Long post incoming. I wrote this over the last few days, coming up on the 1 year mark of initiating substantial weight loss. Ignore if you like
I have been fat as long as I can really remember.
Thinking back, I can distantly recall my mother warning me about my weight when I started the 3rd grade, something which became a continuous theme whenever the subject of food or exercise came up throughout my adolescent and teenage years. I wasn't 'chubby' until I hit high-school. For the most part, my overeating was limited to what was readily available at school or around the house, since without an independent income or means of ready transportation, fast food was fairly unavailable to me until I turned 17, got a car, and got a job.
At that point, the doors flew wide open: fast food, social eating, late-night meals became the order of the day.
By the time I completed college, my peak weight was 226-227 lbs. At a height of 5'5.3", that placed my BMI squarely at 37.7, in the category of morbidly obese.
In my 4th year of medical school, spurned on by the newly reinforced fear of developing type 2 diabetes, I had attempted weight loss through exercise and some caloric restriction (drinking milk in the morning, a slim fast for lunch, then fish / protein for dinner). My results were initially encouraging, dropping my weight to a nadir of 195 after 3-4 months of hard work.
I maintained that for about 2 months before creeping back up to > 200 lbs.
Upon starting my internship, my exercising had about ceased entirely. The combined stress of the medical resident lifestyle (long hours, inconsistent meals, fatty foods, sedentary living) coupled with an increasingly cavalier attitude toward my general health created a situation that, within a year, left me back at a steady weight of 218-225 lbs. A brief stint with the South Beach diet dropped my weight to 213-14, but this was short lived.
By the time I graduated and moved on to fellowship, I was again back at my peak of 226 lbs.
I feel it important to note that, throughout this time of my life, I was aware that I was fat, however I was in a state of denial with regards to the degree of my obesity. To put it another way, my physical self image was so distorted that I literally could not see it in front of my face; Looking back, I have found surprisingly few pictures of myself to illustrate how large I was. I feel this is because seeing photographs of myself seemed at odds with my own distorted self image, and this conflict increased my subconscious anxiety about my weight to the point that I avoided the camera altogether.
6 months into my fellowship, I had lost all motivation to eat regular meals, restrict my dietary intake, or exercise. In addition, I was consumed by a slowly-burning depression that darkened my overall outlook beyond my next meal. I wore the same faded shirts and pants that I had in medical school (as I had no motivation to shop for fat-person clothes) . Type II DM was an inevitability, given my strong family history and my persistent obesity. I was developing shortness of breath, pain in my knees, and I was unable to sleep comfortably on my back because of trouble breathing when I did so.
There was no 'eureka' moment. I was a creature of habit, and not even my field of study (endocrinology and metabolism) motivated me to affect any changes to my lifestyle. I was well aware of the irony that I would be a morbidly obese physician telling his patients that they had to lose weight.
Thinking back on it now, the turning point came shortly after my 33rd birthday, which falls in mid-November. Thanksgiving with my family (my own on the day of, and my wife's extended family the following weekend) was a difficult time for me, as I was becoming more and more self conscious about my body. I gained little satisfaction from the lovingly prepared food placed before me, though I still overate when my hunger got the better of me. Losing weight was, at this point, the furthest thing from my mind.
Over the course of the last few months, I had become increasingly aware of how much money we were spending on food on a weekly basis. That, coupled with the surprising amount of spoiled food we had to throw away every week, had created a real concern that was at the forefront of my mind on our ride home from my extended family's thanksgiving weekend.
On the ride home, I discussed this concern with my wife, and we decided the best way to save money was to only buy the food we needed for the week (since most of our meats/veggies would expire in that time.). The next question was obvious: how would we determine how much food was enough? The simple answer was, if we started eating regular meals daily, and created weekly meal plans based around single servings of those foods, we could easily estimate how much we needed to buy each week. We created a list of those dinners we liked the most (Tacos, chili, rice dishes, etc), and did our shopping based upon how much beef / chicken / turkey / rice would be needed to create a 1 serving meal for each person each night for dinner. This generally equated to 2-3 16 oz packages of meat per week, and a bag of rice per month.
In order to be certain we weren't burning through our ingredients early in the week , we began using measuring cups, measuring spoons, and a kitchen scale to estimate actual serving sizes. I want to emphasize here that we still ate foods we liked, we merely exercised tighter portion control, and adhered to at least one scheduled mealtime.
I was in for a bit of a shock, then, when I stepped on our bathroom scale 1 month later and saw that I had lost 13 lbs.
Now, I had seen my weight fluctuate before, up to 6-7 lbs. As such, I didn't place too much stock in what was happening. We had stopped hemorrhaging money with our meal plan ( I refused to call it a 'diet,' since we were still eating out on a weekly basis) so I saw the weight loss as a welcome, if unexpected, side effect that would likely be fleeting.
I lost 10 lbs more the following month.
