Yes, I lost 105lb. Without surgery, without diet pills, and without any fad diet. Over the course of four years I accomplished something I am incredibly proud of, and yet I struggled to write this blog for a very long time. With every mental draft of this story came a feeling of uneasiness. I felt that there were parts I had to leave out, because I didn’t want to inspire people that way. For months I thought about how much I wanted to talk about my experience, and for months I wondered how the hell I was going to do it.
If you are reading this because you want to read a perfect story about an ever-smiling person losing some optimal number of pounds every month, that’s not a story I can tell. I certainly did not begin my weight loss journey as the poster child of happiness and if I plotted my weight loss it certainly wouldn’t resemble a linear graph. In fact, I couldn’t even provide a plot of my weight loss because, over the four years that I was shrinking, I rarely got on a scale. I knew that I was losing weight in a healthy manner, most of the time, at least, and so I didn’t get bogged down in what I considered unimportant details, like knowing exactly how much weight I lost in X period of time. There were also times over these four years that I got off track, gained some weight back, fell off my exercise routine, or even lost weight unintentionally. Some of these times were linked to struggles with my mental health and some of them were not. With every obstacle and setback, however, came lessons and growth. And so while I cannot give you that perfect little weight loss story you may want to hear, I can and will give you everything I have: a real story.
In early 2013 I was wrapping up my final year of medical school and my weight was at a lifetime peak of 236lb at 5’6’’. I have herniated discs at L4/L5 and L5/S1 and I was experiencing severe back pain with accompanying sciatica. I was taking multiple pain medications, received multiple epidurals, nerve blocks, physical therapy, and more. Finally, an orthopedic surgeon told me it was time to operate and I scheduled a surgical date. During the weeks leading up to the surgery I gradually developed an overwhelming sense of guilt. I knew perfectly well that excess weight was a significant contributor to my pain. I felt like having that surgery without first trying to lose the weight in the same year I was becoming Doctor Moskow was hypocritical. I felt like becoming a overweight doctor was hypocritical, too. I knew that obesity puts a person at a significantly increased risk for developing many medical conditions including cardiovascular disease, stroke, certain forms of cancer, diabetes, hypertension, and osteoarthritis.
I asked myself how I managed to devote so many years of my life studying science, yet blatantly ignored all that I’d studied when it came to the one thing that should matter more than anything: my health. I was in denial. When I saw photos of how large I was, I genuinely didn’t believe I looked that way in “real life.” I told myself it was just a “bad angle.” I told myself that since I’d had many great relationships, I must be physically attractive (required note: the 2017 version of me is disgusted by this thought process). I also told myself that it wasn’t “that big of a deal” that I was overweight because all four of my grandparents were alive, in their 80s, despite the fact that three were obese and weighed more than I did, so I had “great genetics.” These are just some of many rationalizations that had kept the weight on me. Still, I was living a life where the simplest of tasks, like putting on pants, required a serious pep talk in order to suffer through a few seconds of excruciating nerve pain. I had to face a reality I was hiding from for 30 years; I was obese.
After canceling the surgery on my spine in 2013 and committing to getting healthy, almost all major aspects of my life have changed. I left medicine as a full time career and learned to earn income via poker. I ended a long term relationship. I severed friendships I found to be toxic. Family dynamics changed. I moved. All of these changes were made in conjunction with my decision to focus on my health and happiness. Sometimes life requires drastic changes to get to a healthier or happier place. The changes often won’t be easy and some may come with intense opposition from others, but if I had listened to the countless people who weighed in on all the various “mistakes” they felt I was making, I wouldn’t be sitting here right now feeling the happiest and healthiest I have ever felt in my entire life. Consider the opinions and input of others, and then do whatever the fuck you feel is best for you. As Miyamoto Musashi said, “There is nothing outside of yourself that can ever enable you to get better, richer, stronger, or smarter. Everything is within. Everything exists. Seek nothing outside of yourself.”
