Losing weight when your BMI is 40 or higher can feel impossible—but it’s not. I’ve helped hundreds of people, including myself, lose significant weight. One client sticks with me—a former rugby player and sumo wrestler whose health was rapidly declining. We started small, but sometimes, even small changes come too late. If you’re ready to make sustainable changes, this article will guide you through practical, realistic steps to healthier living.

*TW – blunt language and story about obesity*

Fighting for Your Health — Taking the First Steps

Story time. Fair warning this could get a bit heavy (pun intended).

I’ve helped hundreds of people lose weight including myself; I lost 30kg (66lb) in order to join the army. One chap sticks with me. He was huge. Not just big, enormous. I’ve worked with some monster folk in my time, between strongmen, soldiers and the like, but this guy probably tipped them all off the scales. He’d been a rugby player, sumo wrestler, bouncer — all those jobs where being big was a plus. But life had hit hard, he kept eating like he was still in those gigs, and his health went downhill fast. He was too scared to even come into the gym, and said people laughed at him outside when he’d first tried to come. I doubted it, knowing how accepting and friendly my gym is, but when I saw him I was less dubious…people probably stared.

We started with a walk, 20 meters at a time, at which point he had to catch his breath. We just talked about small changes he could make. I gave him the similar advice I give lots of people, the advice that’s helped countless clients turn their lives around, get back to sports, and be better for their kids.

Sadly, it was too late for him. He passed away during the pandemic likely due to comorbidities. I can’t help but wonder if he’d made those changes sooner, things would have been different.

If you’re reading this, you’re hopefully ready to make real, lasting changes to your health. A BMI of 40 or above indicates significant obesity, and while quick fixes might seem tempting, sustainable lifestyle changes are the key to long-term success. Looking at the research, those who use quick fixes like Ozempic or surgery seem to fare better when they make these changes anyway, usually with the help of some coaching.

This article will guide you through practical steps to improve your health and begin a sensible weight loss journey, while thinking of diets, surgery and medications as potential tools, not miracles.

All About the Body Mass Index (BMI)

BMI serves as a valuable initial screening tool for assessing weight-related health risks. While it doesn’t directly measure body fat, it offers a quick estimate of whether someone’s weight falls within a healthy range for their height. It’s crucial, however, to interpret BMI within the context of lifestyle factors like activity levels and muscle mass. Even though increased muscle mass can enhance quality of life, a high BMI due to excess muscle still places a greater burden on the cardiovascular system.

Ultimately, regardless of composition, carrying excessive weight, even if it’s muscle, statistically increases the risk of health complications and can reduce longevity, as the heart must work harder to circulate blood throughout a larger body. Many heavyweight bodybuilders with a higher than average BMI end up with suspicious heart problems.

In my experience, many detractors of BMI as a measurement could do with paying it some more attention and I will include myself in this statistic.

Author’s note: According to the World Health Organization (WHO), in 2022, 2.5 billion adults (18 years and older) were overweight, and 890 million of these were living with obesity. This means 43% of adults worldwide are overweight, and 16% are obese. Obese people are more than 2.5 times more likely to develop high blood pressure and have an increased risk of certain cancers, including being 3 times more likely to develop colon cancer.

Understanding the Risks of Quick Fixes

Before we dive into healthy habits, let’s acknowledge the drawbacks of some “solutions” that are seen as easy and are becoming more common:

Weight Loss Surgery (Bariatric Surgery):

While effective for some, surgery carries significant risks, including:

• Nutrient deficiencies (requiring lifelong supplementation)
• Dumping syndrome (causing nausea, vomiting, and diarrhea)
• Infections and complications from surgery
• Psychological adjustments and potential for addiction transfer
• Long term changes to the digestive system – imagine not being able to ever enjoy a proper Christmas/thanksgiving meal again…

Ozempic and Similar Medications:

These drugs, while helpful for some with diabetes, can have side effects:

• Nausea, vomiting, diarrhea
• Potential for pancreatitis
• Gallbladder problems
• Rapid weight loss can cause loose skin, which can frankly be as demoralising on any given day as being overweight
• Dependence, and weight regain after stopping the medication
• Long-term effects are still being studied

Focusing on Sustainable Lifestyle Changes

The foundation of healthy weight loss is a balanced approach to diet and exercise which can sound boring or intimidating, but that really depends on how you approach it.

