I lost half my weight in 3 years. I have body dysmorphia from all the loose skin I have.

Courtesy of Betsy Smith

• Betsy Smith weighed 500 pounds at her heaviest in July 2021.
• The 53-year-old lost a total of 270 pounds through diet, exercise, and using Mounjaro.
• She's relieved to have gone from a 6X to a 1X — but worried about excess skin and her body image.

This as-told-to essay is based on a conversation with Betsy Smith, a mother of three from Billings, Montana.