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It’s finally here.

The blog post which some have been requesting. Aptly, it is being published on New Year’s Eve. I hope this encourages and inspires you to consider realistic fitness and health goals, particularly if you’re one who sets New Year Resolutions.

For those just interested in the rough ‘before’/’after’ photos and only want an overview of the progress, head to the bottom of this post.

PRECIPITATING AND PREDISPOSING FACTORS FOR THE DECISION TO LOSE WEIGHT

Let’s go back to the beginning.

I enlisted on 5 January 2016, and ORD-ed in November 2017. I finished my BMT in March 2016, after which I was posted to 48 SAR 1st COY where I trained as a tank operator (specifically as a driver of the L2SG main battle tank, but I also underwent training operating the weapon systems of the main battle tank, and how to load the rounds).

Within my unit, I was always considered by many to be slightly above average (for my running, at least) in my physical fitness parameters. My company had around 50-60 servicemen and for the 2.4 km run component of the IPPT, I would normally be among the first five to complete the run.

In May 2016, I was required to take the IPPT shortly after being transferred to 48 SAR/1st COY. On this occasion, I achieved my all-time personal best for the 2.4 km run: 9 min 39 sec.

Fast forward to November 2017, when I completed my mandatory full-time NS. After a three-month break, I then commenced my medical studies in Australia in Feb 2018.

You see, back when I was studying in Australia, I pretty much lived independently. I had my own bedroom in a house which I shared with other occupants. I did my own groceries and had much greater freedom regarding my gastronomic choices. I was quite disciplined with what I bought – adhering to a diet that many would dismiss as boring. I would pretty much eat the same thing every day (eg muesli, full-cream milk, either salmon or steak, and a ton of eggs). I would pretty much never buy any snacks/dessert during my grocery runs.

As such, my weight had hovered between 61-62 kg for more than 2 years (I had studied in Australia for a grand total of slightly over three years: from Feb 2018 to May 2021).

When I first returned to Singapore due to the medical school transfer in AY21/22, I arrived in Singapore in end-May 2021. Largely due to a complex interplay of different reasons (e.g. reduced autonomy over the food I ate as I no longer settled my own groceries and chose what I wanted to eat at home, the constant ubiquity of highly processed food in my fridge at home, less flexibility over my eating hours due to a persistent family tradition of eating together for dinner as much as possible, larger-than-average portion sizes for home meals, easy access to fatty and oily foods from the coffee shop across the road), my weight dramatically increased as soon as I returned to the little red dot. Grappling with the transition in the different medical school learning environments, it was all too easy to rely on food as a constant stream of quanta of solace.

Since I returned to Singapore in end-May 2021 for good to continue my medical studies in YLLSoM, the exit permit I previously possessed that had hitherto exempted me from all annual reservist IPPT obligations officially become null and void. As such, when I birthday came around last November, I was informed by MINDEF that I ought to complete my IPPT within the fresh “window”. Such a window (time period) is personalised for every reservist personnel and commences whenever it is the serviceman’s birthday. Officially, at least for MINDEF, a person’s birthday is measured by when the person’s actual birthday passes, and not when the calendar year changes.

In June 2022, when I took the mandatory IPPT, the score that I obtained was 84, a mere 1 point from gold. By many people’s standards, passing the IPPT when it has been half a decade since the last IPPT attempt as an NSF is a fantastic result, let alone doing well enough for the monetary incentives. However, I wasn’t contented with a mere ‘pass with incentive’, or mere Silver. The result stang so much because I was so close to Gold (achieved at a minimum of 85 points).

It’s not a regular 1-point difference. The one-point difference was ultimately due to the fact that I had run 10:21 for the 2.4km run instead of the required 10:20 (given my combination of scores for the push-up and sit-ups stations) for the Gold Award. As such, for my first reservist IPPT attempt, I clinched a Silver award at 84 points. However, because I didn’t clinch the Gold award, I only received a $300 incentive (for Silver) instead of the typical $500 incentive (for Gold). Can you believe that?

