balance doesn't go down?

If a small change in weight causes severe anxiety, if the fear of gaining weight leads to eating less, or if your self-esteem becomes almost entirely dependent on the weight you achieve, it is useful to talk about it.

The goal of the treatment is not to replace a constant preoccupation with food with a constant preoccupation with the balance.

GLP-1 monitoring also allows us to keep this issue in perspective and not reduce progress solely to the balance sheet figure.

Am I afraid that everything will start over if GLP-1 works less well?

This concern is common and understandable.

«And what if I stop?»

« And what if the medication doesn’t work as well?»

« And what if my desires return?»

Pharmacological treatments for obesity are generally considered long-term when indicated, effective, and well-tolerated.

Since obesity is a chronic disease, the reappearance of hunger or a weight gain after stopping a medication does not mean that you have failed.

Monitoring can also be used to prepare for more difficult periods.

A heavy workload, a period of stress, holidays, illness, a change in treatment or the return of certain desires do not necessarily mean a return to the starting point.

It is precisely in these moments that the strategies built during the follow-up of the treatment can become useful.

GLP-1 monitoring also serves when things aren't going as smoothly anymore.

Treatment for obesity does not always proceed in a straight line.

There are periods when everything seems easy and others when some old habits reappear.

One meal becomes several meals. A period of stress triggers the snacking behavior. A food that was no longer a problem starts to become very appealing again. Physical activity decreases. Weight stabilizes or slightly increases.

This is the time to understand without judgment, by exploring:

What just happened?

How did I function before?

What change has appeared?

What do I need now?

Monitoring is precisely intended to help overcome these periods, to resolve difficulties when they arise, and to prevent a single event from gradually becoming a lasting return to old behaviors.

What GLP-1 follow-up do I need?

We don’t all need the same things.

If you could say today:

«I eat enough and in a balanced way. I am much less hungry. My relationship with food has become simple. I no longer lose control. I have other sources of pleasure. I move regularly. I feel good in my body and in my life.»

Then your follow-up may probably become more light-hearted.

It remains useful for monitoring your treatment, your health, your diet, your physical activity and the evolution of your weight, but it is not necessary to look for a problem that does not exist.

On the other hand, more intensive support deserves to be considered if you find yourself in several of these situations:

• I continue to have loss of control or food crises; ;
• some foods still trigger cravings that are very difficult to control; ;
• I still eat mainly to manage my emotions; ;
• since I eat less, I no longer really know what gives me pleasure; ;
• I eat so little that I have difficulty meeting my nutritional needs; ;
• My strength is decreasing or I fear losing too much muscle mass; ;
• my weight or my scale occupy a lot of my thoughts; ;
• The fear of regaining weight returns; ;
• I don't really recognize my new body; ;
• A difficult period in life has brought back my old behaviors.

In these situations, Having a need for follow-up does not necessarily mean that you need long-term psychotherapy.

It could be an adjustment nutrition, a muscle-strengthening program, some targeted behavioral interventions, work on triggers and habits, new strategies for managing emotions or, where indicated, with genuine support psychotherapeutic.

The intensity and type of monitoring must adapt to your needs.

To go further

The medication can do a lot. Follow-up allows us to know what remains to be done.

Treatments that act on GLP-1 have taught us something important.

When hunger, certain food cravings, and thoughts about food decrease sharply, then difficulties that were once too easily attributed to a lack of willpower can improve significantly.

It is necessary to recognize this success.

But this period can also become a tremendous opportunity for change.

When the former eating behavior becomes less powerful, it can become much easier to build a new one.

Like learning to eat enough despite a decrease in appetite. Protecting your muscle mass. Or moving more. Recognizing your triggers. Finding other ways to manage stress. Discovering new sources of pleasure. Adapting to a changing body. Knowing what to do when a difficult period arises.

That's also what monitoring is for.

And if, after some time, you feel better, your diet becomes more varied, your health improves and you feel able to continue with greater autonomy, that’s because The follow-up has also fulfilled its mission.

The GLP-1 follow-up does not aim to create dependency on the support provided. On the contrary, it should gradually help the person to better understand what suits them and to gain in autonomy. Because in the end, the success of an obesity treatment is not measured solely in terms of the kilos lost; it is also measured in terms of what you have gained in health, strength, freedom and quality of life..

Therefore, good GLP-1 monitoring must remain individualized and evolve with each person's needs.

Monitoring when taking GLP-1 should gradually allow you to better understand your functioning, recognize the situations in which you need help, and know when you can continue on your path with greater autonomy.

L’article De quel suivi ai-je besoin quand je prends un GLP-1 ? est apparu en premier sur Clinique médicale CO-ATTITUDE.

They can reduce hunger, increase satiety and facilitate weight loss that previously seemed unattainable. They can also improve several health parameters associated with obesity.

This is a remarkable advance.

But there is a question that perhaps we are still talking too little about: What happens during and after this weight loss?

And above all: Does losing weight necessarily mean that one will finally feel good?

Not always.

Because weight doesn’t define a person and, behind the kilos we want to lose, there is often something else to understand, to find, to transform, or sometimes to treat.

Weight loss: « What do I want to win?»

When a person consults in obesity medicine, His request is often very simple: “I want to lose weight.”

And sometimes she adds: «I want to be thin.»

I understand this request. We live in a society that has taught us to associate thinness with health, beauty, success, willpower, and even happiness. For years, many people have been given the message that they would finally be fine with their bodies once they reached the «right» weight.

So they come with a very specific goal: to lose weight.

However, during the counseling process, another question may gradually arise: If I want to lose this weight, what exactly do I want to find instead?

This question may seem strange at first, but it profoundly changes the perspective.

«To lose» describes what we want to get rid of. It still doesn't say what we want to go towards.

However, in the therapeutic approaches I use, including hypnosis and neuro-linguistic programming, we pay a lot of attention to the way an objective is formulated. In particular, we consider that an objective formulated solely in negative terms — no longer being like this, no longer doing this, no longer having this body, losing this weight — provides little information about the desired direction. The unconscious needs a representation of what we want to build, feel or find in its place.

It is therefore not just a matter of asking the body to lose weight.

It is also about allowing the person to discover what she wants to win.

And the answer does not belong to me.

What we want to gain is different for everyone.

This is probably one of the dimensions of my work that I care about the most: I don’t know what the person should want in its place.

My role is not to decide that its goal should be to love oneself better, to do more physical activity, to eat differently, to resolve one’s past, or to transform one’s relationship with one’s body.

