In my last post I remarked that I ended up in A&E with chest pain during UKGE. What I didn’t say was that when I got checked out by the medics my blood pressure alone was in the “go to A&E right the fuck now” territory. Now, that was probably down to the stress of “oh shit am I having a heart attack”1, and by the time I was seen my blood pressure was barely raised, but as I waited around in the hospital to be seen at the various stations it dawned on me that something needed to change.
Tiamat2 says: this is a post that is going to talk about healthcare, weight loss, the culture around those both and my own personal journey. It goes without saying, none of this is medical advice, but if this if anything in here is something you struggle with, don’t be afraid to close the tab.
I was quite overweight. I’d had a few health issues in the preceding year which had all turned out fine3, and various blood panels had given me a reasonably clean bill of health, so I’d been taking it relatively easy in terms of trying to fix my diet by cutting out junk, trying to do better about portion control and limiting how often I indulged in obviously unhealthy things. Like, I already cook most of what I eat from scratch with good ingredients4 so there wasn’t a lot to do in that regard, but there were definitely issues with how I was eating.
It’s no secret I love food. I love good food, and being honest about it I was eating more than I would like for comfort rather than for health. It also didn’t help that I live on my own and it is difficult to cook for one, and I was often guilty of eating my leftovers the same day5.
Well, what’s actually the matter with being overweight? It should go without saying that overweight isn’t the same as unhealthy, and that a lot of what you can see in public health advice mistakes correlation for causation, and in fact the biggest health risk for overweight people is doctors6. But that isn’t to say there aren’t risks. The big one is blood pressure: whilst my resting blood pressure was fine, clearly during an emergency it was not and that does put you at all sorts of risks and two of the big contributing factors to blood pressure are weight and diet7.
Tiamat says: and genetics, and how much you drink (both volume and alcohol) and stress and lifestyle and a million other things, and if you have issues with blood pressure you should talk to a doctor and not a pikachu and a cat in a spacesuit.
So I decided, sitting in the Same Day Emergency Care waiting room that I should try to lose some weight. Fortunately for me there were already people in my family who were further down this line than I was who were willing to share their thoughts and what worked for them. (I was also referred to my GP for “lifestyle advice” but that was a big whoop8) From my family members, there were two primary approaches: structured diets and calorie counting.
Structured diets means things like weightwatchers, with or without the communal sessions. It’s the idea that by replacing some portion of your food with altered recipes that substitute calorifically dense ingredients with less dense ones or are formulated to limit them in the first place, you can reduce a person’s calorie intake enough to result in weight loss, and there are usually holistic systems in place to limit the amount of off-plan eating a person does, often in the form of some kind of count like “syns9” that assign calorie-, fat- or sugar-dense foods a number of points and you’re allowed a number of points per day/week/month.
Structured diets do work for some people and the communal aspect provides motivation and accountability to many10, and there are recipes from some of these diets that have (through family or exposure online) entered my general rotation11. There’s a chicken and orzo in mustard sauce dish I love that came from either weightwatchers or slimmingworld.
Calorie counting is in one respect much simpler: you count the calories in the food you eat and you keep this under some number, and if this number is less than the calories you burn then you should lose weight. The problem is you need to track the calories, and you need to track them accurately, and you need to keep an eye on actually how much you’re burning both to make sure you maintain a deficit and to make sure you’re not maintaining too much of a deficit12.
Tiamat says: diet is a deeply personal thing and whilst I am quite sceptical about diets like weightwatchers and slimming world, they do work for some people and as you will see calorie tracking isn’t for everyone.
Two things make me feel like in the year of our lord twenty twenty-six calorie counting isn’t nearly the pain that it would have been even fifteen years ago: we all have a supercomputer in our pocket that can maintain a database of everything you eat alongside a database of almost every product in a British supermarket13, and I live in the UK where calorie counts on the back of packages are going to be more or less accurate than in the USA where it’s all very wibbly wobby14.
That being said, I’ve now been doing it for about three months and there are a couple of major drawbacks. First off, my cooking style can be described as highly improvisational and there’s been a real learning curve in terms of measuring and logging everything, and it’s not always clear how to log some things, like if I fry something in butter it’s not always obvious how many calories the butter should contribute, same goes for any kind of deep frying. The second is that whilst the app I use has a large number of popular takeout and fast casual franchises in its database, they don’t have the kind of small restaurant I really like in there, and the UK law that means you need to put calories in your menu only kicks in at 250 staff15.
