A month of losing weight. It isn't easy.

I weighed myself for the first time on March 1. When I set out on this exercise on February 1, I set a goal to reach 85.4kg by March 1. Unfortunately, I used a newer scale to weigh myself on March 1, and lo and behold - I'm 87.7kg.

It was tough to see that number. Really tough. Even though I know it is most likely due to the older scale being accurate, this means I was actually heavier than I thought I was at the outset. And for some reason, that hurts. I may have even been above 90kg, a threshold I never thought I would reach.

Anyway, I have to believe this hypothesis before the alternative: that I lost just 300 grams in a whole month of calorie restriction.

I learned how to do a basic cardiovascular examination last week. I discovered the jugular venous pressure, a nifty little indicator of high right atrial pressure. This lady has a really high JVP.

My blood pressure is 114/82. It was a bit of a relief to see this, given the number of lectures I have listened to lately about obesity as a major risk factor for basically everything you can think of. Alas, if only I could just throw my hands up, declare myself risk-free, and devour a bagel - stat. God, I miss bagels.

Not that I am depriving myself! I haven't altered my diet too much - just the quantity. Of course, dessert has gone. Chocolate has gone. Anything fun has gone. Hm. Maybe my diet has changed quite a bit. I mean that I haven't altered the macronutrient makeup in any way. I eat carbs. I will never give them up. I don't care if my weight loss takes an extra two years to achieve: carbs and I will always be friends.

In light of the great weight loss failure of February 2016, I have reassessed my goals and wish to weigh 85.4kg or less by April 1. This time, I'll use the same darned scales. 

If you are interested in the tool I use to calculate these goals, visit the Pennington Biomedical Research Centre.

Creating Habits for Weight Loss

My very first, very loose qualitative weight loss goal was for someone else to notice. The last week has truly delivered. First, my grocer, who hadn't seen me in a few weeks, asked me if I had lost weight. This morning, my boyfriend remarked that I had lost weight (and I see him every day!). I was starting to wonder if this whole calorie-restriction thing was even working out. Having both a stranger and my closest friend recognise the fruits of my efforts makes it feel all worthwhile.

I'm dreading my clinical class next week. We have to take anthropomophic measurements of each other, including BMI and waist circumference. Leaving aside the fact I recently published my measurements for the whole world to see, I'm not so happy about people I know and study with having a quantitative measure of my fatness. The otherwise arbitrary numbers carry so much shame: it is an unarguable, concrete representation of my overeating and all the laziness, gluttony and self-disrespect this implies. Personally, I don't subscribe to this notion of fatness. Although the cause is very simple at the surface (food in > energy out), there are so many nebulous factors that essentially make this equation irrelevant. WHY do I eat so much? And why is it so terribly difficult not to? Why is it that I reach for the ice cream when I'm upset, while other people turn to their friends for support or go for a run or just study more? And why on Earth does it all feel completely insurmountable sometimes?

I don't know the answer, but I do know that calorie counting and a moderate dose of meal planning seems to be working for me. Frankly, I don't have the time to sit around and chew the fat (ha) about my childhood and any emotional pre-disposing factors. I'm taking a bit of a shortcut instead. Rather than think about my overeating as a pathological, psychologically-mediated response to stress or grief or whatever, I decided to approach it as a bad habit. The best way to get rid of a habit? Create a new one using repetition, automation and sheer force.

1. Plan all meals for the week and write them down. This includes breakfast, even if you eat the same thing every day. Ensure the meals are nutritionally balanced and don't exceed the calorie allowance.

2. Shop for ingredients for above-mentioned meals. Don't go while hungry. Every second website and magazine I read about weight loss mentions this, to the point I roll my eyes every time I see it. But holy mothballs, it's true. Much easier to avoid the confectionary aisle when your empty stomach isn't screaming at you for a quick hit of glucose.

3. Eat those meals. Nothing less and nothing more.

Simple. And I feel like it's getting easier. I no longer have to leave my cash at home so I don't stop in for an unscheduled candy stop on the way home from school. I'm not worried about binge eating while my boyfriend is out of the house. Well, that's not true - I'm obviously concerned to avoid doing this, but I am not crippled by the overwhelming fear of food I have had in the past. Not so long ago, a weekend binge was just a foregone conclusion. I have managed to avoid binges on a few occasions now, and it has given me the confidence to feel as though I can say No again.

Other than this, school continues on nicely enough. I love medicine. I have a very clear image of myself, in size 6-8 professional clothes, fit and content, comfortably walking the ward rounds without worrying about being the 'fat doctor'. This mental picture keeps me going, to be honest.

Losing weight in med school

I'm not due to weigh myself until 1 March, but from the way my clothes are fitting, it's possible I have dropped a kilo or two.

It's going well so far, but it's not easy.

School started last week. We were scheduled to attend a free lunch that included meats and various canape-style treats. I diligently spent the night before researching possible options, calculating the amount I should eat, and committing the calorie content to memory. I ate less at breakfast to compensate for a slight increase in intake at lunch,  and smugly rocked up to campus thinking about what a bloody winner I am at losing weight.  Imagine my surprise (and sudden increase in salivation) when fifty pizzas showed up instead of the promised cocktail snacks.

What do you do when the only food available is fattening?

I ate it. Duh. I couldn't possibly stand there watching everyone else eat while I was both hungry and incredibly self-conscious. If you're fat too, you may be familiar with this feeling. It's a lose-lose. If I eat the fattening food, people will look down at me for eating junk at my size. If I don't eat anything and stand there while everyone else scoffs down their glorious triangles of congealed fat, I will stick out like a sore thumb. May as well wear a sign around my neck that says "Fat Lady. Can't Eat Pizza and Feels Ashamed. And Very, Very Hungry".