My role is to accompany her so that she can find her own answers.

For one person, losing weight can mean regaining enough energy to play with their children or grandchildren. For another, it will be being able to walk without pain, reducing certain health risks, or considering pregnancy under better conditions.

Another woman will want to regain freedom in her movements, dress as she feels like, resume an activity she had abandoned, regain confidence in her body, or simply stop thinking about her weight from morning to night.

And sometimes the answer is much deeper.

The person wants to find a life that she has gradually put on hold. She wants to take her place back. She wants to start making plans again. She wants to feel free. Sometimes it’s about looking at herself in a different way. Or sometimes the person wants to be able to eat without feeling guilty. And often the patients want to stop fighting against themselves.

It is these answers that interest me, because they give direction to change. One is no longer looking only at what the person wants to lose, but at what they want to go towards.

The weight is visible. The rest is much less so.

Behind the number on the balance sheet, there is always a person.

There is its history, its biology, its diet, its sleep, its physical activity, its medications, its hormones, its environment, its level of stress and its psychological health. There is also its relationship with its body and with food.

And sometimes there are years of instructions to be thinner, remarks heard in childhood, diets started very early, periods of restriction followed by a loss of control, the fear of eating certain foods, or guilt after eating.

There may also be a family history in which weight and food took up a lot of space. Some habits may be linked to belonging, comfort, shared moments, or family loyalties that are sometimes difficult to perceive. Conversely, a person may have spent their entire life trying to avoid reproducing what they experienced in their own family.

Sometimes there’s even this impression that you have to choose between being thin and being yourself. All of this lies beneath the surface. Weight, on the other hand, is what you see. It’s the tip of the iceberg.

Not everything necessarily needs to be «fixed»

However, accompanying a person beyond their weight does not necessarily mean that we must look for a psychological injury or a deeper explanation behind each kilogram.

Not everyone with obesity has a trauma to treat, a pathological relationship with food, or a family history to resolve. Sometimes, the needs are much simpler. It’s necessary to find an objective. Relearn how to recognize hunger and satiety. Find an exercise activity that you truly enjoy. Reorganize meals when the medication severely cuts down on appetite. Maintain muscle mass. Find energy. Sleep better. Or simply learn to live with a changing body.

At other times, however, something requires deeper support. This can be a painful relationship with the body, a fear of regaining weight, difficult eating behaviors, a history of repeated restrictions, low self-esteem, or even certain old wounds that continue to weigh on current life.

It is precisely for this reason that there is no one path that is the same for everyone.

We don't treat a number; we accompany a person.

Losing weight is not necessarily the end of the treatment

It is also one of the most difficult things to understand when starting treatment.

One might think: «When I have lost weight, I will be at the end.»

But Obesity is a chronic disease. As with other chronic diseases, treatment takes time. Medications may be necessary in the long term for some people, especially because the biological mechanisms that promote weight gain do not simply disappear just because the weight has decreased.

The studies conducted with modern treatments It illustrates this well. In the extension of the STEP 1 study, people who stopped taking semaglutide regained an average of about two-thirds of the weight they lost over the following year. In the SURMOUNT-4 study, stopping another drug, tirzépatide, was also associated with a significant weight regain, while continuing treatment allowed maintaining and intensifying the weight loss.

This does not mean that the medication did not work. It means that the disease remains present. And this reality can be difficult for some patients to accept.

Sometimes it is even a real shock. The people had finally managed to lose weight and discover that they might need to continue their treatment to maintain the benefits achieved.

This is where support becomes particularly important, because it is no longer just about prescribing a medication. It is also necessary to allow the person to understand what is happening to them, to adapt to this new reality, and, most importantly, to continue building what they want to achieve through the treatment.

Last week, three completely different stories

Last week, I met several people who reminded me of how important it is to look beyond weight.

The first is a 28-year-old woman. She is not ready to become pregnant now, but she has a plan to become pregnant in about two years. She lives with grade 2 obesity, prediabetes, and polycystic ovary syndrome.

She would like to lose weight, but she gradually discovers that her therapeutic journey may not be as simple as she imagined.

Her pregnancy plan must be taken into account. Some medications used to treat obesity must be discontinued before conception and are not used during pregnancy. Therefore, one must plan the treatment based on one’s life plan and anticipate the various stages. She also discovers that the treatment may need to be extended. This idea shakes her. She cries and she is afraid. It is completely normal to experience emotions during treatment.

At that moment, my role is not to explain to her what she should feel or to tell her to stay positive. It is first of all to listen to her and to give her the necessary space to understand what this new reality represents for her.

Then, we can move forward together. We discuss the options, choose a treatment, and give it time to work.

She doesn’t have to accept everything today or have all the answers immediately.

His path belongs to him.

Not everyone is ready to take the same path.

The second person I met needed to lose a significant amount of weight to improve her health. Her BMI was over 40, she had prediabetes, an increase in her triglycerides, and the beginning of liver disease.

She starts an injectable treatment, but does not want close medical follow-up.

I respect his choice, even though, as a professional, I believe that support can be very beneficial.

Because losing weight doesn’t necessarily mean that other issues will disappear. We may have to learn to better understand our hunger and satiety, review our diet to ensure it remains sufficiently nutritious, preserve our muscle mass, incorporate more movement, or simply learn to live with the changes that occur.

Perhaps one day she will also wish to look at what lies beneath the surface.

Or maybe not.

This lady was not ready today to invest more time or finances in her career because treatment costs money and that too must be respected.

An accompaniment should never become a new injunction.

There must remain a possibility, a resource, and a door that can be opened when one feels the need.

And sometimes the weight comes back

The third person had lost weight with treatment.

Then the treatment was stopped and the weight returned.

She had not understood that treatment might have to be continued and she had not also taken into account that follow-up could be part of the treatment.

Once again, it would be easy to simply look at the number on the scale and conclude that it is a failure.

But that would be missing the point.

The rebound in weight after stopping treatment tells us much more about the biology of obesity than about the person’s will.

When a significant recovery occurs, we can therefore ask ourselves what is happening now. Is the treatment still appropriate? Has the life context changed? Has hunger returned? Has sleep deteriorated? Has an important event occurred? And, beyond all these questions, how is the person really doing?

Sometimes it is precisely at this moment that we can also return to that other question: What did you want to find when you started losing weight?

And is that still what you want today?

Getting rid of the kilos, but also of the weight that we carry on our shoulders

It is here that I believe the relationship of help takes on its full value.

