Graduate school is tough. Relationships are tough. Advancing to graduate training after completing my first two years in medical school, I began to struggle deeply with both and lost track of myself in the process. I gained 45 lbs, became depressed, and the relationship with my significant other eventually failed. As I turn 31 and reflect back on my journey I’m struck by how much the core principles matter. When we neglect our own health everything we care about can slip away, even if we’re focussed on those very things. Here’s some of how I began to pick things back up, to reshape my body and mind, to become a person I’m proud of once again.
It’s difficult to know where to start, but perhaps a summit or valley is the best spot. In November of 2018 my grandfather died, I learned that the person I thought was my biological father likely wasn’t, and my fiancé and I called off our engagement. I was in a terrible place mentally, emotionally, and physically, but I had been there for some time. I had let myself go. The most difficult time of training for most MD-PhD students is right in the middle, when we shift into the constant stresses of graduate school, when close bonds to our MD only colleagues transitioning to residency fray, and when once promising thesis projects we’ve thrown ourselves completely into begin to fail. I had lost so much of my identity and purpose at that point, and it was reflected in my physical health. My exercise, journaling, and reading habits had shifted into unfocussed experiments trying desperately to gather the next piece of data that would surely resolve my failing projects and my failing relationship. Failure is at the core of doing science, but facing it day in and day out strains your self-worth. You lose hope. You blame yourself. You tell yourself it’s due to you making a mistake, not being careful enough, or at the very least, to you picking the wrong experiment to do in the first place. It’s this middle period where we haven’t yet accepted that this is the reality of science, that failure is a core and essential part of the process, before we fully grasp the need to separate our self-worth from our experimental results. This is the period in which we are most vulnerable as trainees, and that’s exactly where I was at. The failures were adding up, and the pressure I carried pushed me down. I shifted between periods of either retreat, to spreading myself thin with as many experiments as I could muster, all the while neglecting relationships I cared deeply about and my own health. I grew to the heaviest I had ever been, and entered a really depressed place. My family visited me towards the end of summer in 2018 and helped me realize just how low I had fallen.
My weight loss journey began shortly after that visit. They helped re-inspire me, helped me begin to believe in myself once again. But then November of 2018 happened (the first arrow to the left on the chart above). When you lose your own self worth, others can stop valuing it too, setting up a cycle which is difficult to recover from. I had neglected my relationship with my significant other, had stopped being the confident partner I once was, and helped set up a behavior cycle for which we both realized there would be no recovery from. With the passing of my grandfather and the identity crisis and relationship collapse following shortly thereafter, things came to a head all at once and the little progress I had made slipped. I plunged into depression and began having suicidal thoughts. I knew there was a problem, and I took my first extended time off of graduate school to visit my brother. This is when my true recovery began (second arrow). I set up counseling appointments with UAB’s Professional Development Office. I began journaling, playing music, going to concerts, and building in and prioritizing “life” time again. I began to work through my problems and to reconnect with and reclaim value for myself. I set up a structure and committed to stepping into a gym again for the first time in several years.
And then I did it again.
And again. For two days, then three, then a week, then 2 weeks, then a month. I didn’t have a plan, I didn’t know where I was going to go, but I knew I wanted to go somewhere, and that I would feel good at the end of each day if I just showed up. I focussed on the routine. Get to the gym 3-4 times a week, try to do a workout you enjoy, experiment, try yoga, try a headstand, play. But most importantly, just show up. If I did that I knew I could call it good enough and be proud of myself each day. Similarly, I began tracking what I ate. I downloaded a calorie tracking app (I chose LoseIt) and committed to just logging what I was eating. I put my metrics into the app and picked a plan/weight loss goal, but I decided it didn’t matter if I went over the daily calorie budget or not – as long as I logged my meals I called it a win at the end of the day. Slowly I began to feel good about myself again, to regain confidence in who I was, in what I offered. The scale began to move and it kept moving, and I kept moving too and kept showing up. The success felt great, and I similarly began to dissociate experimental results and how others saw me from how I saw myself. I began to take control of things in my life that had felt uncontrollable. We all accept it as truth, but often fail to behave as if it is so: when you take care of your body you take care of your mind. I had more clarity in which experiments were the right ones, in who I was as a person, in what I wanted to reach for each day. Some of my experiments began to work, and progress finally began to come. I dropped 35 lbs, re-established friendships, and took the first vacation for myself I’d ever taken with one of those friends.
