Author: Sylvia Caswell – MS4 Campbell School of Osteopathic Medicine

Obesity is a worldwide epidemic. According to the latest report from the Centers for Disease Control and Prevention, 39.8% Americans have obesity¹. Obesity is associated with cardiovascular disease, hypertension, Type 2 Diabetes, metabolic syndrome, and various types of cancer. Therefore, it is no surprise that weight loss is a priority when a patient is struggling with those conditions.

Several years ago, after the birth of my third child, I found myself at my heaviest weight and suffering from severe depression. As a mom, I did not feel my best and was not giving my family the best version of myself. As a pre-med student, I was not living the healthy lifestyle I was about to be preaching to my future patients to help them with their health. These reasons encouraged me enough to learn to develop long-term positive and healthy habits that led to a total weight loss of 90 lbs and reversal of chronic depression.

Below you will find 10 things I learned along the way that led to reaching my goals, and successfully developing the skills to keep my newly-developed positive habits forever.

1. Your reason for losing weight must be stronger than any excuses. – Losing weight is not about fitting into smaller pants. The reason a person should have for losing weight is directly associated with something they truly care about. Without a strong reason, people lose sight as to why losing weight is important for them. While your doctor may talk about your laboratory markers as a measurement of your health, do they matter to you as much as being able to do the things you love doing without your health problems getting in the way? Reasons vary from person to person, and it’s important to have those reasons clearly visible to you on a daily basis so you know what you are working towards. If those reasons are not important to you, your brain will ignore your goals and steps you are taking to get there.

What I did: my reasons for losing weight were to be a better mom to keep up with my family and not be a hypocrite physician one day. These reasons were written down on my planner so I was reminded daily of what I was working towards.

2. Start with SMART goals – The more weight that needs to be lost, the easier it is to get overwhelmed and quit when small problems arise along the way. Therefore, it is important to break down the weight loss into smaller goals. These goals should be “SMART” (see table below). In addition, these SMART goals can be in regards to anything, including the amount of exercise, types of foods or nutrition that need improvement, more sleep, etc. One important fact to remember is that these goals should always be added slowly over time to prevent feeling overwhelmed, and they’re added at your own pace while being challenging enough that you feel successful as you accomplish them.

“SMART” Goals	What I did
Specific: what do you want to do?	I wanted to lose 70 lbs, but I started out with 10 lbs to begin with.
Measurable: how will you know when you’ve reached it?	I checked my weight and measured myself once weekly on Friday mornings. I also tracked what I ate each day using MyFitnessPal.
Achievable: is it within your power to reach it?	Yes, other people have done this and there’s no reason that I could not!
Realistic: can you realistically achieve it?	Yes, 1-2 lbs of weight loss weekly is the healthiest pace of weight loss that is most likely to stay off.
Timely: when exactly do you want to accomplish it?	I wanted to start out by losing 10 lbs in 6 weeks.

 

3. Surround yourself with positive people – Research shows that social support leads to greater adherence to weight loss efforts². There are several methods in which this can be done: finding a group of friends who are looking to lose weight as well, finding weight loss online groups via social media, finding in-person group meetings in your area through the health department or local healthcare organization, etc. Each person is unique in how they find support, but the important thing is that you show up for them and support them as they support you! What I did: I did not have the best support system at home at the beginning of my weight loss journey, so I chose to become involved with a fitness challenge group through Facebook and that group of girls became my rock. Without their positive support, it would’ve been nearly impossible to keep going. They were also losing weight and they knew the struggles I was going through. As time went on, my kids and husband began to accept the new foods I was eating and now my children devour salad and my husband cooks healthy as well! 

4. Accountability matters forever – Accountability can be to a device (like a food tracker), a friend, a family member, a trainer, a health coach, or a combination of any of those.Having someone or something keeping you accountable leads to higher adherence to weight loss according to research. This is vital.

What I did: As I mentioned above, being involved with a group and coach was a necessary part of learning healthy habits and sticking to them. However, about 6 months into my weight loss I wanted to share what I had learned along the way with others who struggled like I had. At that point, I began running fitness challenge groups of my own and that accountability increased. In addition, my friends and family also began coming to me for help and teaching them the things that worked for me in developing healthy habits helped me stay on track. This level of accountability not only helped me stay on course through the weight loss process, It also helps me with the maintenance phase to this date. I believe that being the example to those close to us helps to keep this new lifestyle in place.