Because a person may want to lose weight for their health while carrying another weight, which is much less visible: the weight of comments, shame, diets, comparisons, guilt, or the idea that they should finally succeed in becoming thin.

There may also be the weight of a difficult relationship with food, of certain family stories, of the need to eat in order to belong or, conversely, of having to restrict oneself in order to be accepted.

These things cannot be cured with a drug injection.

They also do not settle for a list of nutritional recommendations.

However, they should not be interpreted or decided for the person’s sake.

In a therapeutic relationship, my role is not to absolutely seek out what is «wrong» with her. It is rather to create a sufficiently safe and non-judgmental space for her to discover what matters to her, what may be holding her back, and what she needs to move forward.

Sometimes, a few encounters are enough to put words to what is happening.

Sometimes psychotherapy is relevant and the work takes more time.

Sometimes, no deep exploration is necessary and a few very concrete adjustments are enough.

It is the person who gives the direction. The therapist helps them find the path.

Psychological work is not there to guilt-trip anyone.

It is important to clarify this, because some people still hear the word «psychological» as if it meant: «The problem is in your head.»

That is absolutely not what I mean.

Obesity has multiple biological, psychological, behavioral, social, and environmental determinants. Psychological interventions constitute one of the pillars of possible treatment and support for its management, just as medical, nutritional, and behavioral interventions do.

Psychological work can help us understand what is happening rather than judging what is happening. It can help a person break free from weight-related constraints, develop a more peaceful relationship with their body, or explore a difficult relationship with food.

But it can also serve for something much more forward-looking: to bring out what the person wants to build instead of what they want to lose.

This is where different therapeutic approaches can become interesting. Hypnosis, NLP, certain psychotherapeutic approaches or behavioral tools can help explore the person’s resources, their values, their needs, and the changes they truly want to see in their life.

The goal is never to provide him with a ready-made answer.

It is to help him bring out his own.

Not all professionals necessarily have the same training

There is also a reality that must be able to be discussed with respect.

Obesity medicine is a specific field. Understanding obesity as a chronic disease, knowing its biological mechanisms, knowing how to use modern pharmacological treatments, and accompanying the psychological and behavioral issues that may be associated with it require special training.

Not all doctors and healthcare professionals necessarily received this thorough training.

This is not a criticism, but simply a reality of our healthcare system. This may explain why some people have sometimes received conflicting messages: «Eat less,» «move more,» «take this medication,» «stop taking your medication,» or «you simply need to have more willpower,» when their situation required a much more comprehensive approach.

The goal is therefore not to replace one professional with another, but to work better together, because someone living with obesity deserves to be supported in all its complexity.

Creating customized solutions

That is probably the best way to describe the CoAttitude.

There is no standard course that is applied in the same way to all people.

Of course, there are medical knowledge, recommendations, treatments whose effectiveness has been proven and essential principles for protecting health. This rigor is indispensable.

But within this framework, there remains a unique person.

That is why solutions are built together, between the patient and the caregiver or therapist.

For one, the work will mainly focus on medical treatment and nutrition. For another, work on body image will need to be added. One person will need to find physical activity that gives them pleasure, while another will first need to find sleep or energy.

Some will need hypnosis, behavioral strategies, psychotherapeutic work, or tools to better navigate certain emotions. Others will mostly need information, a framework, occasional support, and time.

And these needs can change over the course of the journey.

The solution is therefore not entirely contained in the medication, nor is it entirely contained in psychotherapy, nutrition or physical activity.

It is built gradually and individually, in accordance with what medicine can offer and what the person really wants for their life.

And what if the definition of success changed?

Perhaps the question should no longer be solely:

« How many kilos have you lost?»

We could also ask:

«What did this weight loss allow you to gain?»

Has your health improved? Are you sleeping better? Have you regained energy? Can you do some things that you used to be unable to do? Is your relationship with food more peaceful? Are you less afraid of your body? Have you regained a sense of freedom? Has your life become bigger than your weight?

And maybe along the way you discovered an objective that ultimately had little to do with the balance.

That is why I believe that we need to be careful when weight loss becomes the ultimate goal.

The goal of obesity treatment is not to make each person weigh less on the scale. The goal is to take care of their health and improve their quality of life, while helping them move towards what truly matters to them.

Sometimes this involves significant weight loss. Sometimes a more modest loss already brings considerable benefits. And sometimes, despite efforts and treatments, the body reaches a limit. This does not mean that the person has failed. It means that the number on the scale has never, by itself, been a sufficient definition of success.

Medications can alleviate one weight while the accompanying treatment can alleviate another.

I strongly believe in the role of medication in the treatment of obesity.

They can be extraordinary and change a life. However, they are not the whole story.

They can have a powerful effect on the biology of hunger and satiety and help the body lose weight. However, they cannot decide for a person what they want to do with this new opportunity.

They cannot tell the person what they want to gain instead of what they lose.

Medications alone cannot undo years of weight-loss mandates, rewrite a family history, repair a painful relationship with food, or teach someone to inhabit a body that changes in other ways.

That is why I believe in accompaniment.

Not because the medications aren’t working.

That’s exactly why they work.

When the body begins to change, something becomes possible. And perhaps it is at that moment that we can stop looking only at what is disappearing to focus on what may appear in its place.

Beyond weight loss: what do I want to gain?

What do I want to find? What do I want to be able to do? How do I want to live? How do I want to take care of my body? What do I want to leave behind? What still deserves to be cared for?

And above all: What do I want to gain?

The responses will be different for each person, and that is precisely why the support must be individualized, without judgment, and built with the person rather than for them.

Maybe that’s what I would like people to understand, in the end.

The treatment should not only help to lose the kilos that harm health; it should also allow us to discover what is the winning exchange: health, mobility, energy, freedom, confidence, projects, pleasure, peace of mind… or something completely different, which belongs only to us.

And sometimes, to reach that new place, you will also have to put down another weight.

The weight of shame, expectations, instructions, certain family stories, guilt, or the feeling of always having to start over.

Because underneath the weight is the person.

A person who doesn’t need to be told who they should become.

She needs to be heard, respected and supported in order to discover for herself where she wants to go.

And if we can do both, taking care of the body while helping the person find what they really want to achieve, Then maybe losing weight will finally stop being an end in itself. And the course becomes something completely different.

L’article Se libérer du poids du corps… et de celui que l’on porte sur les épaules est apparu en premier sur Clinique médicale CO-ATTITUDE.

Before continuing your reading, try to answer this question:

If you had almost no hunger today, what would you eat to be sure to still give your body what it needs?

