"I am fat; therefore, I am no good." Those who are overweight absorb and internalize this belief without even trying. It remains a sturdy part of emotional life whether they eventually lose weight or not. In many cases, it forms the groundwork for regaining lost weight as well.

Few people can remain impervious to a world hostile to who you are—whether it's the color of your skin or your sexual orientation. Many understand this truth when talking about people of color, or gays, for example. However, the normal weight and thin often don't see the same phenomenon at work with the overweight. And at work it is: studies show that the obese have a harder time getting jobs and earn less overall than others. They're more likely to receive substandard treatment from doctors. The majority of clothing sold doesn't fit them. People pay them less attention. And many endure terrible childhood teasing. This is all despite the fact that, for better or worse, being overweight is no longer a minority concern in our country.

Adults enter psychotherapy or other treatment programs to improve their lives. This may involve losing weight and improving how one eats. Even where it doesn't , though, it's hard to make a dent in any issue—from depression to problems in work and love—without experiencing the oppression of sunken self-esteem.

Natalie, for example, worked hard to set herself apart from other "fat people". Always on the go, she'd built a thriving retail business, dressed impeccably, kept a busy social life, looked after aging parents. Heavy for 40 years, she's kept 100 pounds off for 6. She still feels different from others, "not good enough", fearful of others' quick criticism. She finds it hard to slow down, even when she wants to spend time with her husband. As soon as she does, she's plagued by tense, self-critical thoughts. "I feel like being fat is going to rule my life forever," she says.

Karen, likewise, had kept weight off for some years. Still, she was in her 50s before she sought help for addictions that kept her feeling tortured much of the time. She couldn't explain exactly why, but felt it shameful to ask for help. "I should have been able to do this on my own," she kept thinking. The idea of someone caring enough to help her brings tears to her eyes. She, too, describes feeling different and somehow "wrong" or inferior since childhood days.

These women grew up in the 60s and 70s. Is it different these days, when a heavy person doesn't stand out in a crowd so starkly? The statistics mentioned here suggest not. And both anecdotal and empirical reports from today's schoolyards suggest not. We hear 8-year-olds discussing diets. Studies report that bullying targets overweight kids most. Fat in our culture continues to represent something out-of-control that we disparage. It remains an acceptable target for our derision.

Softening the hold of "internalized fat phobia" once it's got you is not easy. What helps? Taking care of yourself well, doing those things in life that you care most about. Therapy—whether cognitive-behavioral, psychodynamic, or pharmacological—can contribute. Even so, these feelings, often developed when young and reinforced over many years, can linger. They can come to seem fundamental.

I find that mindfulness meditation can help people ease the dominance of such hardened negative self-concepts. Alone, or augmenting other therapies, mindfulness practices support acceptance. And this allows a relaxation in the mind and emotions, and then room for real change, to occur.

Dr. Katz’ workbook, Eat Sanely:  Get off the Diet Roller Coaster for Good, is available in paperback, or as an ebook for Kindle, Nook, or ipad:   www.eatsanely.com/order-the-eat-sanely-weight-loss-workbook

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