Losing out on $200 due to a 1-second difference!!

Tragic, isn’t it?

This was certainly the precipitating factor for my decision to initiate my journey of intentional, sustainable weight loss with the aim of reducing total body fat percentage.

In retrospect, missing out on Gold wasn’t all too bad. After all, it was the wake-up call that I had to lose weight. To illustrate the effect of body weight on running speed, a cursory Google search would reveal that for each pound (about 0.45 kg) of body weight lost, you can run a mile by 1-2 seconds faster than that of your current speed on average for the same effort expended.

However, to give even more context, this miss on the Gold acting as the triggering factor occurred on a background of a progressive discomfort and uneasiness that I experienced over the fact that I was technically in the ‘overweight’ category (my peak recorded weight was 71.5 kg in Feb 2022; for an Asian of height 173 cm, this corresponds to a BMI of greater than 23.0, which means I’m overweight), a label which I did not like on myself (not only because I had never been overweight, but also because of the dire acute and chronic complications that generally being overweight had on my constitution). One thing that too many people in Singapore aren’t aware of is that Asians have a higher risk of cardiovascular complications at any given BMI compared to the typical Caucasian whose ethnicity constitutes the majority in influential countries such as the US, UK, Canada, Australia, or New Zealand.

Guess which ethnicity the World Health Organisation (WHO)’s BMI guidelines are catered towards?

Beyond BMI, the same can also be said of another anthropometric measurement: waist circumference.

A well-known limitation of BMI is that it doesn’t consider the varying contributions of the different components of one body’s weight (mass due to muscle, fat, water), and therefore should be interpreted with caution, particularly in pregnant individuals or individuals who have a unusually significant lean mass (e.g. bodybuilders). Compared to BMI, waist circumference is a better surrogate marker of one’s body fat distribution and one’s risk for cardiovascular disease. WHO’s guidelines for the waist circumference threshold for truncal obesity are: 102 cm and 90 cm in men and women respectively.

As with the example of BMI earlier, the 102/90 figures apply to the typical Caucasian and provides spurious reassurance to people of Asian ethnicity. The corresponding thresholds for truncal obesity in the population in Singapore, which have been previously determined from Asian-specific epidemiologic studies, are more conservative: 90 cm and 80 cm for men and women respectively. It certainly wasn’t reassuring to know that at one point, my waist circumference was 86 cm, just a mere 4 cm away from the abdominal obesity threshold for males.

The message was clear.

These personalised anthropometric measurements were of great concern and certainly necessitated prompt action.

As such, on 26 June 2022, I officially endeavoured to rectify my dietary habits and exercise habits (or lack thereof). The following sections will reveal how exactly how I went about doing this.

HOW EXACTLY THE PROCESS OF WEIGHT LOSS TRANSPIRED (INCLUDING MISTAKES TO AVOID)

As someone who was embarking on a process of weight loss for the first time, there was clearly room for improvement in terms of how I started the journey on Day 1. These were issues with the very start. Therefore, if you yourself want to lose weight while following the general trajectory I took, I highly suggest you address the following issues to have a smoother and more satisfying experience:

• Not having a reliable weighing scale.

A reliable weighing scale is an important tool for tracking progress in a weight loss journey because it allows a person to accurately measure and monitor his weight. This information can be used to gauge the effectiveness of a weight loss plan and make any necessary adjustments. For example, if a person is following a calorie-controlled diet and exercising regularly but the scale is not showing any changes in weight, they may need to reassess their plan and make adjustments in order to see progress. On the other hand, if the scale is showing consistent weight loss, it can be a motivating factor that helps a person stay committed to their weight loss goals. With the manual mechanical scale that my family had for aeons, it was hard to track progress, particularly when one has doubts regarding the accuracy of the scale itself.

• Not taking the steps to minimise interday variability in weight due to factors that are easily mitigated.