Imagine it.

It’s noon. You could easily skip lunch. There’s no hunger pangs or particular urge to eat. Yet you know your body needs to be fed. So, what do you choose?

A fruit?
A yogurt?
A few walnuts?
A soup?
A slice of bread with peanut butter?
Two eggs?
A piece of cheese?
Or nothing at all, since you’re not hungry?

And among these choices, do you know which would provide you with enough protein? Fiber? Which foods would be most interesting if you could only eat a small amount of them? The answer is often much less obvious than one might think.

And what if the challenge wasn’t simply to eat less?

For a long time, advice on weight loss has mostly been based on the same idea: reduce what we eat. Less calories. Smaller portions. Less fat. Less sugar. Reduce snacking. But new obesity treatments are fundamentally changing the question. When a treatment effectively reduces hunger and increases satiety, some people no longer need to be taught to eat less. They do it spontaneously.

Then you have to learn something else:

How can we properly feed a body that requires much less food?

This is an important change of perspective. As quantities decrease, the nutritional quality of what we eat becomes even more important. We need to continue providing our bodies with what they need to preserve their muscles, energy, bones, intestinal function, and, more broadly, their health.

In other words, with modern treatments for obesity, the question is no longer just:

«How to eat less?»

She also becomes:

« How do I make sure that what I eat actually nourishes my body?»

And to answer this question, we sometimes have to relearn some basics that we thought we already knew.

Let's start with proteins: do you really know where they are located?

In the previous article dedicated to physical activity, I was explaining to you why it is important to work our muscles during weight loss. But a muscle that we want to keep must also be nourished.

Proteins contribute to maintaining muscle mass. When weight loss is significant and food intake decreases, their role in the diet becomes particularly important.

However, we sometimes overestimate the amount of protein contained in certain foods.

Peanut butter contains protein. So does hummus. Cream cheese, nuts, or certain plant products can also provide it. But in the portions usually consumed, some of these foods do not necessarily provide as much protein as we might imagine. I sometimes call these foods, together with my patients, the «fake friends» of proteins. They are not bad foods. There is absolutely no need to eliminate them. They provide other nutrients and can perfectly be part of the diet. Simply, if you eat little, they should not be your sole source of protein.

Greek yogurt rich in protein, eggs, fish, chicken, meat, cottage cheese, tofu, legumes or other protein-rich foods can help you get more of these nutrients in a sometimes rather small amount.

The right amount obviously depends on each person: age, weight, health status, physical activity, kidney function, the importance of weight loss, and other medical conditions must be taken into account.

The goal is therefore not to turn every patient into a gram-counting accountant; rather, it is to develop a new reflex:

«Since I’m eating less, where is my source of protein in this meal?»

When every bite counts more

Now imagine that your appetite allows you to eat only half of what you used to eat.

Your body does not need half of all the vitamins, minerals, proteins, fiber, or fluids it needed before. This is where one of the new challenges of nutrition during obesity treatment lies.

When the volume of food decreases significantly, every bite counts more.

This does not mean that every bite has to be «perfect». It simply means that it becomes interesting to regularly give space to foods that actually nourish you: proteins, vegetables, fruits, legumes, whole grains, adapted dairy products or substitutes, nuts and seeds, oils and other sources of good fats.

And it’s not necessary to cook for hours to get there.

Microwaved frozen vegetables remain nutritious vegetables that are easy to prepare and interesting for their fiber, vitamins, and minerals. 

A soup prepared for several days counts.

Eggs with a slice of whole-grain bread and some tomatoes can form a real meal rich in fiber, protein, and vitamins.

A Greek yogurt with fruit can be much more interesting than not eating anything when your appetite is very low.

Quality food doesn’t need to be sophisticated to be effective.

And if I’m really not hungry, should I force myself to eat?

Not necessarily.

One of the benefits of these treatments is precisely to allow certain people to regain a sense of satiety that they had previously found difficult to achieve.

It would be quite paradoxical to then learn to ignore that satiety and to finish their plate at all costs.

Therefore, a balance must be found.

Respecting your satiety does not mean neglecting your nutritional needs.

You can eat smaller portions, take more time, prioritize the most nutritious foods in the meal and distribute your intake differently throughout the day. For some people whose appetite is particularly diminished, three small meals plus one or two snacks will be easier to tolerate than large meals. For others, the organization will be different. There is no one correct way to eat.

Nutritional therapy must adapt to the person, not the other way around.

Let’s not forget about water and fiber

When we eat less, we can also drink less without realizing it. Some obesity treatments also slow down the emptying of the stomach and can be accompanied by nausea, a feeling of fullness, or constipation. Hydration becomes particularly important then.

Once again, There’s no need to turn the day into a competition for water bottles. The goal is simply to drinking regularly and being attentive Certain signs: dry mouth, very dark urine, dizziness, constipation or headaches can in particular be accompanied by insufficient hydration.

Fibres also have their place, However, they should be increased gradually and accompanied by adequate hydration. Fruits, vegetables, legumes and whole grains can contribute to both fiber intake and the overall quality of the diet.

A smaller plate should not become a sad plate

However, there is something that nutritional tables measure poorly: The pleasure of eating.

Food is not just a combination of proteins, fibers, vitamins and minerals. We can add all kinds of flavors to it with spices and aromatic herbs, for example.

We also eat because it’s good.

Because we share a meal.

Sometimes a recipe reminds us of someone.

The conviviality in the restaurant can be pleasant.

Sometimes we just want to treat ourselves to a dessert… or some ketchup chips! 

And that is part of a Normal relationship with food.

Treatments for obesity can alter hunger, satiety, and sometimes even the interest in certain foods. However, their goal is not to transform eating into a permanent medical prescription.

A diet that supports health should be able to leave room for pleasure.

There is therefore no «perfect» food on one side and no «forbidden» food on the other.

Eating better does not mean eating perfectly.

This means learning to make choices that take care of him most of the time, while continuing to live.

Taking advantage of this period to observe rather than to control

Something particularly interesting also happens when hunger becomes less overwhelming. For some people, it is the first time in a long time that food takes up less space in their minds. This can become an opportunity to observe:

When do I actually feel hungry?

Which bite will satisfy me? 

Which foods give me satisfaction?

Which ones are less well tolerated now?

Do I eat because my body craves energy, because something is in front of me, out of habit, for pleasure, because I am stressed or because I am trying to soothe something else ?

It is not a matter of deciding that some of these reasons are good and others are bad. We are human beings. We will never eat only in response to a perfectly regulated biological signal.

