Please remember, this column is designed to help the consumer seeking behavioral-health information, and not intended to be any form of psychotherapy or a replacement for professional, individualized services. Opinions expressed in the column are those of the columnist and do not represent the position of other SelfhelpMagazine.com staff.

Question

I used to weigh 270lbs and have gotten down to 175lbs through vigorous exercising and dieting. Now that I am thinner I still have enlarged breasts, stretch marks and stretched out skin. This is causing me to avoid relationships and only have sex when I am drunk with people I do not feel anything for. What do you suggest aside from radical plastic surgery?

Answer

First let me applaud you for losing the weight. I admire your commitment to your health and your desire to change. You should feel very proud of yourself. One downside of losing so much weight is that your skin has not shrunk to fit your new body. While surgery could repair that issue, it does not seem to be the most important.

What strikes me as at the heart of the matter is more about your feelings about yourself. When you say that you only have sex with when you are drunk and with people that you do not care about, this says more about how you feel about you than anything else. I would imagine that you did not feel too good about yourself and your body at 275 lbs. Apparently, despite the fact that you have lost 100 lbs, you still are not feeling good about you or your body.

This says more about how you feel about yourself than about how others may feel toward you. Others seem to find you desirable enough to go to bed with you, but you don't feel desirable. The more you get drunk and the more you have sex with people that you do not feel anything toward, the lower your self-esteem will go. I suggest that you do some personal work on issues regarding self-esteem and body image. Perhaps you should seek psychotherapy to help you integrate the new you into your self-image.

11/16/98

Richard B. Patterson is a clinical psychologist in private practice in El Paso, TX. He is the author of three books on psychology and spirituality.