Oh, and was I.

So I ate one darn piece of pizza and tried not to freak out about it. Not a great start to the semester, though. I feel as though I am treading a very fine line sometimes. I want my weight loss to be relatively slow and sustainable in the long term. There will be many times in my life where I will be offered pizza as the only option for lunch.  I want to be able to handle these situations with a good sense of perspective and social grace. But it's very difficult to maintain balance at the moment; I felt as though each bite was de-railing my progress, calorie by calorie. Anyway, I basically flew home trying to burn off some extra fat. 

Speaking of food at med school, I could have kissed the guy who brought in vegetables and dip for our first PBL group the following day. We have established a roster whereby one person brings in snacks for everybody each PBL session. So I will have to get used to having tasty, delicious food under my nose every week. Them's the breaks I guess. Stay tuned for the next instalment of Med School Temptation: Food Edition. 

how to set weight loss goals

All of the sensible weight loss advice recommends a 'slow, steady and sustainable' approach. When you're 16kg overweight and desperate to look like Kayla Itsines, it's not easy to follow. I have never been a comfortable fat person. At no point have I ever thought to myself, 'this is just how I am going to be forever so I may as well get used to it'. I have worn pants three sizes too small in desperate refusal to buy more, because I knew I wouldn't be this way for much longer. Never mind that I could barely breathe, sitting in class feeling as though I was being cut in half at the waist.

I have tried to lose weight too many times to count, all in pursuit of a quick fix. I have starved myself, cut carbs until my breath stank of ketones, and taken pills that made me dangerously constipated and seriously angry. All of these methods worked insofar as I lost some weight, for a brief period of time, but put it all back on once I lost patience and drove back into McDonalds for a pre-dinner snack.

This time, I am trying something new. I'm going to give this expert-approved 'slow, steady and sustainable' weight loss method a try. And so, I hereby present: my goal. I'd like to lose 20kg in a year. Too easy, right? Just lay off the chocolate and create a calorie deficit for twelve months and magic is bound to happen.

Twelve months of weight loss goals

Month	Weight Loss Goal	Predicted Weight (kg)
1-Feb	0	88
1-Mar	-2.9	85.1
1-Apr	-2.5	82.6
1-May	-2.3	80.3
1-Jun	-2	78.3
1-Jul	-1.8	76.5
1-Aug	-1.6	74.9
1-Sep	-1.4	73.5
1-Oct	-1.3	72.2
1-Nov	-1	71.2
1-Dec	-1	70.2
1-Jan	-0.8	69.4
1-Feb	-0.7	68.7

first steps.

I took some measurements last night. A small part of me (whichever part of the brain regulates denial) actually thought that despite my BMI (30), my waist circumference might just redeem me. It did not.

I have a waist circumference of 94cm. Waist circumference, in combination with BMI and waist-to-hip ratio, is used to predict whether we are at risk of developing health problems. At lot of pseudo-scientific blogs out there like to point out some of the limitations of these methods. But let me tell you: for most of us, they're accurate and satisfactory. Believe me, I wish I could honestly say I have an athletic build with more muscle mass than normal. Truth is, I look like every other fat person: rotund and lumpy. 

Anyway, 94cm puts me just a teensy weeny smidgeon above the healthy range. The wonders of science have shown us that as a woman, anything above 80cm is bad news. I know. Fourteen centimetres is hardly a teensy weeny smidgeon. Insert emoticon conveying despair here. As for waist-hip ratio, I actually fall within a healthy range (0.78). If you don't have a medical or health background, you may find this confusing. I just find it a drop of comfort in an ocean of bad news: it's possible that the way in which my body distributes fat slightly reduces my otherwise high risk of health problems. But with a BMI that categorises me as 'obese', it's certainly not licence to help myself to cake.

Tomorrow I'm going to take my blood pressure. There is only so much bad news I can take in one sitting. I had some glucose tests done earlier and - praise be - I do not have type 2 diabetes. Small miracle, my friends.

The question now, of course, is what I do with this information. Anyone struggling with their weight knows the answer: eat less. Putting that into practice is very difficult. I'll let you know how I go with that - you have plenty of weepy blog posts about emotional eating, stress, and the hereditary impact of obesity to look forward to.

30.

I don’t think of myself as the fat girl. When I lust over cute, tailored outfits on asos.com, or admire a fashion blogger’s penchant for stilettos paired with ripped jeans, I imagine myself looking not too dissimilar in the same clothes. I go to posh restaurants with my husband and enjoy the wine, feeling every bit as sophisticated as the woman two tables down in her size 6 suit. It isn’t until I accidentally catch a glimpse of my reflection in a window, or see the photo our waiter took of us celebrating our anniversary, that I really see my body for what it is: obese.

Obesity is a disease; or at the very least, an incredibly powerful predictor of future disease. Reconciling the woman I think I am - smart, driven, loving - with the person who is wilfully eating her way to an early grave is painful. I have a BMI of 30. I am at risk of developing diabetes, a diagnosis of heart disease, and leaving behind a husband who loves me. 

I am also a medical student, and my future patients deserve better.

This is not an exercise in self-loathing, or shame, or pity. I just want to live well and long. I don’t have much patience for platitudes, and I’m not going to post daily weigh-ins with regular progress photos. But I am going to use the many and varied resources available to me to get that BMI within a normal range, and write about what works. After all,  If I can’t do it, how can I possibly look patients in the eye when I tell them to do it?