I have a vivid memory of sitting down in a circle on the floor on my first day of kindergarten, looking around the room and noting, “There is only one girl here who is fatter than me.” This was in 1989. If my five year old brain was conditioned to think this way in 1989, the thought of what little girls of today are conditioned to think or feel about their bodies is truly frightening. As a child, my dad worked very long hours and my mom spent her days hectically caring for five children. Meals were generally whatever was quick: fast food, delivery, microwavable dinners. My parents really didn't “know any better”: they didn’t realize much of the food and soda we were consuming were lacking nutritive benefit. But they did recognize I had a weight problem and made attempts to address it. They encouraged me to go to dance and karate classes, but I hated the classes. My weight made those activities harder for me than it was for the other kids and I was embarrassed. When I was eleven my dad put me on the Atkins Diet with him as something we could do together. I lost some weight, then quickly gained it back when I went off the diet. Atkins was a poor choice, but the sentiment was not. Today, approximately one out of every three children in the United States is overweight, and a staggering one out of every five is obese. If you are reading this and you are the parent of an overweight child: tackling the issue together is imperative, tackling the issue in a positive manner is imperative, and tackling the issue now is imperative.
At thirteen, unbeknownst to anyone, I began having severe depressive episodes that involved suicidal ideation. I did not seek help for this until I was nineteen and I did not find resolution until rather recently. I believe it was around the onset of my psychiatric struggles that I went from merely having a poor diet to having an actual addiction to incredibly unhealthy food. I didn’t self medicate my depression with alcohol or drugs, but I did self medicate by eating. My standard diet was composed of big portions of often fried carbohydrate-filled meals. To make matters worse, I almost always skipped breakfast and lunch and would consume the vast majority of my calories at night. This type of diet and eating schedule went on from that point through high school, college, the years after that while I was working, and then throughout medical school. Do these eating habits sound familiar to you? If you can’t relate to them directly, you probably know someone who can. So many of us sacrifice our health because we are “too stressed” to address it, but, ironically, prioritizing personal health and wellness (mind, body, and spirit) can be one of the most effective ways of eliminating stress.
People constantly come up to me and ask me how I “did it.” And yet when I start discussing it, the majority of people usually go on to explain to me why they can’t do what I did. They explain to me how they are too busy to eat in the morning, or how there is nothing healthy to eat where they work, or how there just isn’t enough time to exercise. I generally respond that I completely understand, that I face many of those obstacles too, and that they are not insurmountable. If you want to commit to living a healthier lifestyle, commit right now. Don’t tell yourself that you will start implementing change “after X event.” Do not wait until “after the summer is over” or “after I change jobs” or “after I finish reading Jaclynn’s long blog.” Commit right now. Fuck obstacles. Fuck those narratives you’ve created about why you can’t prioritize your health because those narratives are all bullshit. My narratives were bullshit and so are yours. Whether you need to lose some weight, quit smoking, tackle other substance abuse, seek medical attention for something you’ve been putting off, whatever it is (maybe you’re overdue for a mammogram or colonoscopy?): Commit right now. If you can’t yet find it in yourself to do it for you, do it for the people who love you.
Before I get into more specifics about how I lost an entire person in weight, know that nothing in this blog should be taken as medical advice. I encourage you to speak to your physician about weight loss and if you do not feel satisfied with their guidance, go to a registered dietitian-nutritionist. Most people are incredibly surprised when I explain to them how nutrition is, for the most part, glanced over in medical school. Ask a doctor how much time they spent learning about nutrition during their training and you will probably find yourself shocked by their response. The internet can also be an incredible resource to learn about nutrition when utilized properly.
When I finally committed and decided I would get the weight off, I turned to exercise first. In retrospect I may have done this because it seemed like an easier start than the complete dietary overhaul I ultimately required. I began by getting a personal trainer and showing up in his gym three times a week. He provided me with a general outline for a diet that coincided with training, and although I never missed a session in his gym, I certainly struggled with his dietary recommendations. After three months, I had not lost a single pound. To give you an idea of just how bad of shape I was in, my resting heart rate during this period was around 100 beats per minute and when I exercised it escalated quickly and hovered around 200 bpm. I am relieved to report that today my heart beats at a normal and healthy rate. By losing weight, I avoided going on medication to slow down my heart.