But to understand Why? Eating allows us to gradually regain more freedom in our choices.

And this period when hunger is less intense can become a wonderful laboratory for learning to know ourselves better.

Attention: «I am not hungry» should not become «I no longer eat».»

The reduction in appetite is sought through several treatments for obesity.

A persistent inability to feed properly is not.

Significant fatigue, unusual weakness, dizziness, persistent nausea or vomiting, dehydration, significant constipation, a decrease in strength or food intake that has become extremely low deserve discussion with the professional overseeing the treatment. It should not be assumed that a treatment is working «even better» simply because it becomes almost impossible to eat.

The highest dose is not necessarily the best dose for every person.

The goal of treating obesity is not to create a person who never feels hungry again.

The treatments help to treat a chronic disease while preserving health, function, and quality of life. quality of life and the ability to Continue to live fully. 

Nutrition and the treatment of obesity: what science tells us

Visit Recent recommendations Regarding GLP-1-type treatments, there is an increasing emphasis on the importance of nutritional support.

The decrease in appetite and food intake that accompanies these treatments can expose some people to insufficient protein, vitamin, mineral, fiber, or liquid intake. The recommendations therefore suggest evaluating the diet before and during treatment, monitoring digestive tolerance, and paying special attention to preserving muscle mass and bone health. This is what we do at each consultation in obesity medicine.

Proteins and muscle strengthening play an important role in this strategy, but there is not yet a universal amount of protein that would suit all people undergoing treatment. Needs must be individualized, especially in older people or those at risk of muscle loss.

In other words, the new medications do not make nutritional support less important.

They change the nature of this support. Nutritional therapy is part of the treatment. 

Sometimes we have to move from a medicine that primarily sought to help a person reduce their intake to one that must also ensure that, in intakes that have become much smaller, their body continues to receive what it needs.

Better thinking about nutrition during obesity treatment

Perhaps you can now return to the question at the beginning.

It is noon.

You are hardly hungry.

Which do you choose?

This time, you might ask yourself some additional questions:

Where are my proteins?

Does this small meal provide me with any nourishment, vitamins?

Did I drink enough today?

Am I still hungry, or am I satisfied?

And do I also enjoy eating what I choose?

You don’t need to be perfect every time you eat.

You don’t need to weigh each food item.

And you certainly don’t need to start a new diet.

Modern treatments for obesity offer us something that we had a great deal of difficulty obtaining before from certain people: a significant reduction in hunger so that food can finally take up less space.

Let us take advantage of this not to learn how to eat as little as possible, but to learn to listen better and to better nourish this body.

Because when you eat less, the real challenge isn’t filling a plate; it’s making sure that what you eat really counts.

L’article Comment nourrir son corps quand les nouveaux traitements diminuent la faim pour favoriser la perte de poids ? est apparu en premier sur Clinique médicale CO-ATTITUDE.

Why physical activity isn’t just about burning calories and how to get back on track when you’re tired, in pain, or not very sporty.

One of the phrases I hear often in consultations is:

« I will start exercising when I lose some weight. That will be easier. »

And that’s perfectly understandable.

When you live with a heavier body, fatigue, joint pain, shortness of breath, or simply years of inactivity, then the idea of starting to exercise may seem daunting.

For a long time, we have often thought in this way: let’s start by helping with weight loss. When the person is lighter, they will be able to move more.

Today, our approach to physical activity in the treatment of obesity is evolving.

With modern treatments for obesity, such as GLP-1 medications, gastric balloons, or dietary replacements, weight loss can be significant and relatively rapid.

When we lose weight, we don’t just lose fat.

The body can also lose muscle. And we want to protect that muscle. from the very beginning of the weight loss.

Physical activity is not primarily about «burning off» the kilos.

We have long been presented with a very simple equation:

I eat → I accumulate calories.
I exercise → I burn calories.
So I have to exercise more to lose weight.

This view is too simplistic and it is sometimes guilt-inducing.

Yes, physical activity increases energy expenditure. But in a normal life, the amount of exercise that most people can reasonably achieve usually produces a fairly modest weight loss when used alone.

Because physical activity doesn’t need to bring the scale down to be effective.

It improves cardiovascular health, mobility, insulin sensitivity, metabolic health, strength, and quality of life. It also contributes to bone health and the prevention of many chronic diseases.

And when you’re trying to lose weight, physical activity has another fundamental function:

protect our muscles.

When the balance tilts, what are we really losing?

Ten kilos less on the scale does not necessarily mean ten kilos less fat.

Part of the weight lost may correspond to lean mass, including muscle.

This does not mean that new drugs «melt the muscles». A decrease in lean mass often accompanies significant weight loss, regardless of the method used.

But the more effective the treatments become and the faster the weight loss can be, the more we must ask ourselves at least two questions:

«How much have you lost?»

And also:

« How does your body change during this weight loss?»

Do you retain your strength? Your mobility? Your ability to climb stairs, get up from a chair, carry your bags, and walk for long periods of time?

One of the goals in obesity medicine is to promote fat loss while protecting as much as possible. muscles, strength and physical function.

And for that, walking is excellent… and you need to gradually work the muscles against resistance as well.

The muscle needs to know that you still need it.

The body is extraordinarily adaptable.

When a muscle is regularly subjected to stress, we send it a kind of message:

«This muscle serves me. I need it.»

This is the principle of muscle strengthening.

And it doesn't necessarily require dumbbells, machines, or a gym membership. Yet the weight of your own body already constitutes resistance.

To maintain this muscle, it is also necessary to provide it with enough protein. During a significant weight loss, Muscle activity and adequate protein intake therefore work together to help preserve lean mass.

This is particularly important as we age, when preserving our muscle capital becomes progressively more valuable. Nevertheless, we can build muscle at any age and it is better to protect the muscle we have than to wait until we lose it before we start to worry about it.

What science tells us

Physical activity is essential for health, but its effect on weight when used alone remains generally modest. European recommendations report an average weight loss of about 2 to 3 kg with aerobic exercise alone, While emphasizing its numerous cardiovascular, metabolic and functional benefits. Muscle strengthening is particularly recommended to preserve lean mass during weight loss.

With modern treatments for obesity, this question takes on even greater importance. A meta-analysis published in 2026 reports that lean mass accounted for approximately 25 to 39 % of the lost weight in studies using incretin-based treatments. This does not mean that these drugs «melt the muscles»: a loss of lean mass also accompanies the weight loss achieved through other methods. However, interventions combining lifestyle changes and Resistance training They had a lower proportion of lean mass loss.

