Reflections on the Weight-Loss Journey of a Morbidly Obese Medical Student

Our member Sebastian Shaw shares his experience battling with weight-loss and the way that it has affected his approach to medicine. If you’re interested in learning more about career development in either clinical or basic research endocrinology check out the careers section of our website.

Aims

I want to share my thoughts with you. These encompass several areas in both medical education and medical practice.  I also aim to shed light on how I lost the weight, why I lost it and what it might mean for my career. It is my hope that this short piece might change the ways in which we see and help patients who are trying to lose weight – a view into their world facilitated through my experiences and introspection.

Background and Introduction

Having had a very unstable childhood, I turned to food for comfort from a young age. As the years passed by, my appetite grew until I was regularly eating more than double my daily recommended intake of calories. Although I was always aware that I was overweight, I had never thought of myself as obese – despite knowing my BMI to be over 40 (Figure 1). I lived for years in a state of complete denial.

fig 1

When I first applied for medical school, I will always remember a relative saying that I was “too big to be a doctor” and that I would never be accepted after interview. Although disheartening, I ignored the comment and optimistically awaited my interview dates.

Interviews

I was invited for interview at 3 medical schools – the 4th made me an immediate offer.  I had  mixed experiences in these interviews. For my first and second, I was greeted warmly and was not, at any point, made to feel different or out of place.

The third interview was however a different experience.  The main interviewer would not shake my hand, nor stand as I entered the room. He began to probe my knowledge of public health – purposefully and abruptly silencing the second interviewer. When he said “Give me one of the main risk factors for coronary heart disease” I promptly responded with “obesity”. He then leant forwards – the most engaged he had been throughout the entire interview – and gestured to my stomach whilst giving a judgmental look and saying “isn’t it just!”

Absolutely mortified, I did not know how to respond, so simply looked to the floor. I could not believe that a doctor could be so judgmental – not exhibiting the qualities that were expected of us applicants. I withdrew my application from this medical school. The experience left me feeling insecure and inferior for several months. Thankfully I had already received 2 offers to study medicine by then.

Having now come full-circle and having interviewed on behalf of my own medical school, I am in further shock and disbelief that such a thing could be done at interview.

Realisation

In many ways, that interviewer was to be my salvation – albeit sparking long-term self-image issues. The interview acted as a rude awakening to reality. I was obese and I did need to act. If I didn’t, how were colleagues or even patients ever going to take me seriously?

The weight-loss process

I remember being so unfit that I could not jog more than 100 metres without becoming completely breathless and dizzy. A friend who was keen on fitness suggested I started by alternating walking and jogging. I would jog until I could go no further and then slow to a walk without stopping. Once I had caught my breath I would recommence jogging.

Initially, food was extremely challenging. The primary part of my diet was carbohydrate – mostly pasta and sugar.  Changing to healthier options was difficult. But the true challenge was portion-control. I used to eat meals 3-times larger than my friends and family. Cutting this back was agonising! I found that the exercise helped to decrease my appetite and that, if I reduced my intake by a small amount each day, I was able to avoid feeling starved.

The best motivation in the early days was the constant revamp of my wardrobe. I had to buy myself a new shirt every couple of weeks – so this became an incentive for me to keep losing weight – to earn my next one.

Importance for Future Career

I am aware that I have many years until I need to choose my speciality. However, for several years now, I have had my heart set on endocrinology/diabetes as a career pathway. Whilst the complexities of this speciality fascinate me, I also feel that I could give much to my patients within this field. Having lost this weight myself, I feel more able than most to empathetically guide patients through their own weight-loss journeys – as is so particularly important within diabetes care. I have been there. I know how hard it is.

I could never have felt comfortable telling patients to ‘lose weight’ or ‘get fit’ when I was the prime example of how not to be. I would have felt a complete hypocrite and could not have expected people to take the advice that I could not follow myself.

The new me

I have now reached my goal. I stand 19 BMI units lighter than my previous size – having lost half my body weight (Figure 2).

FIG2If my previous size is mentioned by people who knew the old me, others listen in disbelief and often ask for photographic proof.  These occurrences motivate me to maintain my achievement.

Fitness still proves invaluable in maintaining my size – running several times each week. The old me would never have believed myself capable of running 9 miles as a leisurely activity on Boxing Day morning – the thought of even walking that distance would have seemed a form of torture.

Although losing the weight was hard, maintaining it proves to be the real challenge. It is very easy to feel like the achievement is complete and to unknowingly slip back into bad habits. By surrounding myself with great (and sometimes ruthlessly honest!) friends, I manage to keep myself in check – as would be important for any patients wanting to lose such vast quantities of weight.

Advice to others in my old situation

Losing weight is a daunting thought. It is very easy to want to do it, but so hard to work out how to. So often the ‘lose weight fast’ diets help to shift a little, but it always seems to come straight back from nowhere. Being told to eat better and less is all well and good, but that is hard! This is much easier said than done and, more often than not, those suggesting it have never been there themselves.

I found the key is know where you want to be and to set reasonable goals – decide where you want to be, not where you ‘should’ be. Do not deprive yourself of everything you love – you’ll never maintain it, and will hate life in the process. Start by substituting the foods you love for similar, healthier alternatives. Cut back on evening snacking and pace yourself throughout each meal. Allow perhaps a meal out each week with friends where you can just relax and enjoy yourself – do not make it a daily habit, but do not feel guilty about it! Every set-back I faced was fuelled by guilt over food. Take each day at a time and do not catch yourself saying “I’ll just have that now and make up for it tomorrow” or “I’ll start again tomorrow”. Keep up the exercise – it makes a surprising difference. Constantly remind yourself of why you’re doing it and how you will look. Do not give up.

Conclusions

Losing large amounts of weight is no easy task. Then, it is a constant struggle to maintain the weight loss. This is, however, one of my proudest achievements. It is my hope that my personal journey might inspire and encourage others. It has put me in a unique position to help my future patients. If they can be expected to do it, so should we.

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