The most accurate way to track one’s weight day-to-day is to measure one’s weight on the electronic scale the first thing after waking up in the morning (after completely emptying one’s bladder and clearing one’s bowels, and before consuming any food or liquid whatsover), with all accessories, jewellery, garments, and undergarments removed.

Any deviation from what I have described in the paragraph above will most likely lead to an unncessary increase in interday variability in weight, which makes progress tracking more challenging than it needs to be.

• Not using an app for weight and calorie tracking from the very start.

With an app such as LoseIt (which I only started using a few days after commencing the weight loss journey), I was able to have visual overview of my progress, and this motivated me to persist with what worked for me. A comprehensive outline of the benefits of using the app such as LoseIt to facilitate weight loss is beyond the scope of this blog post, but in essence, it aided me greatly. I tracked my calories, my macros, and received encouraging reminders of the milestones I had attained.

• Not taking adequate ‘before’ photos.

I should be grateful that I at least have a photo of myself (taken on 26/6/22) that was taken around the time I decided to lose weight. It’s certainly better than nothing. There are many people who don’t even have a single photo around the time that they decide to start their weight loss journey, and this makes accurate comparison (via a before-after) challenging.

Nevertheless, if I could do things all over again, I would definitely take more photographs. Clearer photographs. Photographs of myself from the hips and up, and in the side, frontal, and back views. This way, the ‘before’/’after’ transformation would certainly be more inspiring and motivational.

• Not tracking progress via photos at regular time intervals and consistent photo conditions.

It was only on 5/11/22 that I realised that the progress photos weren’t taken on regular intervals, and that it could be improved. As such, starting on 5/11/22 (Saturday), I would take a progress photo every Saturday using the front camera of my phone, with the photograph being in the dimensions of a square shape, with the visage being centered appropriately, with the lateral canthi of both eyes at the level of the 2/3 way up within the centre subsquare (when dividing the entire square photograph into nine equally-sized subsquares), and with the inferior border of the middle subsquare corresponding to the level of the subnasale. The facial expression is also kept consistent as much as possible (you can see a smile plastered on my face!).

Such standardisation as described in the above paragraph may appear excessive at first glance. However, when these photos are compiled into a specific album on one’s phone, it’s actually remarkable when one swipes left and right and instantly appreciates even subtle changes (made possible because the position of the face and all the relevant features are kept constant as much as possible!). In fact, outlining all these specifications for my progress photos is precisely what facilitates easy comparison between the progress photos that you’re about to see in the section below!

OVERVIEW OF WEIGHT LOSS JOURNEY + BEFORE/AFTER PHOTOS

In sum (particularly for those of you who just scrolled all the way down here to see the visual transformation), I made the decision to start losing weight on 26/6/22. On that day, a Sunday, I had gone to Tenya Orchard Central for lunch and had my ‘before’ photo taken.

On 1/7/22, I decided to ‘up’ my game by formally tracking the nutritional content of my meals and my weight, in order to better document my progress. However, the manual nonelectric scale I had at home was both imprecise and inaccurate. As such, I went to Decathalon Waterway Point to grab a simple and affordable electronic scale at about SGD 16 (cheaper than the ones from even retail pharmacies) a few days later. On 1/7/22, I also started tracking my calories on an app called LoseIt!. Starting on 5/11/22, I started taking progress photos at a consistent time interval (every Saturday).

Key milestones:

71.5kg (26/6/22 – date of ‘before’ progress photo) > 70.5 kg (1/7/22) > 67.4 kg (1/8/22) > 64.6 kg (1/9/22) > 62.6 kg (1/10/22) > 62.1 kg (1/11/22) > 61.5 kg (12/11/22) > 62.6 kg (10/12/22 – date of ‘after’ progress photo).

Apart from cropping the individual photos to a square shape and putting the watermarks, these photos are unedited, and have not been tampered in any way.