The practical message is therefore simple: during a significant weight loss, protecting your muscles is part of the treatment. Progressive muscle strengthening, an adapted diet with sufficient protein intake and the maintenance of physical activity all contribute together to preserve lean mass, strength and physical function.

«Okay… but I’m tired and I have no motivation»

So don't start by saying «exercise».

Start by moving around.

There is a psychological difference between saying to oneself:

«Starting Monday, I have to do 150 minutes of exercise a week.»

and:

«Tomorrow morning, before my shower, I'm going to move for five minutes.»

No need for sports attire.
No need for gym.
No equipment required.

You can even stay in pajamas.

And if you took the pajama challenge: 5 exercises, 5 minutes to start over, what would change in your day?

Attention, before you start: if you suffer from a significant cardiovascular, respiratory or musculoskeletal disease, if you have problems with balance, unusual pain, marked shortness of breath or any other health problem that may limit your effort, or if you have not moved for a long time, talk to your doctor or healthcare professional before starting or intensifying physical activity.

1. Get up and sit down from a chair, 5 to 10 times
You work the thighs and buttocks, essential muscles for getting up, climbing stairs, and maintaining your independence.

2. Perform push-ups against a wall, 5 to 10 times
More accessible than floor pumps, they work the arms, shoulders, chest and trunk.

3. Walk around the place for 30 seconds to 1 minute
Alternate lifting your feet or knees as you are able. If necessary, hold onto a chair.

4. Stand on the tips of your feet, 10 times
Go up slowly, then come down slowly. A simple exercise for your calves, ankles and balance.

5. Waking up the deep muscles of the abdomen, 5 slow breaths
Lying on your back, knees bent, or standing, place one hand on the lower abdomen. Inhale calmly, then exhale slowly by gently contracting the lower abdomen, as if you were to slightly bring your navel closer to your spine. Continue breathing normally, without blocking your breath or forcing it. Release, then begin again.

The transverse plane is involved in controlling the trunk and posture. Thus, exercises inspired by Pilates are indeed an excellent way to gradually work on breathing, trunk control, mobility, and deep muscles.

And after the first five minutes?

5 exercises and that’s it for today

It may have taken you five minutes.

And five minutes count.

When these five minutes become easy, don't necessarily try to go much faster: gradually add a few repetitions, a second round of the series, or a little resistance.

It is this progression that allows the muscle to continue adapting.

Motivation sometimes comes after the action.

We often expect to feel motivated to start.

But motivation doesn't always work that way.

It can also be built:

Small action → success → satisfaction → sense of competence → motivation → new action.

That is why the first objective sometimes has to be almost ridiculously easy — and, if possible, pleasant.

Five minutes today.

Then five minutes tomorrow.

Then ten.

The walk gets longer. The chair raises become easier. A few repetitions are added. Then an elastic band. Maybe a Pilates class. Maybe aquagym, cycling, dancing, walking, or finally a gym.

We progress based on where we are, not where we think we should already be.

Finding what prevents you from moving

When someone tells me: «I lack motivation», my next question is often:

What makes the movement difficult for you today?

The answer is not always motivation. However, it can be pain, fatigue, fear of injury, shame about one’s body, a bad experience with sports, lack of time, the belief that physical activity is only useful if it is intense, or simply the difficulty in turning an intention into regular behavior.

In consultation with obesity medicine, At the CoAttitude clinic, I work with each person to identify the obstacles that make movement difficult, in order to build a gradual, realistic, and adapted physical activity program that is appropriate for their abilities, pain, and pace.

Pain deserves to be evaluated and treated. When medications are necessary, we can also take into account, when possible, their impact on weight and fatigue.

Coaching and cognitive-behavioral therapy can help to define goals that are small and concrete enough to become achievable, to track progress, and to gradually build a new routine.

Hypnotherapy can also be used as a complementary tool to work on certain representations of the body and movement, resistances, automatisms or The difficulty in moving from intention to action.

The first goal for the physical movement is therefore not to become a sports person.

It’s about regaining confidence in your body and your ability to move.

And what if my weight doesn't go down anymore?

It is here that it is important to recall a reality: Obesity is a chronic disease.

We do not entirely choose the weight at which our body will arrive, nor the one it will be able to maintain over time.

The biology of weight is complex. It depends, in particular, on genetic, hormonal, metabolic, environmental, and neurobehavioral factors.

After weight loss, the body can activate physiological defense mechanisms: increased appetite, hormonal changes, and reduced energy expenditure. This is why these mechanisms, inherited from our biological ability to protect ourselves against food shortages, can promote weight regain.

So it’s not simply a matter of will.

Physical activity does not eliminate this biology.

It does not guarantee a specific weight or the absence of weight gain.

And I find it important to say it, because Moving should never become a new way of blaming someone whose weight doesn’t respond the way they hoped it would.

The movement brings us something much more reliable than the promise of a figure on the balance sheet.

It allows us to act on the health and the capabilities of the body that we have today.

Moving towards something other than the balance

So, when you start an obesity treatment, don’t just measure your progress in kilograms.

Also ask yourself:

How many floors are easier to climb?
Do I get up more easily from a chair?
How is my breath on the walk?
Do I feel stronger?
How can I recover better after an effort?
Do I have more confidence in my body?
Can I do something today that was difficult three months ago?

These are also results of the treatment.

And sometimes, they are the ones who count the most in everyday life.

New treatments for obesity now allow us to achieve weight loss that was once difficult to achieve. But our goal cannot be solely to create a slimmer body.

In obesity medicine, we want to help the person live in a body. stronger, more mobile, more functional and healthier, Whatever the figure ultimately appears on the balance sheet.

So don’t wait to lose 10 or 20 pounds before you start.

Start small and gradually increase.

Start slowly.

Start in your room if necessary.

Start even in pajamas.

Your goal today isn’t to do too many things. Don’t do too many things. It’s more important to do enough things that you’ll want to do them again tomorrow.

And while your weight is changing rapidly, slowly, or sometimes very little, keep sending your body a message that remains relevant:

«My muscles serve me. My mobility matters. My health matters. So I move to take care of the body I have today.»

References

Oppert JM et al. Exercise training in the management of overweight and obesity in adults: Synthesis of the evidence and recommendations from the European Association for the Study of Obesity Working Group on Physical Activity. Obesity Reviews, 2021.

Locatelli JC et al. Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? Diabetes Care, 2024.

Lean Mass Changes With Incretin Therapy Versus Lifestyle Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes, Obesity and Metabolism, 2026.