What I tend to do in both cases is guestimate. Can I find something in the database that’s close enough16, or can I make a recipe for it from ingredients and then add a fudge factor? But equally, the goal is not a perfect record but to assist in maintaining a calorie deficit. This is where I see the benefit in a system like syns. The same reason I hate it, that it’s a purely qualitative measurement with a side order of moralism, is what makes it useful. What’s a syn? One tenth (or whatever) of your allowance of off-plan food. Maybe a cheeseburger is five syns. It’s figurative, not literal.
But that’s the problem for me, because it turns out you can make a pretty good cheeseburger at about 600 calories that makes an excellent lunch17, and for me aiming for about 1800 calories per day that’s a good meal and gives me wiggle room for things like snacks and a decent dinner. As I expected, the main thing I needed to learn to be better about was portion control, and whilst I be lying if I didn’t say there were things I’d either cut out or cut down on (goodness there are how many calories in mayonnaise? Oh wait, it’s egg and oil18) most of it has been keeping to a reasonable portion of lunch and dinner, and doing things like no longer eating seven hundred calories of apple lattice19 every time I go to do a food shop. That was not a “little treat”, that was an entire additional meal.
Tiamat says: we’re about to start discussing specific numbers about weight loss, alongside targets for further weight loss. You can skip to the next (and final) “Tiamat says” section to skip all of that or just bail out here.
The week after UKGE I went out and bought a new set of body composition scales20 and for the first time in years I weighed myself. It was an unpleasant experience as it’s something I’ve had significant anxiety about, but I did it. My first good reading was 124 kilograms, which worked out for a BMI of approximately 43. It should be noted that BMI is bullshit, it has very poor predictive power and it was computed by an astronomer looking at highlands soldiers trying to find the average man, but here it stands in as a coarse metric of how far from a goal I was.
The app I use for calorie tracking uses your weight, height, age and your choice of one of two sexes to calculate an estimate for your base metabolic rate, or BMR21, which is a rough figure for how many calories you expend just being alive, and then it gives you a calorie target based on how quickly you want to lose weight. I got given a target of about 190022 calories per day based on a relatively sedentary lifestyle and a goal of about 0.9kg (or 2lb) per week. This was frankly more than I thought it would give me, but it turns out that fat is alive and it burns calories like the rest of you, so it needs calories too.
The advice I got from everywhere was for the first few weeks to just log what I ate. Fat chance of that23. Very quickly I realised that my portion control was fucked, and that there were many things I thought of as “not a big meal” that easily hit a thousand calories. Goodbye chicken wing starter at Pho24, farewell side Caesar salad with a pizza, so long routine double sausage and egg mcmuffin meals25 when travelling alongside a day of otherwise heavy food.
It’s been about three months, and in that time I have now lost about 12 kilograms. Based on the proportion of fat and muscle that the body composition scales say that I have lost, that’s about ninety-thousand calories that I didn’t eat26. This takes me to about half way to my target of less than 100 kilograms by the end of the year. At that point I will look to see where I’m at physically and maybe consult some medical professionals about what a sensible target weight might be27.
One thing I have had to be very vigilant about is not becoming obsessed. I know first hand that it’s a risk. I never really talk about it but I had a period of disordered eating when I was a young teenager, and frankly I’ve been living with disordered eating in the other direction since at least the pandemic. Fortunately, what with the restriction being limited enough, it’s not felt restricting, aside from a few early wobbles of “is this forever?”28 it’s mostly just faded into my background and I don’t need to be too strict about it.
Calorie restriction isn’t the whole of it. I’ve been working to get back into cycle training, using an exercise bike and the generally very good Apple Fitness+ videos29. I did hit 30 minutes a day for two weeks before the heatwaves hit, but not since, however I am for the first time possibly ever hitting the government recommended 150 minutes a week of moderate exercise, which is good. Turns out, moving your body is good, and I just need to find ways that don’t suck for me30.