At this point, my weight was approaching 200 lbs, and I began to take notice. I began to wonder just how far this would go, given that prior experience (in my patients and myself) had shown me that restrictive diets simply didn't work (and if they did, they didn't last). So, I began keeping a food diary on my smartphone. The one I chose had the additional perk of setting a caloric limit based upon your current weight and your body's basal metabolic needs (utilizing the Harris-Benedict formula). I decided my goal would be a weight less than 200 lb.
When my weight dropped below 195 (my previous benchmark for weight loss 6 years prior) I began noticing a difference in how I felt on a day-to-day basis. My outlook was better. I was sleeping and breathing better. My knees stopped hurting. As such, I began a program of regular, low impact exercise which was comprised of walking on a 5% incline for 30 minutes 6 days a week. Still, I kept the knowledge of my weight loss between myself and my wife.
When my weight dropped below 185, I went wardrobe shopping for the first time in 5 years.
It was more out of necessity than anything else, as my work clothes no longer fit well, and it had begun to show. I asked my wife to come with me, to help me pick out a couple of dress shirts and a pair of pants with a new belt.
Prior to this I had been wearing a size 42 waist, which had been fairly tight (my actual waist size was likely closer to 43-44.) By our best estimates, we decided on a size 38 pants and a Large shirt.
Our estimates turned out to be too conservative, however, as the size 38 was too big. So was the size 36. We finally settled on a size 34, much to my continued shock and awe. My shirt size had dropped to a medium, meanwhile, which was a surprise unto itself.
This pattern of weight loss continued steadily over the subsequent 6 months. In addition to the meal plan we already had in place, I began purposely cutting out very calorie and carbohydrate dense foods, such as rice and pasta. We had long ago switched to whole grain foods, and I increased the proportion of protein and fresh fruits and vegetables in my diet. Whereas, previously, I never ate things like apples, carrots and broccoli, they became daily staples. I made a conscious effort to reduce my sodium intake as well, reducing my intake of processed / preserved foods. I also stopped salting my meals altogether.
I also steadily increased my activity level: I began walking for an hour daily on a 15% incline, and incorporating daily calisthenics into my regimen (push ups, sit-ups and, for the first time in my life, pull-ups).
The entire time, I continued my daily tracking of my calories, eating a regular breakfast, lunch, and dinner, without any 'grazing' behavior. I stepped on the scale daily, becoming intimately familiar with how certain foods might effect day-to-day fluctuations in my weight. I avoided restaurants and fast-food altogether. I packed my lunches (in a Scooby-Doo Mystery-Machine lunch box, much to the bemusement of my colleagues). Over the course of a a few months, this behavior evolved from something requiring focused effort toward lifestyle modification to a simple matter of habit.
Within 8 months, my BMI dropped below 25.
To say my life changed would be an understatement. People around me (especially those I did not see on a daily basis) began to take notice, offering words of encouragement and congratulations. On more than one occasion, I was regarded initially as a stranger by patients that I had taken care of only 6 months before, and by colleagues I hadn't seen in over a year. One of my attendings even pulled me aside to ask, bluntly, if I had cancer, so rapid was my weight loss.
My waist size subsequently dropped to 30, and my shirt size plummeted from medium, to small, to extra-small. I gave my entire wardrobe (including the size 34 pants and medium shirt I had been so proud of only a few months before ) to Good Will, and purchased designer clothes for the first time in my life. I stopped being camera-shy, and finally began to enjoy taking trips and taking pictures with my wife.
Fear of re-gaining the weight remained ever-present on my mind. I was well aware of weight loss trials which had demonstrated a strong propensity for those who lose weight through behavior modification to relapse within 3 to 5 months. As such, I continued to track my meals on a daily basis (if a diabetic on insulin could do it, why couldn't I?).
Looking back, I feel that, on the whole, beyond giving up a few of my favorite foods, I had to make few sacrifices along the way. The hardest part, to be honest, was giving up 'social eating' for a time. Going out to eat lunches and dinners with friends and family had to fall by the wayside, as the food was either too calorie rich, too difficult to measure or track. There was always the looming temptation to fall off course as well, and I felt the best remedy was to remove myself from the situation entirely.
9 months after my journey began, I finally reached my ideal weight for my frame.
I have loosened my restrictions on my meals to a small degree: once to twice a month, my wife and I have what we call an 'independence day' which consists of eating out at a restaurant, enjoying sweets, and not tracking the day's meal. This has revealed an unexpected benefit of our structured meal plan: Food, especially restaurant and even fast food, has become an event to be savored and enjoyed, without the post-meal guilt that used to taint eating out in the past.
Regardless, I've made a conscious decision to remain vigilant. Exercising every day with little to no exception, tracking my portions as a matter of maintaining rather than as a means of losing weight. I share this leg of life's journey in the hopes that it may prove useful to someone in a situation similar to my own.
