On Weight Loss

When I was 8 years old, my doctor told me I was obese. I am pretty sure my mom came home from the visit and cried telling my dad about what had been said. So my dad decided that in order to solve this problem he was going to have me participate in sports that would burn a lot of calories. He knew that our family would struggle to make dietary changes, so the only other solution was to burn more calories. I started playing soccer first. And when I wanted to play sports like softball and volleyball- well those sports just did not require enough running per my dad. I played several different sports, but primarily stuck with both soccer and tennis.

I was made fun of as a child for being overweight, as most fat kids are. Ever since childhood, I was sensitive about my weight- a burden that I carried into adulthood. Luckily, I played sports almost 7 days a week throughout my adolescence until a chronic back injury led me to pull out of college athletics during my freshmen year. My weight had been fairly stable during middle school and high school, but slowly increased throughout college, medical school, and residency. I was the heaviest I had ever been after my intern year of residency. The long hours and huge amount of stress had only amplified and exposed my poor lifestyle choices. I had used eating as a coping mechanism my entire life, which was no longer compensated for when I wasn’t exercising every day.

In medical school, we didn’t really learn about nutrition. It was a glaring hole in the curriculum. In fact, there is not much emphasis on how to treat obesity. We are, of course, trained on the health risks and downstream consequences of obesity. We are trained to discuss the topic of obesity, but we are never really trained on how to actually help our patients lose weight. I would assume that even now medical schools are actively trying to improve curriculum in this area. I think there are two reasons it is not currently adequately addressed. One, it just was not taught when medical schools were created- obesity was not an epidemic at that time. Two, there has never been an easy fix or straightforward method for treating it. If I had not lived this journey, I honestly don’t think I would have thought about it much either. Obesity is a behavioral problem, and quite frankly it is very difficult for patients to make behavioral changes. We would all like our patients to quit smoking, exercise, and have a healthy weight. If it was easy, then everyone would already be doing it.

I lost 35 pounds during my last 2 years of residency. All my coworkers would ask me how I was doing it. I would say “diet and exercise,” and then laugh ironically because that is what we always say to patients. It sounds easy, but it is not. Even though it is not easy, the concept is actually incredibly simple.

There is only one thing you need in order to lose weight and that is a CALORIE DEFICIT. I put it in caps because that is all you need to remember from this entire blog post- calorie deficit. Meaning you need to eat less calories than you burn. Even if you only eat 10 less calories than you burn- you will be in a calorie deficit and you will lose weight, it may just be a very slow weight loss. That is why my dad put me in sports that required a lot of cardiovascular activity – he knew I would probably burn more calories than I could consume. He was right, and that worked until I couldn’t play sports several hours a day every day.

I think we all succumb to certain common pitfalls. We eat in such a severe calorie deficit while dieting, that we are constantly hungry and grumpy. This leads us to binge when we finally do eat what we want, which of course ruins the calorie deficit. We follow fad diets like Atkin’s, intermittent fasting, etc. Which can work but are difficult to maintain over long periods of time. The reason they work is because they are leading to a calorie deficit.

The key to achieving and maintaining a healthy weight is to eat in a small calorie deficit- so small that you are not miserable but small enough that you are very slowly losing weight over time. Even if you only lost 1/2 pound per week, you would lose 26 pounds in a year and 52 pounds in 2 years! Then once you lose the desired weight, you can increase your calories slightly to maintain it. The weight loss journey is not a sprint- it is a marathon. If you have a ton to eat on a holiday or birthday, don’t beat yourself up and self-sabotage. One day is not going to make a diet, but it is also not going to break a diet either. If you “fall off the band wagon” so to speak, just hop on the next day. I was hard on myself for years and it led to a lot of self-sabotage. I have learned to be kind to myself, make smarter choices more consistently, and accept slow change. Slow change is really the best change.