L’article Perdre du poids en gardant sa force, dès le début : pourquoi bouger change tout est apparu en premier sur Clinique médicale CO-ATTITUDE.

With GLP-1 agonists and the new molecules that are gradually being introduced, it is now possible to achieve weight loss levels that would have been difficult to imagine with the medical treatments we had just a few years ago.

This is a major therapeutic advance.

But when a treatment acts quickly on hunger, satiety, food cravings, and sometimes even on interest in food, a question deserves to be asked:

What happens when chemistry changes faster than the person has time to adapt?

At the CoAttitude Clinic, in obesity medicine, I call this possible experience the Chemical Void.

This is not a recognized medical diagnosis. It is a clinical concept that allows for putting words to an experience that some patients may encounter when something that previously occupied an important place in their equilibrium quickly disappears.

When the «food noise» dies down

Patients sometimes describe it in spectacular terms:

« I don’t think about it anymore. Before, I thought about what I was going to eat all day long. Now, nothing. »

Scientific literature is increasingly interested in food noise, which consists of repetitive, sometimes intrusive thoughts about food.

GLP-1-type treatments can reduce hunger, food cravings, and the attraction to certain foods. For many people, this reduction represents a real liberation.

Finally, there is room for something else.

But this new psychological availability sometimes raises an unexpected question:

of space for what?

Because eating didn’t always have the sole function of satisfying hunger.

Food could comfort, calm, celebrate, occupy, reward, anesthetize an emotion, fill a lonely evening, or simply provide several small moments of pleasure in a difficult day.

When the medication greatly diminishes this interest, the person may discover a space they had never really had to inhabit.

This is a first dimension of the Chemical Void:

The treatment can withdraw a response before the person has built up what might take its place..

When pleasure changes too

This observation is all the more interesting because the action of GLP-1 does not only concern hunger and satiety.

The brain circuits involved in motivation and reward are also affected.

A systematic review published in 2024 in Physiology & Behavior The authors analyzed human studies involving GLP-1 agonists and reward-related behaviors. In particular, they report a decrease in energy intake and changes in brain activation in response to food and rewards. They also highlight possible interactions with the dopaminergic mechanisms involved in motivation and reward.

Most of the time, reducing this power of the food reward is precisely what we are looking for.

But there are two things to be distinguished:

No longer being a prisoner of a desire is not the same as no longer having a desire for anything.

In some patients, it is therefore necessary to be able to listen to the onset of a more general decrease in drive: less interest in food, certainly, but perhaps also less enthusiasm, less desire, less pleasure, or that strange feeling of «something having gone out.».

Research today does not allow the existence of a specific syndrome caused by these drugs to be confirmed.

However, it gives us an additional reason to ask the question.

And what if those extra pounds had also served some purpose?

There is another dimension of the Chemical Void, much more intimate.

We often talk about weight as a problem that the patient should get rid of.

But the story of some patients tells of something more complex.

I have had the opportunity to accompany a person who deeply wanted to lose weight and who had succeeded in doing so several times.

Yet each weight loss gradually awakened an extremely painful sensation: the feeling of being exposed to others.

This feeling had its roots very deep in his history, going back to a childhood marked by abandonment and poverty.

His desire to lose weight was completely genuine.

But another part of her had learned, long ago, that this bodily envelope could also protect.

When the envelope disappeared, the vulnerability reappeared.

And until this dimension was accompanied, the weight gain episodes kept happening.

Another person once told me a very different phrase:

«I am finally ready to no longer hide behind my body. I can also feel strong in a body that is not as large.»

Everything was there.

Weight was no longer necessary to fulfill the same function.

This person wasn't just giving up kilos; she had started to build another way of feeling safe.

This obviously does not mean that obesity systematically hides a trauma or that weight always has a psychological function.

But this means that when such a function exists, quickly modifying the body without recognizing it can leave the person without the protection they used to have for a very long time.

The Ghost Corps and the Chemical Void: two different shifts

It is here that it is important to distinguish two phenomena that I encounter in my practice.

The Ghost Body appears when the brain continues to inhabit a body that no longer exists.

The Chemical Void appears when the treatment eliminates a function before the person has built what will take its place.

In the first case, the internal image of the body is out of sync with the real body.

In the second, the emotional and hedonistic adaptation may lag behind the biological transformation.

And the two can obviously coexist. The body changes. Hunger changes. Desires change. The relationship to pleasure can change. The way others look at us can change.

However, identity, emotions, protective mechanisms, and sources of comfort do not necessarily transform at the same rate.

Before embarking on a weight loss program, ask if the weight is holding on to something beyond itself. 

That is why the arrival of extremely effective medicines imposes, in my opinion, not less support but more.

Access to these medicines is essential, and so are information and support for patients.

Prescribing an obesity treatment should therefore not only consist of asking the question:

« How many kilos can this person lose? »

It is often also necessary to ask:

«What might change in life when these kilos, this hunger and this relationship with food are no longer there in the same way?»

The 10 questions of the Chemical Void

Before the treatment, and then during weight loss, here are ten questions we can explore:

1. Is food today one of your main sources of pleasure?
2. Do you sometimes eat to calm yourself down, to comfort yourself, to reward yourself, or to fill a void?
3. What do you do when you are sad, anxious, lonely, frustrated or exhausted without using food?
4. If your thoughts about food decreased enormously tomorrow, what would take that place?
5. Have you ever felt a sense of vulnerability, exposure, or «unmasking» during a previous weight loss?
6. Has your body or your weight ever given you, consciously or not, the impression of protecting you from the gaze, desire, closeness, or judgment of others?
7. Can you imagine being safe and feeling strong in a smaller body?
8. Is your current identity strongly linked to your weight or your body appearance?
9. Apart from food, what are your main sources of pleasure, comfort, connection and inspiration today?
10. If your body changed much faster than expected, what support would you need to recognize yourself and continue to feel like yourself?

There is no wrong answer to this questionnaire. There are no good or bad answers. Everyone has their own. 

A difficult answer is not a contraindication to losing weight. It is an indication of what will need to be accompanied.

Five antidotes to Chemical Voids

I propose this prevention through five axes:

• 1 Building a map of pleasures

• 2 Give another response to the emotions

• 3 Identifying the protective function of the body

• 4 Gradually adapting to the new body

• 5 Monitoring and nurturing the vital momentum

These five dimensions can be worked on before and during weight loss so that the physical transformation can gradually be accompanied by an emotional, hedonistic, and identity-based transformation.