1. Calculate Your BMR (Basal Metabolic Rate)

This should be good news in case you’re worried or already bored. Your BMR is the number of calories your body burns at rest. Knowing this helps you create a realistic calorie deficit.

Calculating BMR (Mifflin-St Jeor Equation): This is considered one of the most accurate equations to calculate BMR.

For men: BMR = (10 × weight in kg) + (6.25 × height in cm) – (5 × age in years) + 5

For women: BMR = (10 × weight in kg) + (6.25 × height in cm) – (5 × age in years) – 161

Example: Let’s take a woman, 40 years old, 170cm tall, and weighing 120kg (BMI approximately 41.5).
BMR = (10 × 120) + (6.25 × 170) – (5 × 40) – 161
BMR = 1200 + 1062.5 – 200 – 161
BMR = 1901.5 calories.

To find your TDEE (Total Daily Energy Expenditure) you must multiply your BMR by an activity factor. For someone with very little activity this factor would be 1.2, for someone with light activity 1.375, moderate 1.55, very active 1.725, and extra active 1.9.

Example: if the woman from the example had light activity, her TDEE would be 1901.5 x 1.375= 2614 calories.

A 250-500 calorie deficit would mean she should aim to eat between 2114 and 2364 calories per day.

Try this link for an easy online calculator: https://www.calculator.net/bmr-calculator.html

From this you can hopefully see that you don’t have to starve yourself to start losing weight and more often than not, an all-or-nothing approach will do more harm than good. Being larger means you will burn more calories than the average person, which is nice to know as a starting point (but bear in mind that this will reduce as you lose weight).

Even if you don’t track calories (which understandably some people find difficult or triggering) simply and slowly following the advice below should bring you into the required deficit. But you need to allow for time, and we’re talking years, for the process to take effect. Remember you didn’t get where you are in 2 weeks — allow yourself time to get to where you want and to start enjoying how you feel as a result.

2. Gradually Implement These Dietary Changes

Prioritize Whole Foods: Focus on fruits, vegetables, lean proteins, and whole grains

Practice Portion Control: Be mindful of serving sizes. Use smaller plates and measure your food. Think of your hand as a gauge of how big your stomach is [see diagram]

Limit Processed Foods: Reduce intake of sugary drinks, fast food, and processed snacks.

Increase Protein: Protein helps you feel full and supports muscle mass.

Hydration: Drink plenty of water throughout the day.

Sample Day of Eating (Approx. 2200 Calories):

• Breakfast: Oatmeal with berries and nuts (400 calories); two chicken sausages
• Lunch: Large salad with grilled chicken or fish (500 calories)
• Snack: Greek yogurt with fruit (200 calories)
• Dinner: Baked salmon with roasted vegetables (600 calories)
• Snacks: fruit, or a small handful of nuts (500 calories)

Consult a Registered Dietitian: A professional can create a personalized meal plan.

3. Move Your Body

• Start Slowly: Begin with low-impact activities like walking, swimming, or cycling. I like walking since it costs nothing. In the case of my client simply walking 20 minutes per day would have been progress from where he was.
• Gradual Progression: Gradually increase the intensity and duration of your workouts. A 5-10% increase every 1-2 weeks is a good starting point. Week 1: walk for 20 mins per day. Week 2 walk for 22-25 mins per day, then 27, 30, 33, 36, 40. There’s a free 2 month program to get you started!
• Find Activities You Enjoy: This will make it easier to stick to your routine.
• Do Some Strength Training: Incorporate strength training exercises to build muscle mass and make you stronger. Pick 5 exercises that look interesting to you, understand how to do them with good, slow, controlled form, and aim to do them 2-3 times per week at first. Start with 2 sets of 8 reps each. Add reps each week for a month and then add sets next month when you should also increase the load slightly. See the table below. After 4 months choose 5 different exercises.
• Consistency is Key: Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, but build up to this if you need to. Remember, done is better than perfect and any movement at all is better than none.

