You need to start with a doctor and a full blood workup. It's possible, even likely, based on what you describe that you may have Type 2 diabetes or are at least pre-diabetes. You almost certainly have metabolic syndrome and a fatty liver.

Once you have the blood work you can create targets. You'll want to get your sugar and A1C down if you have diabetes. You can do this through a combination of eating better, moving more and maybe medications like insulin or a GLP-1 like Ozempic.

I have lost 45 pounds since February since getting the diabetes diagnosis doing the above. What works for me:

-- Writing down everything I eat in an app. Every meal. No heating.
-- Aiming for under 125 carbs a day total. This isn't keto -- it's more reasonable than that. But forces you to be more mindful of what you're eating.
-- Along those lines, eating at least 30 grams of fiber.
-- More vegetables. Some fruits, although you have to be a little careful with fruit because it can spike your blood sugar. Like, don't eat a banana.
-- Keeping calories to between 1,500 and 1,800 a day.
-- No alcohol or sugar at all. At ALL.
-- Walking 4-6 miles per day. I usually do at least one 45-minute brisk walk.

You didn't get this way overnight. It will take months, if not years, to correct. Be good to yourself. But having reachable goals will help. Mine was to get my A1C down from 9. I did that -- it was 6 at my last appointment. My fasting glucose now most days is about 95-100. It's how I know I am maintaining.

I just started on Ozempic. The doc is taking me off the insulin. She says once that happens, the weight loss will accelerate.

BTW I started out at 285. My goal is 185.

I do NOT think IF or WW is a good idea for you. Not for a very long time.

PCP, therapy, some movement, add in healthy foods.

Work on those things for awhile. Any fad diet will be just that, a fad. That includes WW and IF. Both can lead to serious eating disorders.

Lots of good advice here.

My own 2 cents about where to start if you want to lose weight and generally become healthier and feel good.

- drink 1/2 tsp of Inulin in a glass of water - 30 minutes before lunch and dinner. If you do not experience bloating and gas, slowly bring it up to a tsp of Inulin.

Inulin is a fiber and a prebiotic that dissolves completely in water and is colorless, odorless and tasteless. It works by taking space in your stomach and holding on to a lot of water, as a result your stomach has less space for food. It helps by making you feel wonderfully full and sated with less food. It is also a prebiotic and good gut bacteria need it to thrive, so you will be encouraging a good biome inside that can get the most nutrition out of the healthy foods that you eat. It also balances out blood sugar (like all fibers do), so you will not experience the sugar rollercoaster of a diabetic.

What else? Inulin makes pooping easier, keeps your insides clean and may help to clear out acne-prone skin. Furthermore, Inulin does not behave like a laxative. It basically makes you regular but it does not trigger uncontrollable bathroom going.

For people who are usually constipated - I also suggest taking dinner early (like 6 pm), remaining active and taking inulin with warm water and juice of half a lemon at night before bed. This does wonders for regularity, helps with gas and BO, helps with morning breath, and helps with a glowing skin. Best of all, it helps with minor aches, joint discomfort, pains and inflammation because the lemon juice is alkaline and neutralizes inflammation in the body.

This is an easy fix to implement, and it makes an immediate and visible impact from the very first day. When you are beginning a long road to fix your health, you need some impactful, low hanging fruits, easy fixes that gives you instant big returns.

IF (or time restricted eating, for example an eating window of 10-6 or 11-7 every day) is one good option as mentioned above, BUT if you have issues with overeating/binging it may actually lead to you overeating more if you feel deprived. You could try as it is good for insulin resistance improvement but one size doesn't fit all IMO.

I also wanted to add, if you are drinking anything sugary- regular soda, juice, sugary coffee- that is an easy target to cut out and you will see a vast improvement in blood glucose levels and very likely weight loss. Replace with water, La Croix, unsweetened teas, etc.

Anonymous wrote:Lots of good suggestions here, especially a twenty minute daily walk.

Try not to buy into the calories in, calories out bunk. This will lead to guilt and shame. And it would only be true in a closed system. Which our bodies are not. Gut microbiota can have a huge effect on weight. There are some bacteria that extract more calories from food than others. Think about that. So you want to shift those populations over to the ones that skinny people have. Increased veg and fiber, decreased sugar and processed foods, exercise can all help. So can a berberine supplement, which will cut those cravings, and make it all that much easier.

A good nutritionist could help, but choose carefully.

Yes, calories in calories out is wrong for SMO. It just won’t work.

I have recently lost 65 pounds in about a year, through diet not exercise, mostly through intermittent fasting. You can do this! It means will power, but once you start and have the power to refuse the food you want for a few days, and see the scale move, it gets easier. Good luck!

Lots of good suggestions here, especially a twenty minute daily walk.

Try not to buy into the calories in, calories out bunk. This will lead to guilt and shame. And it would only be true in a closed system. Which our bodies are not. Gut microbiota can have a huge effect on weight. There are some bacteria that extract more calories from food than others. Think about that. So you want to shift those populations over to the ones that skinny people have. Increased veg and fiber, decreased sugar and processed foods, exercise can all help. So can a berberine supplement, which will cut those cravings, and make it all that much easier.

A good nutritionist could help, but choose carefully.

My husband was in your shoes, OP. I loved him then, and I love him now. You are worthy of love no matter your weight.