THE EFFECT OF THE WEIGHT LOSS, AND LESSONS LEARNT

Following the weight loss, I became a totally different person from the person I was in June 2022 and the few months preceding it. Mobility was enhanced. Running felt more enjoyable. My sleep improved slightly. My mood and self-confidence has flourished, and life is simply more interesting and enjoyable. Life’s just easier when you’re healthier, fitter, and more attractive.

Despite attaining my weight loss goal, I continue tracking my weight every morning religiously, and also still track my macros, and calories to a reasonable extent as this is excellent way to remain conscious of what I’m consuming. These are great habits that I hope to sustain indefinitely. After all, for any fat loss to be permanent, there needs to be some permanent and lasting change in one’s lifestyle habits. Bad habits need to be eradicated. Good habits need to be established.

Oftentimes, people embark on ambitious ‘detox’ programmes or fad diets that last a few weeks only to do a complete 180 and return to their old ways after the temporary programme ends. Under such circumstances, it should thus be no surprise when one regains all the weight one lost during whatever temporary programme one was on.

It’s hilarious how along the way, many people (including quite a few fellow medical students, one nurse in NUH, one of the admin staff in NUS, one surgical resident) couldn’t help but point to me that I had lost weight (particularly people I hadn’t seen in a while). Those are some of the greatest encouraging reminders of what I have accomplished and never fail to write glee on my face. When other people notice and also feel compelled to explicitly tell you, that’s when you know that it’s significant. Of course, I’m sure there are also more who noticed but chose not to point it out for fear of committing a faux pas.

Overall, the weight loss journey has been quite humbling. Often, doctors tell patients to ‘lose weight’ as a first-line noninvasive approach for the management of a variety of chronic metabolic conditions (see my previous blog post where I explored the role of weight loss in the management of osteoarthritis). While this advice is generally sound, it’s too easy to rattle it out of habit and without any conscious regard for how challenging it can actually be. This may be discouraging for patients who have already heard this advice repeatedly but nevertheless find it very challenging to lose weight.

This personal journey that I undertook will certainly be paramount in helping me empathise with my future patients when advising them to lose weight.

Indeed, as supported by the various guidelines, sustainable weight loss with the goal of reducing total body fat is achieved by sustaining a net caloric deficit, while still ensuring adequate macronutrient intake and appropriate amounts of resistance training and cardiovascular activity. The highly personal weight loss journey has etched this cardinal rule of weight loss into my mind forever.

WHAT’S NEXT

After that glorious run of a cut, I made the transition to a brief period of eating at maintenance (i.e. having neither a net caloric surplus or deficit in order to maintain weight, with the proportion of lean muscle and body fat remaining the same during maintenance), followed by a controlled ‘bulk’ (i.e. striving for a slight caloric surplus accompanied by adequate daily protein intake (0.82 g/lb of body weight) to facilitate muscle hypertrophy).

I realised that if I wanted to get even fitter, healthier, stronger, and look even better, I had to incorporate consistent resistance training into my life. As such, on 6/12/22, I started checking out various gyms (aided by the guidance of my youngest brother who had already been consistently doing strength training for about four months) in the vicinity of my residence and soon realised some limitations. Many fairly basic gyms (particularly in most condominiums) lack barbells, which are required for the classic compound exercises: deadlifts, squats, bench press, and overhead press.

While chest press and shoulder press machines exist in virtually all gyms, they are suboptimal compared to barbells because they do not activate the required stabiliing muscles to the same extent. Additionally, the weight increment intervals on the machines are far larger, which makes tracking incremental linear progress via weights more challenging.

Fortunately, after some research, I managed to locate a reasonably priced gym near my residence that has barbells, and the relevant bench press stations and squat rack.

As such, on 26/12/22, I officially began a structured beginner’s strength training programme. Looking forward to reporting both visual and numerical progress/results in a year’s time. Stay tuned!

Nic
31 Dec 2022