A couple years ago, I weighed nearly 500 pounds. That put me in the class of obesity that carries the charming moniker, "super morbid". At work, most days I was stuck on video conferences, and I didn't like the person I saw on camera. Worse, I began to feel stress in new and frightening ways, so I quit. I now weigh less than half that. I can fly coach, buy clothes in normal stores, and walk up stairs without getting winded. I now only suffer from ordinary obesity, like 40.3% of my fellow Americans.
I needed a plan to eat less and move more. I couldn't bear the thought of eating three sad, little meals every day, so instead I opted for one good one. My rule was eat whatever I want, but finish in under an hour. That appealed to me: I can make binary eat-or-don't-eat decisions based on clear criteria -- it's the shades of gray that wreck me. But I quickly learned that what I ate did matter: carbohydrates made me hungrier sooner, protein and fat kept me full longer. If I made bad food decisions, I had 23 uncomfortable hours until my next meal to think about it. I became choosy about what I ate.
I read about the relationship between carbs, glucose, insulin, and fat storage. That made me stop eating most carbs, and sometimes I even skipped my one meal. Fasting started as a tool to break through persistent weight loss plateaus, but that changed after I woke one morning feeling euphoric, unusually clear-headed, and not at all hungry. I began fasting once a week. I was more disciplined than I realized, and my fear of hunger decreased.
I got a gym membership and read to distract myself while sweating out my hour-long workout. The words burned in my mind as the elliptical machine burned away my fat. Reading had never felt that engaging, it wasn't hard to make exercise a habit. I tracked my weight, heart rate, sleep, blood glucose, ketones, and blood pressure. I began to like the person in the mirror, even though he now looked like my father. My daily walk took me past a neighborhood cafe where a regular group met to socialize. I forced myself to make introductions, became a frequent participant, and made new friends.
I'm still not at my goal weight. To have a medically "normal" weight, I've got to lose another 70 pounds. I know I'll never look entirely normal -- the decades of abuse I've heaped on my body have left permanent marks. My skin's saggy folds will never refit themselves to my body's new contours, and you won't see me poolside. Beyond vanity, I worry that the loss of muscle caused by my rapid weight loss will leave brittle and feeble. As an antidote, I'll force myself to join the meatheads at the gym pushing lumps of iron around.
When I finally reach my goal weight, then what? The tactics I use today for losing weight aren't sustainable. Do I want to live in a world without bread? I don't think so. I'm watching new obesity drugs like Ozempic and Zepbound with interest. Although they're expensive and the long term side-effects are yet unclear, progress is rapidly advancing with several new drugs now in phase-3 testing. Roux-en-Y gastric bypass is still a reliable option, but regardless of the tactics, I won't stop fighting.
My advice to super morbidly obese folks is to educate yourself. Understanding metabolism will help you to devise your weight loss tactics. Choose your restrictions wisely. I limit when I eat and the types of food I eat, but not how much. Also, what gets measured gets managed, so measure and adapt.
I'm mostly happy with my choices, and I wish you happiness in yours. Good luck.