This is also the point where I feel like I need to talk about GLP-1 antagonists. Everyone has to do what they have to do, but for me I didn’t think the risks were worth it, especially considering that evidence suggests that you just put the weight back on when you come off the drugs. Not to mention the eye watering costs. People talk as if you can save money on food but how? I do not skimp on my groceries and I enjoy eating out, but I would have to cut my diet by two thirds to come out even. And a big part of what I like about calorie counting is that I can have a stupid big steak, or a hot chocolate, or fried chicken, as long as I make it up elsewhere31. The descriptions from people on GLP-1 antagonists of being unable to enjoy food sound like hell32.
Tiamat says: that’s the end of chat about specific numbers around weight loss. You could stick around for a closing statement or just close the tab. This isn’t a youtube video, no-one is tracking user retention.
Overall it’s been good. I’ve used it as an opportunity to clean up my diet in a few other ways as well, like making sure I’m getting enough protein and fibre, and trying to cut down on salt. It’s also been good to re-evaluate where I’m getting my protein from, and to try and incorporate more beans in my diet. Beans are good, people. Eat more beans33.
The physical changes have also been nice, and not just appearance wise. About two months ago I adopted Tiamat, my new cat who was the model for the new cartoon mascot of the blog. Before all of this, I struggled to lie down on my front, but now it’s much easier. I’m sleeping better, my knees hurt less, and I can still enjoy my food. Even if I am looking forward to having a few hundred extra calories a day to play with some time next year to eat a little more fried chicken a little more often.
Heart attacks are sufficiently bad that the NHS want people to treat them seriously, so anything that could be a heart attack gets you to call 999 immediately. This is bad for the stress of the people like me who injured the muscles in their chest, but good for people who might think “oh yes I did move a box” and downplay their actual heart attack. ↩︎
The adorable Tiamat cartoons were drawn by Rossy↩︎
It’s amazing the number of ways a human body can fuck up that are within tolerances. As a person who likes certainty, I did not enjoy “well there’s nothing obviously wrong, try drinking more water”, but also I drank more water and tried to be less stressed and it fixed the things, and I got to see that there are parts of the NHS that work very well when there’s a reasonably immediate risk. Still sucks for chronic issues though. ↩︎
In the past few years I got into buying good olive oil, and one thing I have had to adjust is how much I use in day-to-day cooking. At nine calories per gram, it’s an indulgence but also it’s good for you and it turns out I didn’t need as much of it as I was using. ↩︎
I wish I had something better to say here, but it really did come down to building the discipline not to do this. Boxing stuff up early and making sure it goes in the fridge. ↩︎
In the form of doctors refusing treatment (either formally or casually) to people they deem to be overweight. It manifests in big ways (the NHS won’t give you knee replacements if you’re overweight) and small ways (overweight patients get told “lose weight” rather than referrals). The general consensus I found was that the real issue is inflammation, and that’s not a straightforward correlation with excess weight. ↩︎
Oops it turns out I’m also eating too much salt. I am still under the UK average though. Reduction is more difficult here, as looking at my stats a lot of it is coming from ingredients that are hard to replace like high quality jarred beans and stocks. ↩︎
I eventually got to talk to someone, who told me that I was intelligible for assistance because I had already started losing weight. Good job. ↩︎
You can miss me with this fake moralism around food. They’ll wax lyrical about how it’s an accident that it sounds like the word “sin”, but they clearly want to label food as “bad”. This stuff is clearly quantifiable, so quantify it. But you can’t sell “count your calories, eat enough but don’t eat too much” for twenty quid a month. You can for forty a year though. ↩︎
I have pathological demand avoidance, so I feel like going to a place and having a person tell me I need to lose more weight would be counterproductive. I do have support from friends and family though, which is important. ↩︎
I did make modifications though, mostly in the form of adding way more seasoning and swapping out chicken breast for chicken thigh. Sadly this is a change I’ve had to change back as thigh is too fatty and I tested it and preferred more breast meat than less thigh, and it doesn’t cook long enough for the thigh to really win out. ↩︎