He tried many diets and exercise plans and nothing stuck. He’d lose 15 lbs, then stall, then quit. He finally did gastric sleeve 10 years ago and it was life changing. He has now begun to gain again and he’s working on it with his doctor. But regardless of whether he gains or not now, he’s had 10 years of increased movement, energy, activities, travel than he would have, and those 10 years put less wear and tear on his vascular system. So well worth it.

If walking hurts or you just can’t make yourself do it, don’t worry. You don’t lose weight through exercise, and right now it is the weight and not your fitness that is probably more damaging to your health. If walking (or other movement) makes you feel good, prioritize it!

Please see your doctor and make sure they put all the options on the table for you, including surgery and medication. Why we make such a big to-do about bariatric surgery I don’t know - people have surgery because they don’t like the shape of their boobs, for heavens sake. This is about your health and your life. Surgery is the only proven treatment for obesity - keep it as an option.

I was obese very recently and the first and in some ways easiest step is just to get rid of the “bad” foods in the house (candy, chips, things with no nutritive value) and make sure there is an abundance of healthy, low calorie snacks that are easy to eat immediately. For me that is oranges, carrots, bananas. When I am hungry for a snack, that’s what I eat. The next step was to make sure that whenever I had a meal on my plate, the majority of the content has to be fruits or vegetables. In order to do this I keep a huge bag of frozen veggies in the fridge and whenever I have chicken for example I have to basically eat a big bowl of steamed veggies with it. Steaming veggies is very easy, just 5 minutes in the microwave.

For me, I have insulin resistance issues and PCOS so I had to cut out white flour and sugar. This was very very hard for me, but made a huge contribution to my weight loss. The key with cutting sugars is that once they are out of your diet, you don’t really crave them anymore.

I also made sure my health was in order- getting my vitamin D levels up helped me too.

After the above had become habitual, then I added in exercise. I play a fitness game on my kids Nintendo switch and it has helped me so much, I do it every single morning.

The key is not to do everything all at once and overwhelm yourself.

Walking to start.

Find a doctor who isn’t fat phobic (it’s going to be hard because so many of them are simultaneously incredibly ignorant and judgmental about obesity, so you will probably have to try a few)

Consider therapy. A huge percentage of SMO people have a history of sexual abuse and trauma in their background, and it is hard to lose weight without emotional support.

Look into semaglutide.

Consider bariatric surgery but as a warning, the gastric sleeve doesn’t have great permanent outcomes for SMO patients. The duodenal switch does, but that is a very serious surgery that requires a lifetime of nutrition supplements. It is extremely successful, though.

Consider this to be a multi year project.

Consider evaluation for ADHD, also often associated with SMO people.

Be extremely skeptical of DCUM (although this thread hasn’t been as bad as I’d expected).

I would start at the grocery store. If its not in the house you're not going to eat it

Anonymous wrote:Great advice so far - small goals, walking. But also, May I suggest listening to Maintenance Phase (podcast), perhaps while walking? There’s a lot of misinformation out there and you might need some deprogramming.

I like the maintenance phase but it tends to take more of a 'you don't actually have to lose weight' perspective. I am someone who was obese and who lost a significant amount of weight (although not at OPs level).

I think the idea that fat people are WORTHY HUMANS who are not defined by their weight is important. I also think looking at the science and facts around how permanent weight loss is difficult etc is important.

But I also feel WAY better than I ever did before. I was fat for like 20 years. I feel like I have a new lease on life, and not from how I look, how I can move, how I can interact with the world. And the messages of the maintenance phase, and HAES programming in general, IMO would have convinced me to not try.

If you want to lose weight OP, there is a subset of body acceptance culture (which I overwhelmingly think is a GOOD culture) that will tell you wanting to lose is bad. You get to decide what you want to do with your life. And you ARE valuable and important no matter what that decision is.

Great advice so far - small goals, walking. But also, May I suggest listening to Maintenance Phase (podcast), perhaps while walking? There’s a lot of misinformation out there and you might need some deprogramming.

Definitely talk to your primary care physician as part of your plan. A GLP-1 medication (like wegovy, but it's a medication class effect) is a great therapy for diabetes that has the beneficial effect of weight loss and appetite regulation. There are other medications for diabetes that have a weight loss benefit, and there are other medical therapies for obesity. Ask for a referral to a therapist, and potentially to an endocrinologist that does obesity management.

At 350 lbs, you can make small changes and see quite a change without being overly restrictive. Doing anything too strict will be hard to commit to. I like the idea of taking a stepwise approach. Try framing this as taking care of yourself! Start every meal with fruit, veggies and water- the things you know you need but aren't eating. For me, I try to buy as few processed items as possible at the grocery store, and then it's easier to avoid the carby snacking trap- if there's not chips/crackers/etc in the house I have to take the step of going out or instacarting them and I can usually resist!

Walking for exercise is a great start. You can make this social (walk with a friend), listen to a podcast, or get a treadmill and walk while you watch TV.

You could also consider gastric sleeve therapy, but I recommend seeing a therapist, getting potential medical conditions well managed, and changing your lifestyle/diet before you consider that- if you don't get to the root of your

First PCP. Based on what your bloodwork shows (diabetes, cholesterol etc), a nutritionist and a personal trainer. And, of course, therapy and perhaps a support group. Good luck!