Losing weight without losing oneself

Modern obesity medications offer us an extraordinary opportunity: to reduce some of the biological pressure that drives some people to overeat and makes weight loss so difficult to maintain.

They sometimes make it possible to silence, almost suddenly, a noise that sometimes takes up an immense space.

Yet they cannot decide on our behalf what we will do with silence.

That may be where another part of the treatment begins.

When the noise of food subsides, when the body transforms, when the old shell becomes less necessary, one sometimes has to help the person build new sources of pleasure, security, identity, and momentum.

Because treating obesity should not only be about losing weight.

The treatment should allow the person to lose weight and find their own way in life.

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You have lost 10, 20, 30 kilos, sometimes even more.

Your clothes have changed in size. Your body takes up space differently. You move differently. Others tell you: «How you’ve changed!» or even: «You’re so good now!»

And yet, when you look at yourself in the mirror, something seems to be lagging behind.

In your head, you still see yourself with your old body.

You spontaneously choose clothes that are too big in your wardrobe or in the store. You hesitate before sitting in a narrower armchair or with armrests. You place yourself behind others in group photos. You have trouble recognizing your silhouette in a shop window. A compliment about your appearance sometimes leaves you perplexed. And when you look at your reflection, your attention spontaneously returns to the parts of your body that you have learned to monitor for years.

However, the kilos have disappeared.

Their representation, however, may take longer to evolve.

That is what one can call it the Ghost Corps, or even the ghost kilos (“ghost kilos” in English).

The ghost body after weight loss: when the brain needs time

At the CoAttitude Clinic, in Obesity medicine, I have been paying attention to this phenomenon for a long time and I take care to address it during the weight loss support program.

Scientific literature indeed describes a possible discrepancy between the physical transformation of the body and the evolution of the body image. After significant weight loss, some people report that their head seems to be lagging behind their body. They continue to feel their old size, still choose clothes that are too large, or experience a genuine surprise at their reflection.

This question is of particular importance today.

Pharmacological treatments for obesity have evolved significantly. GLP-1 agonists and drugs acting on multiple incretin pathways now allow for weight loss of a magnitude previously primarily observed after bariatric surgery. With semaglutide, tirzépatide and orfoglyprone or other molecules, for example, average losses can be significant. The new molecules and multi-agonist combinations currently being studied suggest losses of up to 25 to 30 % of the initial weight in some patients.

These transformations can also occur relatively quickly.

The body then sometimes changes faster than the internal representation that the person has built up over the years.

Why does the brain need time?

Our body image is much more complex than the image reflected by a mirror.

It has been constructed over the years from our sensations, our movements, the space occupied by our bodies, the clothes we wear, our personal history, and the gaze of others.

It also carries the memory of the experiences lived in this body: the comments heard, the comparisons, the sometimes complex traumas, the difficulties in finding clothes, the looks received in certain places, and, for some people, the taunts, rejection, or stigma associated with the weight.

Rapid weight loss transforms physical reality within a few months. Body representation, With age, identity and certain emotional markers change at a different pace.

The adaptation is therefore both bodily, cognitive, emotional, metabolic and hedonistic at a conscious and unconscious level.

The person must gradually learn to recognize a different body, to move in it, to receive the gaze of others differently, and sometimes to rediscover what brings them pleasure, comfort, or a sense of security when the relationship to the food itself has changed.

This adaptation deserves to be accompanied psychologically in the same way as weight loss.

The gaze of others can also keep the extra kilos at bay

After a significant weight loss, comments often become numerous:

«How you've changed!» «You're so much better now!» «You're beautiful just the way you are!»

These phrases are usually spoken as compliments. However, they can be received very differently by the person who hears them.

«If I'm so good now, how were they seeing me before?» «Did I have less value?» «And if I gain weight again, what will they think of me?»

The other person’s gaze then risks strengthening an association that sometimes exists painfully: My appearance determines my value.

The person may begin to protect their new body with anxiety, as if they had to maintain this silhouette in order to continue to be looked upon favorably, desired, recognized, or simply considered «correct.».

The work around the body image aims to build something much more stable: My value exists independently of my body size. The person I was before deserves the same respect as the person I am today. My body has changed. My story continues. My value, on the other hand, accompanies me.

There are also emotional kilos.

Some people have lost a lot of weight and continue to carry the shame associated with their former body with them.

«How could I have become like this?» «I never want to be that person again.» «I have lost so many years.»

These thoughts deserve to be welcomed and worked on. The former body belongs to a period of life and a history. It deserves to be viewed with understanding.

Obesity is a complex chronic illness, It is influenced by multiple biological, genetic, psychological, environmental and social determinants. Body weight results from mechanisms that are much more complex than a succession of individual decisions.

Looking at one's history with greater compassion gradually allows one to replace shame with a more just understanding:

«I have lived in this body. It has accompanied me for part of my life. Today, my body is evolving and I am learning to evolve with it.»

Updating your body chart after weight loss

I sometimes use with my patients the image of a GPS that would still work with an old map. The territory has changed. The brain still has many old landmarks. The goal is gradually to update the card.

Some simple experiments to work on the phantom body :

Look at your current body with curiosity. 

Use recent photographs as a reference for reality.

Wear clothes that suit your current body type. 

Live your body through movement.

Learn to receive compliments in a different way. 

Look at your old body with respect. 

And what if my weight changes again?

Obesity is a chronic disease. Weight can therefore change over the course of life. It can decrease, stabilize, or increase. The biological mechanisms of weight regulation continue to exist, and treatments may need to be adjusted over time.

We can take care of our weight and our health. However, the exact figure at which our body stabilizes is still influenced by many mechanisms that will not be determined by willpower alone.

It is precisely for this reason that self-esteem needs to be built on broader foundations: our relationships, our values, our skills, our creativity, our projects, our ability to care for ourselves and others, what we bring to the world, and the person we gradually choose to become.

A weight can change. A clothing size can change. A body changes throughout life. A person’s value, on the other hand, exists independently of these variations.

Living in your body rather than being its weight

The Ghost Body is not about convincing the brain that it is finally in the «right body». It is about updating the body image without making the identity and personal value of the figure displayed on the scale depend on it. This difference is essential.

The goal becomes learning to recognize our current body, to inhabit it, to care for it, and to allow it to evolve without turning every weight change into a judgment about ourselves. The phantom kilos can then gradually lose the place they occupied in our internal representation. The old body belongs to our history. The current body belongs to the present. And our value accompanies us in memories and in the present.

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