5. If you fail to plan, you plan to fail – Life does and will throw you curve balls: you will get stuck in traffic, you will have appointments run late, you will have sick children requiring more attention, and the list goes on. This is where preparation goes a long way. Meal planning is critical for success every single week. Furthermore, exercise requires planning ahead, and so does adequate sleep. Each of these must be planned on to the best of your abilities.

What I did: I had done meal planning previously when grocery shopping but never with healthier options. I found some recipes that were healthy, easy, and budget-friendly and began putting together an arsenal of recipes that I could quickly turn to. So on grocery shopping days, I sat down and went through recipes and chose ones that were based off current grocery store sales. At the time we still ate meat frequently so finding those sales saved us a lot of money because animal products tend to be a little pricier. In addition, I found recipes which I could use a certain ingredient for two recipes or found recipes that I could use part of one to make another, that way I cut down on cost.
On the other hand, learning to exercise required a little a lot of “self-parenting”. My workouts required that I write them down on my planner as if they were daily appointments. Waking up early to get them done got easier over time, even though I still am not a morning person. A great trick I used for learning to get up early was to place the alarm clock in my bathroom because it forced me to get up quickly to go turn it off and prevent the rest of the household from waking up. Lastly, one quote that stuck with me said: “Think of workouts as important meetings you have with yourself. Bosses don’t cancel.” Get it done first in the morning if you loathe it. If you wish to read more on not procrastinating and getting things done, I suggest the book “Eat that Frog!” by Brian Tracy. 

6. Address stress and sleep – When stress levels are high, a hormone called cortisol rises in the body. Cortisol leads to weight gain and metabolic dysfunction. Because of this, stress management is a priority and an extremely important aspect of weight loss. People generally choose activities such as yoga, meditation, journaling, needlework, reading, etc. as a way to de-stress. In addition, lack of sleep, even for just one night, not only induces an environment of high stress within your body, but also reduces leptin (the satiety hormone), and simultaneously increases ghrelin (the hunger hormone), leading to more eating³.In order to fix these imbalances, go to bed early to get enough sleep— men should aim for 7 hours while women typically should get 8 hours each night.

What I did: I go to bed early and get up early. Not only does it help me be more productive but it also gives me a chance to workout first thing in the morning to have extra energy throughout the day. Optimally I should get 9 hours of sleep each night to feel my best but I am usually getting 7 hours per night during the week. My favorite way to de-stress is physical activity, which includes yoga. These also help me sleep better at night.  

7. You can’t out-work a bad diet – Weight loss is mostly due to improved nutrition and less from exercise, both of them important parts of the process. However, many people do not know how much to exercise, let alone what to do. Current recommendation guidelines for clinicians stated that patients should have 150 minutes of moderate physical activity weekly or 75 minutes of vigorous physical activity weekly for optimal health⁴. Moderate exercise means you can hold a conversation with a bit of difficulty whereas vigorous activity means you cannot hold a conversation because of the intensity. It is important to note that at least 2 days should be devoted to strength training each week. Muscle strengthening is not only great for muscle mass but also strengthening bones and fat burning. If you’re not sure where to start, try different workout classes, join a gym, or get fitness workout plans such as the BodyBoss® book, apps such as Sweat: Kayla Itsines Fitness® and Peloton®, and workout video programs online such as Les Mills On Demand® or Beachbody on Demand®. A sample workout schedule you could do on your own that should last less than 45 minutes may look something like this:

Day	Workout	Sample movements
Monday	Chest/Triceps + Cardio	3×10 of Pushups (wide and narrow), tricep kickbacks, bench presses, etc.; 20 minutes of treadmill or elliptical, etc.
Tuesday	Legs	3×10 of weighted squats, lunges, sumo squats, etc.
Wednesday	OFF
Thursday	Back/Biceps + Cardio	3×10 of bicep curls, hammer curls, reverse presses, bent-over rows, etc. followed by 20 minutes of treadmill or elliptical, etc.
Friday	Abs + Cardio	3×10 of weighted situps, high plank for 60 seconds, crunches, etc. followed by 20 minutes of treadmill or elliptical, etc.
Saturday	Total Body Strength Training	A combination of all strength training moves that cover each of the muscle groups.
Sunday	OFF