It is both as simple as calories in vs calories out and way more complicated than that. If you cut your calorific intake too sharply or increase your expenditure too fast then it’s well understood that your body goes into starvation mode and cranks down your metabolism. This is doubly bad for you because the way it does this is by cutting way back on your immune system and general upkeep, meaning not only do you not lose weight, you also get ill. ↩︎
I use NutraCheck, and it’s generally pretty good, but it has some weird gaps and it turns out if you import tinned cassoulet from France that’s not going to be in the database. It’s also off sometimes, and it’s unclear how I can get them to fix it. ↩︎
In the UK you have to list calories for both each serving and for each 100g/ml of the food, and typically this is also shown as prepared. In the USA, they only have to tell you the calories per serving, they can round to the nearest 5 cal and if it’s under 5cal per serving, they can say it’s nil. There is a spice rub I like that comes from the USA which claims to be zero calories per serving. The second ingredient is sugar. ↩︎
I get they don’t want to put undue burdens on smaller cafes and restaurants but hell, if I can figure out the calorie count for most of what I cook using a simple database tool, so can the cafe down the street. ↩︎
For example, if I want to make fried chicken, can I find a comparable item on the KFC menu and use their calorie count instead? Or if I’m out at a small restaurant, can I find a similar menu item at a big franchise for the menu item I want to order? ↩︎
Generally I aim for about 700 for lunch and 900 for dinner. Some days it’s more like 800/800, but I try to keep both meals over 500. ↩︎
Fun fact: most “light” mayonnaise replaces some portion of the mayonnaise with heavy cream. Dairy free light mayonnaise is diluted with emulsified water and has a texture from hell. I now just use less mayo. ↩︎
They come in a two pack, and don’t keep well. They were only small so I forgot/ignored that they are full of sugar and fat. They are delicious though and in moderation can from part of a sensible diet. ↩︎
Consensus is that the actual numbers it spits out for stuff like “lean body mass” are bullshit, but the trends are useful to watch. ↩︎
This is also a bullshit number, but better backed up with experimental data and there are options for finding out how much energy you actually burn if you want to spend the money. But for most cases, if you’re losing weight then there’s little reason to do so other than curiosity. ↩︎
Technically it gave me a target of ~2150 but it makes a few assumptions that didn’t apply to me, and so the actual target was ~1900 and I aim for about 1800 and try to increase my intake on days where I do meaningful exercise to adjust. ↩︎
You can’t give me a number and expect me not to look at it. ↩︎
It’s eight hundred calories on its own. That more than some of the mains. My regular order (wings, spicy chicken curry, side of Chinese leaf, two homemade lemonades) was more than an entire day’s calorie allowance. ↩︎
It’s easy to say “of course a double sausage and egg mcmuffin is a lot of calories” but it’s about reframing it in my mind. As a treat, it’s one thing. But sometimes when I was travelling for work I’d have it for breakfast every day for three or four days. That’s not good for you. ↩︎
This is about a third of my calories over the period. That’s a bit sobering that I was over-eating by about 50%. ↩︎
There’s a difficult conversation to be had at this point. According to BMI I want to go below 70kg. I wasn’t 70kg as a teenager when I was cycling 50km a week. ↩︎
Some form of vigilance about what I eat will probably be forever, but calorie tracking hopefully won’t need to be a part of my life beyond 2027 if all goes well. ↩︎
There are good instructors and there are bad instructors, but it turns out spite is a powerful motivator to finish a spin class. ↩︎
I found out several years ago I really like running, but my knees really don’t and talking to a sport physio about it, his answer was “don’t run”. ↩︎
There are absolutely bad foods with ingredients that will harm you, and if your diet is nothing but lard you will see the consequences, but there’s a lot you can fit into a diet in moderation. And a little excess is one of them, if you’re willing to cut back on the excess elsewhere. Have the big steak, just maybe have a light lunch. ↩︎
I recall when they were first approved for weight loss in the UK, some of the trial participants never got their sense of enjoying taste back. This was apparently an acceptable risk, which seems mad to me when the same side effect of long covid is considered life alteringly bad. ↩︎
You can fry a diced onion and some garlic in some olive oil, then add a jar of queen white beans alongside a bay leaf, some oregano and thyme, add some lemon juice or fruit vinegar and cook until saucy. Great as a side for simple pan fried meat, or substantial enough to serve as a main with some garlic cabbage and potato parmentier. ↩︎
