Jillian has some good advice, that the caller has merely addressed one of the symptoms of feeling bad about herself, the excess weight, but that she can't expect that to solve the problem because the weight was not what caused the bad feelings. She also asks the caller to explain exactly how people are treating her differently now and how she feels about it.
The part I disagreed with Jillian about was turning the discussion to how issues in the caller's childhood might have triggered the bad feelings about herself and then telling her that addressing those issues was the only way to deal with the problem. I think that can send a message of damage and helplessness. It would be easy to hear this response as, "Your parents didn't love you the right way when you were young, so you will never feel really loved now."
I think this problem is more effectively solved by looking at it through a shame lens. Losing weight might help address the part of our shame that was body-related, but it doesn't get rid of shame itself. Remember, the definition of shame is:
The intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.Brené Brown says that the only people who do not feel shame occasionally are psychopaths with no capacity for human connection. What the caller is describing sounds a lot like shame to me, so congratulations caller, you are not a psychopath. Welcome to the shame soup, we are all in it with you. Even if your parents were Mother Theresa and St. Francis (hard since they were both celibate and lived in different centuries), you would have felt this way sometimes. Sure, reframing traumatic events from your childhood might help, but it might help more to learn some coping strategies for dealing with shame in the here and now.
Since most of us have never learned about shame, we think that this feeling of not belonging means that there is something wrong with us and look for something to fix. Weight is a convenient target, so it is not surprising that the caller feels baffled that she still feels this feeling of being messed up when she has addressed the most obvious flaw.
Why do I think that what she is describing is shame because of a couple of answers to Jillian's questions. One was that she said people treated her better now that she is thin, because "the parts they can see look good." That means that she feels like there are not-good parts hidden from view, and if they could see those, they might feel differently. Also, she said, some people have made unwelcome comments, like telling her husband to watch out, or asking her if she should eat this or that if she wants to stay thin. Think of the "unwanted identities" these comments suggest: unfaithful wife, undisciplined eater. She wants people to know how much she cares about her husband and she wants people to trust that she knows how to manage her own diet.
I'm not saying that a more traditional approach that looks at childhood issues and relates them to present ones is bad necessarily, but I don't feel particularly empowered when I try to apply that approach. Sure, I can point to things my parents did wrong, we all can. They are only human. But what action would it suggest for me if I figure out that my body-image problems are related to an offhand comment that someone made to me 30 years ago? In the absence of a really serious trauma that needs to be addressed, I think it's more useful to look at what I can do in the here and now to address my problems, and I find this whole framework a lot more useful for doing so.