Spain’s Princess Letizia was looking decidedly thin at the wedding of Victoria of Sweden.

Letizia donned an eye-catching red gown for the pre-nuptial celebrations the night before. Her arms were sinewy and her body mass index seemed as though it would barely register on a scale.

Since marrying Prince Felipe of Spain in 2004, Letizia has undergone several changes in her appearance. The most recent was her nasal surgery, described as a necessity for a deviated septum. The bridge of her nose, which once sported a natural bump, was shaved completely straight. Her shoes were also designed to make her look different – though stylish, they have platforms on the bottom to make Letizia appear several inches taller.

The most drastic change is her weight: it seems to have dropped substantially, a worrying sign. Letizia is a petite woman and probably doesn’t weigh much to begin with, but her bones are starting to become noticeable.

Has becoming a Princess caused Letizia extreme stress over her appearance? She was a very high-profile person as a news journalist on Spanish television, but as the wife of the heir to the throne, she naturally has a different kind of responsibility and an image to maintain. Has it all proved to be too much?