People keep telling me I was beautiful before getting a gastric bypass and losing 90 pounds. I know that already.

• After my gastric-bypass surgery, I lost 90 pounds; people keep saying I was beautiful before that.

• I wish people knew I had surgery for health reasons, not because I wanted to be prettier.

• Instead of reassuring me, people should know how happy, healthy, and energetic I feel now.

Nine months ago, I lost nearly 90 pounds after having weight-loss surgery. My decision to have a gastric bypass changed my life and corrected multiple health problems. As someone who spent her entire life significantly overweight, I feel healthier and more energetic than ever. Still, whenever I post about my surgery on social media, well-meaning friends and followers all make the same comment: You were beautiful before you lost weight, and you’re beautiful now.

Just this week, an acquaintance made this comment to me in person. Taken aback, I explained to her that wanting to be prettier had nothing to do with my decision to have surgery.

I’ve always thought I’m an attractive person and have never lacked self-esteem. I understand the intention of most of these comments is to make a sort of anti-fatphobic statement and to reassure me that I was beautiful even before my surgery. But to me, it also implies that people don’t believe there’s any way I could have thought this for myself and that aesthetic goals must have been the reason for my surgery, when neither of those things are true.

I committed to gastric-bypass surgery because of how I wanted to feel physically.

Bariatric surgery doesn’t always fit into typical beauty standards

In November, Dr. Nathan Allison, a board-certified general surgeon at Health First Medical Group’s NewFit Weight Loss Services, performed my surgery. This idea that (most) people have bariatric surgery for aesthetic reasons such as “wanting to be high-school skinny again” is far from the truth, he said.

“The vast majority, like, 95% of our patients, have a medical condition that requires them to need medically significant weight loss to resolve their comorbidities — hypertension, diabetes, obstructive sleep apnea, fatty liver disease, reflux — all these different things,” Allison told Insider. “That’s why we do it. If a patient comes in and they don’t meet the criteria for surgery, we don’t offer them surgery.”

When I underwent my gastric bypass at 42, I weighed 235 pounds and was just 5-foot-4. My feet, back, and legs hurt constantly, and I spent most nights awake with severe acid reflux. In fact, at a presurgical endoscopy, I learned I had a severe ulcer that also needed to be repaired during my surgery. I was always tired and often had trouble keeping up with my kids and husband. Exercising was painful, and I felt tired and unhealthy.

Nothing about my decision was based on not feeling pretty enough or thinking the surgery would make me feel more beautiful — instead, I knew the procedure would give me my life back.

Because I didn’t look overweight, people questioned my decision

I have a body type that was good at hiding my weight. In fact, I remember a traumatic doctor visit as a teenager when a nurse commented on my weight as I stood on the scale.

“I’d never have thought you weighed that much,” she said. I wanted the ground to swallow me up.

When I shared my decision to have a gastric bypass, friends reached out with concern. Some asked if I weighed enough to have the surgery, to which I replied that my health insurance had approved the procedure after a psychology evaluation, bloodwork, multiple medical appointments, an endoscopy, and other requirements. There was a medical necessity for me to lose weight, something Allison said was the whole point of bariatric surgery.

“We see people that don’t look particularly that big, but their BMI is 35 and they’ve got seven different comorbidities,” he said. “People look at them and wonder why they’re getting weight-loss surgery, but they’re like, ‘Because I am having multiple health issues related to my weight.’ We see it all the time.”

People don’t need confirmation that they were pretty ‘before’

After my daughter was born, I spent years trying to feel more comfortable in my own body. I was careful how I spoke about my size in front of her and agonized over how to talk to her about my decision to have weight-loss surgery. I wanted her to know I was having the surgery to get healthy, not because I felt unattractive.

Not every overweight person spends time in front of the mirror criticizing themselves. I was confident at 235 pounds, and I’m still confident. If anything makes me feel better about myself, it’s knowing I can take a longer Peloton class or keep up with my kids on a marathon day at Walt Disney World. My weight loss did not make me feel prettier; it made me feel like I could take on the world.

“You loving your body, and you loving your shape and your size, has nothing to do with the medical conditions caused by being overweight,” Allison said. “What we’re trying to tell you is: If you don’t have those conditions now, you’re at a significantly increased risk of having them later.”

And that was what scared me most. I was in so much chronic pain at 42 that I feared the continued weight on my joints would lead me to needing knee replacements as I aged, or stop me from being the healthy, active mom I was trying to be in the interim. It was about longevity.

“The message isn’t that I don’t think you’re beautiful and I don’t think you’re worthy and I don’t think that you’re deserving,” Allison said. “I’m saying your weight is going to negatively affect you. It doesn’t matter who you are, it happens to everyone. It may not happen today; it may not happen tomorrow, but it’s going to happen.”

Instead of telling the person in your life who’s experienced significant weight loss recently that they were “still beautiful” when they weighed more, consider telling them how happy, healthy, and energetic they now look.

Read the original article on Insider