week	1	2	3	4	Suggested exercises
month
1	2×8	2×10	2×12	2×8 Reduce load (deload)	Bench press – great for upper body, chest and back – https://www.youtube.com/watch?v=vcBig73ojpE
2 increase load	3×8	3×10	3×12	3×8 Reduce load (deload)	Lat pull down  https://www.youtube.com/watch?v=EUIri47Epcg
3 increase load	4×8	4×10	4×12	4×8 Reduce load (deload)	Leg press/squat Check out my article on leg press here: https://www.trainheroic.com/blog/leg-press-like-a-pro/  This is a video on how to back squat: https://www.youtube.com/watch?v=QhVC_AnZYYM it’s a little intense but really helpful.
4 increase load	5×5	4×6	5×5	5×5 Reduce load (deload)	Trap bar deadlift:  https://www.youtube.com/watch?v=v709aJKv-gM  More often available than a barbell in my experience. Also more intuitive. ‘Pick up your shopping bags’ maintain a strong ‘braced’ core throughout.

 

4. Embrace Behavioral Changes

• Practice Mindful Eating: Pay attention to your hunger and fullness cues. This is an important learning curve. Understanding what hunger and satiation (being full) actually feels like is huge. Talking to yourself about what you’ve eaten and how it’s made you feel during and after meals and keeping a diary really helps.
• Do Some Stress Management: Find healthy ways to manage stress, such as yoga or meditation, sports, the cinema, socializing with friends or walking your dog.
• Pay Attention to Your Sleep Hygiene: Prioritize getting 7-9 hours of quality sleep each night. Remove your TV from your bedroom (yes, really).
• Have a Support System: Find a support group or accountability partner; pets are great walking and talking partners.
• Track Your Progress: Keep a food and exercise journal. You’ll be glad you did this 6 months down the road!

5. Seek Medical Guidance If You Need It

• Consult Your Doctor: Discuss your weight loss goals and any underlying health conditions. Chat with your doctor in order to get serious about taking control of your health
• Regular Check-ups: Monitor your progress and make adjustments as needed. Blood pressure cuffs are easy and cheap on Amazon, as are scales. Pictures can be a double-edged sword. It’s best to take them at regular intervals (like once a month), so you can look back on your progress and feel really proud of yourself.

Sustainable weight loss is a journey, not a race. By focusing on healthy lifestyle changes, you can achieve your goals and improve your overall well-being.

Remember, small, consistent steps lead to significant results. Avoid the allure of quick fixes, and prioritize your long-term health.

If you’d like any advice or maybe just a chat, feel free to follow me and reach out on instagram @fred.strengthcoach – feel free to check out my 8 week gym starter plan here which includes training plans, more in-depth nutrition guidance and mindfulness work to help you build a program that works for you.

My Beginner Lifestyle Change DAILY Checklist

These are the most basic non-negotiables for meaningful change.

1. Walk for 20-30 minutes

This can be broken down into smaller chunks eg 10 mins 3 times today – walk to the end of your street and back. If it’s raining walk up and down the corridor or for an extra challenge walk up and down the stairs.

2. Eat 5 portions of vegetables

Use the diagram in this article to gauge what a portion looks like. It’s much easier than you’d think. If I have a meal without vegetables I will often just microwave a bowl of veg on its own to have on the side. These can be things you actually like to eat as well. Treat yourself to 5 minutes on google or using chat gpt to find a way that you will like to eat vegetables, thank me later.

3. Drink 3 litres of water (12 cups/0.75 gallon us)

Drinking more water will help you regulate your hunger signals much better. If you’re drinking enough (and the real cue for drinking more should be that you feel thirsty) and you feel hungry, chances are you’re hungry and you should eat – especially if it’s going to help you hit your 5 vegetable target.

4. List 4 reasons why you’re on this journey

These can be the same reasons every day or can change daily too. For example, my reasons for training and eating right today are:

• Staying healthy for my family (especially as I have a new kid on the way)
• Staying in shape for my combat medical role
• Keeping my mental health in check
• My wife likes my big arms 😉 and that makes me feel great.

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