As this weight had come off so quickly, I decided to try to maintain my new figure and mental/physical habits for some time (the period between the dashed lines on the chart) to get used to my new equilibrium, to prevent a rebound, to focus on finding some happiness in all of this, to enjoy where I was and where I was going, to get back in touch with aspects of myself I had neglected. Things began to add up, and my self-esteem eventually returned. I turned 30. I went to 3 music festivals. I started playing music again. I attended a conference in Hawaii and stuck around for a vacation. As I began to take time out for play and health, curiosity and a sense of wonder returned to my lab work. I began finding joy in science again, to approach experiments from more of a place of curiosity and play rather than as a reflection of my identity, to see “failures” more as progress towards success in the sense that we learned something each time and/or improved our technique for the next attempt. It all became fun again as I put less pressure into things, and this approach eventually paid off. I published my second first-author paper and collected the essential data required for my third and fourth. I took time out for play, and worked with much more focus, intent, and insight than I had ever been able to achieve before. I found myself again. I hit my stride.
Now confident I could control my body and my life, I set my eyes on a new personal fitness goal of achieving ~10-12% body fat or 70 lbs total weight lost, and started tracking my calories closely again at the start of 2020. I wanted to be proud of my figure, to challenge myself to get in the best shape of my life. I hit this goal the same week I defended my PhD dissertation (third arrow). And then I had some cake.
Here are some things I’ve found helpful and want to pass on to those trying to get in shape:
1) Focus on repetition, routine, and showing up every day, and aim small at first so you can stick to it. There is a lot of information out there related to health/fitness, and it is easy to get lost in different diet plans, training plans, etc. Don’t worry about all the details at first. Keep it simple: eat less food than your body uses, and know your workouts probably don’t burn nearly as much energy as you think they do. The biggest thing for me was tracking calories as it made me aware of what I was consuming (I’m a huge snacker and these snacks add up quickly!), and how dense certain foods were over others. By and large, the thing that is going to determine your success is whether or not you do something more days than not. You have to change the way you’re living your life in order to see progress, so invest your energy into building new routine, habit, and focus into your life, aiming small at first so the habit can stick (i.e. just focusing on logging foods into your calorie tracking app). You’re going to miss days and mess up, and that’s okay! I definitely did. The key thing is to try again tomorrow, and succeed on more days than not. Don’t lose hope – the scale will stick or even reverse on some days, but overall across weeks and months, the weight will fall off. Trust the basic system you set up for yourself. Trust the process. Finding the perfectly tuned plan for yourself can come later once you have strong basic habits already integrated into your life.
2) I’m convinced the two main ways people make drastic changes to their lives are either following large life events (such as tragedy or wake-up calls), or with peer pressure across time. We often become those we surround ourselves with, so try to surround yourself with others who share the goals you set for yourself. I didn’t have a community of people near me as interested in reclaiming their health as I was, but with youtube you can build this community for yourself. I personally watched videos by Mario Tomic quite a bit to help keep me motivated and focussed.
3) Some days were more difficult than others to hit my target calorie count, and certain tricks helped. I stocked my cabinet and work space with teeth whitening gum that I could reach for when I wanted a snack. Who knows if the whitening actually works or not, but it seemed better to chew on that than others for my teeth, so I stocked mentos pure white gum everywhere I could (tasted the best of those types of gums to me). Similarly, when I craved something sweet, I occasionally turned to Halo Top and other low calorie ice cream to tie me over. I think they saved me and made things in general much more tolerable for me. Some standout flavors are peanut butter cup, mint chip, and peaches & cream. Also, diet soda is 100x better for you than regular soda. Make the switch if you need to and in general try not to drink your calories. Alcohol adds up quickly too, so stop at one or two drinks. If you have an event coming up where you know you’re going to splurge, by all means do it, but try to account for it by lowering your calories around that day slightly so that you can still hit your overall weekly goal. Don’t beat yourself up though when you mess up – just try again the next week. Finally, leafy greens are close to zero calories and take up a lot of stomach space. Eating a ton of these in bulk with some lean protein goes a long way towards filling up and curbing hunger.
A person’s weight should by no way determine one’s self-esteem (cue Lizzo), but at times, my weight has certainly reflected my own sense of self worth. I’m in a much better place now than I was when I started this journey. Mental illness however is very real. I don’t know if I would have made it here if I didn’t start counseling when I did, or have family members to help me realize how low I had gotten. Seeing a healthcare professional is the best place to start if you’re in a similar spot as I was, and there’s absolutely no shame in doing so. It’s what pulled me out of a rough place. I’ve still got so much to learn, and some days are more challenging than others, but I’m so thankful to be here now.