Since I wasn’t losing weight at the gym, I quit and decided to try something else: walking. I knew that fast walking could provide the same cardiovascular benefits as running and my joints certainly couldn’t handle a run. During this time period I finally started tackling my diet, albeit slowly. I began by eating smaller portions. If you are looking for a first step in dietary change, examine the portions you are eating and adjust accordingly. I also started phasing in healthier foods. My kitchen started accumulating various whole grains, along with green vegetables, mushrooms, nuts, protein powder, and fish (I am a pescatarian now and was 105lb ago, as well). I was also fortunate enough to move to the beach and began swimming several times a week. Whether in the ocean or a pool, water is an amazing place to exercise. I, personally, experience a noticeable post-exercise high. These days when I wake up I am usually exercising within an hour. Doing this enhances my mood and cognition throughout the rest of the day. I am also sleeping without the assistance of medication for the first time in over a decade. I attribute this too to my exercise routine.
As I dieted, exercised, and began to lose weight, I noticed that I was not craving as many calories as I had been. Additionally, the types of foods I craved started to change. There are more bacterial cells in our bodies than human cells, and the majority of them are in our guts, digesting our food. Some scientists speculate that food cravings, and even our moods, are influenced by these bacteria sending signals through our nervous systems. Dietary changes alter the makeup of our gut bacteria and I found that as my diet changed, my cravings changed, as well. Prior to my diet, I would hear people say things like, “The thought of fried food is nauseating” and I couldn’t relate whatsoever. Now at times I find myself feeling similarly.
When I began losing weight I played a game with myself every time I wanted to eat something I knew I shouldn’t. If I was tempted to order a pizza, I would break it down scientifically: I would imagine the actual cholesterol in the cheese. I would imagine it settling down in my arteries, and the cascade of events that would happen on a molecular level from that cholesterol deposit. I would recall what arterial plaque actually looks like inside of someone from having been in the operating room during vascular surgeries in school. I would imagine my own arteries filling up with this plaque, and obstructing blood supply throughout my body. I would do this on a daily basis whenever I was about to make a poor choice. I haven’t done this in a couple years because I no longer find my diet to be a daily struggle, but the tool will always remain in my arsenal should I need it.
After losing the first 40lb my back pain and sciatica almost completely disappeared. I continued exercising and was eating much more balanced meals than I ever had before. I told myself that since my back pain was mostly gone, I had done exactly what I had set out to do: avoided surgery. My weight then hovered at about the same place for around the next nine months. Ultimately, it was tackling both my relationship with food and exercise and tackling my depression as well that got the remaining 65 pounds off. While I used and advocate traditional methods to lose weight (diet and exercise) I opted for alternative methods of treating my depression during my weight loss period, primarily the use of psychedelics, including IV Ketamine infusions administered in a psychiatrist’s office (perhaps the topic of a future blog). If you are struggling with psychiatric illness, addressing it is crucial to the overall state of your health. Few things are worse than one’s own mind attacking them, and it is certainly a barrier to maintaining healthy habits. I found that when I was overweight and going through a depressive episode, I was generally prone to eating even more. As I lost weight, I sometimes experienced a decreased appetite while depressed instead. Appetite changes are a very common symptom of depression. As I began to feel better mentally, it became a lot easier to focus on my physical health. And as my physical health improved, my mental state improved, too. I cannot overstate the connection between the mind and body and between physical and mental health. If you are suffering from obesity and psychiatric illness, addressing them together is the move.
There are obviously an abundance of individuals with psychiatric illnesses who do not have weight issues and there are even more individuals struggling with their weight who do not struggle with psychiatric illness. I will, however, always emphasize the connection between physical and mental health. Disruptions in mental health manifest in ways other than the kind of extreme depression I have alluded to in this blog. Everyone’s journey is different, and while I cannot give you an exact blueprint to follow, I can tell you that health will not find you. Health is something you must seek and maintain by yourself and for yourself: you must find it. There is no substitute for dedication, perseverance, and, above all, commitment to finding it. If you’re not prioritizing the health of you or someone you care for, please consider starting right now.
Commit right now.