What I did: My weight loss began with doing high-intensity interval training (HIIT) Insanity® DVD at home. It was hard at first and I was extremely out of shape and with a lot of weight on me.I have children, therefore I needed something efficient that could be done at home without having to bring my kids with me to the gym, drop them off at the childcare place, then workout, then put them back in the car and go home. That would easily take 1.5-2 hrs of my day. By working out at home, I cut that time down to 30-60 minutes. I prefer to workout on my own, except when I teach group fitness classes at the gym. The workouts I do usually have compound movements which make my workouts shorter, more efficient, and harder. However, some people prefer to be around others when they exercise. If I can learn to enjoy exercise when I used to LOATHE it, so can you. It’s just a matter of trial and error until you find something that you like. It can either be something at home, the gym (either on your own and/or a group class), or walking around your neighborhood with a friend.No excuses, just get it done.

8. Nutrition is individualized – Take the time to experiment with foods. Food journaling is a great way to not only keep track of what you eat, but it also allows you to keep track of how you feel and you can then make connections to symptoms as you eat certain foods, and subsequently, eliminate them if they don’t make you feel your best. Everyone’s gut microbiota is different so a low-carb/high-fat diet may work for some but not for others. The general rule of thumb is to eliminate processed foods and sugar (including artificial sweeteners and sugar-sweetened beverages!) and add more fruits, vegetables, and plant-based fats first. People generally begin to feel much better when they start doing that.

What I did: People always ask me what kind of diet I did to lose weight. The answer is none. I learned to eat instead and figured out what worked best for me that could be sustained long-term. In order, here is a list of things I did about my nutrition that led to the way I eat today:

1. Began food journaling. With a weight loss app such as MyFitnessPal, it was easy to see how many calories I needed to eat each day. At the time I began my weight loss, I was nursing my third baby. Therefore, I needed a baseline of about 1500 calories to lose weight (for my body type including height and weight), then adding about 300-400 calories daily for my workouts, then another 500 calories for nursing. In total, I had to eat about 2300-2600 calories each day to see weight loss. Yes, it was a lot of food.
2. My first nutrition switch was breads and pastas to whole grain because that was literally all I could handle. This was relatively easy to do and my family didn’t mind it.
3. I quit soda (so long, Diet Dr. Pepper, my friend of many years!) and added more water. General rule of thumb for appropriate water intake: your weight in pounds divided by 2 is the amount of water you should have daily. For example, if your weight is 180 lbs, then divide that by 2 = 90 oz of water you should have daily.
4. Slowly, I introduced more vegetables and fruits to my daily meals. About 18 months into my weight loss I started to track my food intake by portions rather than by calories. This was based off the 21 Day Fix plan, which is based on an individual’s specific measurements. My personal goal is to have 4 cups of vegetables daily, 3 cups of fruit, 3 servings of carbohydrates daily (i.e. ½ cup brown rice, 1 slice of bread, etc.), 3 cups of protein, and depending on the type of fat I’m eating, ¼ cup to 1/3 cup of total fat daily (i.e. cheese, nuts, nut butters, etc).
5. Over the course of several months, we eliminated red meat from our house and only cooked with turkey, chicken, and fish. Within the last year, we began decreasing our meat and animal protein intake and added more plant-based proteins (in the form of beans and legumes), which helped with our food budget immensely. Now that we eat a mostly whole-food, plant-based diet at home, which is something my family enjoys, I haven’t found the need to log my food. In part, this is also because I’ve become so accustomed to knowing how much my body needs that it’s become second nature. More on learning about eating intuitively is a book I highly recommend called “Intuitive Eating” by Evelyn Tribole.

The question about “cheat” meals comes up at lot. Considering I don’t have a gastrointestinal problem such as Celiac Disease, I am free to have “cheat” meals 1-2x/week. I felt that rigid nutrition, for me, would lead to a lot of frustration and not having a sustained healthy lifestyle, so I choose to have flexibility in that regard, that way I can attend parties and celebrations without feeling guilty or shame. The key is to always get right back on the wagon and pick up where I leave off.

