It’s hard to think of anyone in American life who gets the freak sociological privilege of abrupt, overwhelming wish fulfillment. There are the impoverished kids who sign NBA contracts, perhaps, or cafeteria workers who win the lottery; on television, there are the lucky contestants who are selected for extreme-makeover shows.

Yet for the morbidly obese, the possibility of rapid and radical change, of a near-existential reorganization of life, is becoming increasingly common: Last year, the number of patients who underwent weight-loss procedures was an estimated 140,600, according to the American Society for Bariatric Surgery, more than double that of 2002.

Most people who undergo this procedure are not doing it to look pretty. They’re doing it to not die young, to save their knees, to be able to walk to and from the grocery store without gasping for breath. Yet the procedure often has striking aesthetic consequences, making conventional beauties of people whose self-images were previously organized, at least in part, around the very principle of invisibility or unsightliness. For them, losing weight turns out to be the least of their transformations. They don’t just have new bodies; they have new narratives, new public identities. “Many patients greatly underestimate just how significant the psychological transformation is,” says Warren Huberman, a clinical psychologist who evaluates prospective bariatric patients at NYU Medical Center. “I ask what they anticipate—and what changes they think will be unpleasant. They look at me like I’ve got three heads. They can’t imagine anything will go badly if they’re thin.”

In the annals of obesity literature, this is not a topic that’s received a ton of attention. But attend any bariatric support-group meeting, and this much is clear: One has to learn to be skinny. Even the smallest adaptive behaviors take years to shake—buying clothes too big, deeming a subway seat too small, refusing to be first through a crowded bar.

via My Life as a Thin Person