As my nutrition was improving in those early months, and my gut was getting rid of years of insult, my depression began to clear. I didn’t understand the connection until clinical research has shown that there is a big gut-brain connection and some even refer to the gut as the “second brain”. Many of the serotonin receptors that are found in the brain also line the gut, and dysfunction in serotonin regulation is highly associated with depression⁵. Once that became regulated, my depression resolved. However, I cannot claim that nutrition is the only thing that cured my depression because increased physical activity has also been found to be an effective adjunct therapy to major depressive disorder⁶. Therefore, with all these changes, it isn’t a surprise I no longer need antidepressants. 

9. Food does not solve emotional problems – Food may help with emotions in the short term, but in reality, there are better ways to cope with stress. Finding coping mechanisms to stress that don’t involve food pays off in the long term. Many people find hobbies that they can turn to in order to cope: needle work, painting, reading, exercising, meditating, doing Yoga, doing crafts, wood working, etc. Find what works best for you and stick to it. One important thought to consider, however: an eating disorder is a medical condition that must be treated accordingly. If you believe you may struggle with your food intake and have concerns, make an appointment with your primary care doctor to be evaluated.

What I did: I used to be an emotional eater. The slightest amount of stress would send me to my pantry and/or fridge to eat all the carbs available. I didn’t know how to deal with my stress. So I would eat as a comfort measure, which would usually leave me feeling mentally worse and guilty and with a stomach hurting pretty badly. To be honest, this problem took several months for me to overcome. Breaking up with my emotional attachment to food was hard. But I learned to listen to my body and slowly broke out of that cycle. I learned how to manage my stress in a healthy way by exercising and keeping my mind occupied with other things. I learned that when I eat junk food, I feel like junk too. And my problems were never solved when I ate poorly. Do I still have cake and cookies? Yes, but not much and not often (compared to what I used to do). 

10. Treat yourself with the same kindness you treat others – One of the hardest things about losing weight is being patient and kind to ourselves. People find it frustrating that the weight doesn’t quickly come off when they have been so diligent. The weight does not creep up overnight and therefore, it will not come off quickly. Weight loss takes time. And there will be problems along the way— weight loss plateaus, birthday parties, or going a week without proper meal planning. The point is that there’s absolutely no reason to treat yourself like a drill sergeant and make yourself feel bad for mistakes being made. Weight loss is a learning process full of trial and error and mistakes are bound to happen— the point is to learn from them so they don’t happen again. This isn’t a competition against anyone except you! So treat yourself with the same gentleness you would someone else. Love yourself for what you can do, and be confident in your abilities to overcome your challenges!

In conclusion, here are the main points to starting a weight loss journey and staying motivated through the process:

• Workout according to the recommendations mentioned above. If you’re unsure where to start, talk to a personal trainer.
• Start with small nutrition goals that are SMART! And work towards implementing more fruits and vegetables into your eating
• Tracking your food is important to learn portions and accountability. There are many apps out there that do that. My personal favorite is MyFitnessPal. Find one and stick to it.
• Learn to manage your stress without using food for comfort and get adequate sleep. Also, if you smoke, talk to your doctor about ways you can quit.
• Be kind to yourself! Believe that you can do hard things! Confidence is key.

REFERENCES

1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: the United States, 2015–2016. NCHS data brief, no 288. Hyattsville, MD: National Center for Health Statistics. 2017
2. Lemstra, Mark, et al. “Weight loss intervention adherence and factors promoting adherence: a meta-analysis.” Patient preference and adherence10 (2016): 1547.
3. Taheri, Shahrad, et al. “Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index.” PLoS medicine3 (2004): e62.
4. Oja, Pekka, and Sylvia Titze. “Physical activity recommendations for public health: development and policy context.” EPMA Journal3 (2011): 253-259.
5. Liang, Shan, et al. “Recognizing depression from the microbiota–gut–brain axis.” International journal of molecular sciences6 (2018): 1592.
6. Kvam, Siri, et al. “Exercise as a treatment for depression: a meta-analysis.” Journal of affective disorders202 (2016): 67-86.