The Physician’s Guide to Fitness is a multi-part series that covers the steps you need in order to get in shape and improve your health.   Read parts 1-4 here.

 

Step 6 Measurement

 

Now comes the cold splash dose of reality that many athletes fail to commit either out of ignorance or fear. With all the hard work you’re putting in, you must track your progress on a regular basis to see how you’re doing on your transformation.

 

The instinctive response is to check your body in the mirror. This literally has no quantifiable metric to provide scientific data on your progress. As I mentioned in Step 3, you’re doing this everyday out of necessity which may create an undesirable subjective opinion of your body.
You need to treat this entire endeavor like a controlled scientific experiment. So try to do your due diligence before asking your boyfriends and husbands if something makes you look fat just on a whim.

 

The traditional wisdom has always been to step on the scale and see how much weight you have lost during cutting. This advice too is not reliable to be the sole metric for tracking your progress. Your body weight goes through a range of daily fluctuations depending on your electrolyte and carbohydrate intake which pulls in water and that can range from 3 to 7 lbs a day.

 

If you have also picked up lifting weights (the only real exercise you need) as a beginner (roughly for the first 6 – 12 months), your body will be adding muscle mass while losing fat at the same time which will create a confusing weight value.

 

To the uninformed rookie weight lifter who sees no change in the scale, this can be considered a plateau (used as a fitness lingo with the same definition) even though the person probably lost fat but did not lose weight because of increase in muscle mass which actually is a good thing.

 

Female fitness expert Dell Farrell says the hormonal changes brought on by menstrual cycles can affect water weight retention giving outlier data on a regular basis for women. Hence relying only on the scale for data at random times is ill-advised.

 

The most accurate way to calculate your body fat percentage is getting a Dual-Energy X-ray Absorptiometry (DEXA) scan. Unfortunately this is a costly and cumbersome method for a typical individual.
Fitness and nutrition expert Brad Pilon advocates measuring your waist circumference on a weekly basis to get the most accurate value of the body fat change. So this is the guideline for tracking your progress.

 

  • The refeed days are your measurement days. In the morning take care of business with your bathroom visit but hold off breakfast until you get your numbers.

 

measurement

 

  • For men measure the thickest part around your waist around the belly button level or half inch below that. For women measure the thinnest part around your waist right below the ribs. Do not flex your muscles or hold in your breath to tuck your abdomen. Stand with good posture and relax while you get your number.

 

  • The IDEAL WAIST you will be working towards is based on a scientific study of the ideal human body called the Golden Ratio.
    • Men – Height in inches x 0.45
    • Women – Height in inches x 0.382
    • For example, I am 5’8’’ so my ideal waist would be 68 x 0.45 = 30.6 inches

 

  • Although not accurate, it is still helpful to weigh yourself just to make sure there are not any aberrant changes. Step on the scale with as minimal clothing as possible.

 

  • Record your numbers on a notebook or an excel sheet if you wish to graph your progression. This is the Objective portion of your fitness SOAP note as you should have gotten used to with Step 4.

 

  • Every 4 weeks, take photos of your torso from the front, diagonals, and sides and catalog them. This will provide evidence for your “before and after” transformation story.

 

  • Reverse dieting – Stay with your 20-25% of BMR caloric deficit along with your resistance training as long as it takes to reach your calculated ideal waist. From there you must recalibrate your body back to baseline. Even with consistent refeeds, your body will have inevitably diminished metabolism and your hormone levels will have changed to optimize fat storage. If you jump back to your old eating habits right away then you will definitely regain all the fat, falling victim to the “yo-yo” effect. This is another major peril of weight loss that plagues many people quite simply because mainstream fitness advice fails to guide them towards maintenance, a fitness concept that focuses on keeping the hard-earned results without pushing for anything else. Reverse dieting is an incredibly important step to finish off your cutting by increasing your caloric intake by 100-150 calories per week after the cutting is finished. You do your weekly measurements and check if the waist isn’t budging. If there is a slight regain then simply cut back down and patiently bring yourself back to your BMR. Once you have reached your BMR and your numbers are stable you have successfully burned off your fat! From there it is your choice what to do moving forward. You can enjoy your new lean body or you can push forward with building muscle (will be covered in the next article).

 

 

For those with heavy amount of fat, the waist may not shrink right away. Fat gain and loss follows a predetermined route and usually your waist line is the first area to grow and last area to shrink.
Your body may have to lose fat in your thighs or your back before the waist finally starts to see some change so be patient. 1 inch lost on the waist roughly equals 4-5 lbs of pure fat. The scale may or may not reflect this so do not except a direct correlation between the ruler and the scale.

 

There might be some quick results at the beginning but everything in life eventually normalizes to a steadier pace of progress. Expect to see improvements of 0.25 to 0.5 inches of waist reduction. That means you’re on the right track with your cutting so you should keep all your other metrics the same and keep going. If you plateau for a week or two it is no big deal. Plateaus are far better outcomes than regression by picking fat back up on your waist. When in doubt, be okay with plateaus!

 

However if you begin to plateau over a month or actually do regress, you have to review your entire routine from Step 1 to Step 5. Ask honest questions on your sleep quality, stress management, and caloric intake. If you keep your meals relatively the same as I have mentioned in Step 5, it is very easy to make adjustments by reducing your portion or omitting that little cookie you may have had for dessert every night.

 

Once you have identified areas of improvement you can plan your week. These are the days to decide if you will be doing the12:12 split or 16:8 split. Review your course work or your rotation schedule and decide which IF plan to use.

 

It is recommended that you stick with a plan at least 4 weeks at a time for your body to acclimate and yield results. I highly advise against doing 16:8 split on demanding months like Neuro system during didactics or in-patient medicine service. This is the Assessment and Plan of your fitness SOAP note.

 

Afterwards leave your week behind you and go enjoy your refeed day. Even if you didn’t see any results, you have to seize the day as a reward for the hard work you put in. However be mindful that this isn’t a permission for you to splurge.

 

You are allowed a cheat MEAL that can add some extra calories which have been missing during the week. Choose an item you absolutely love and enjoy every bite. If you actually regressed then try to be a little more cautious wile treating yourself. I had messed up my refeeds in my earlier cutting days and offset my overall progress for quite some time until I improved.

 

As tedious as this all may sound, it is what every successful strength athlete does to transform oneself. Odds are you have taken a very vague and half-measure approach to your fitness by jogging around the block and looking at the mirror grunting if you will ever improve. So did I for 10 years! So for the sake of variety, try these routines and see where they take you.

 

Once you internalize these principles, the amount of time all this really takes will become negligible as it becomes second nature just like the medicine we study. The benefit of weekly check-ups is you’ll never get caught off guard shopping for clothes or preparing for public ceremonies since you’ll know where your body is at all times.

 

Continue to meditate (Step 3) to not obsess over your numbers and live to enjoy the moment. Keep your eyes on the prize by journaling (Step 4) and reading out affirmations including your ultimate physique.

 

The renowned financial advisor Tony Robbins defined happiness as having progress. Progress is learning what is actually happening in our lives whichever direction it may be on the desirability spectrum. Our entire profession is defined by learning the cold hard facts consisting of A1c and abdominal X-ray readings. It is very liberating when you take ownership of your fitness by taking real measurements beyond the mirror.

 

Even if the numbers you will be seeing every week disappoint you again and again, confront the facts as brutally as possible and take immediate incremental actions: sleep a little earlier, eat a little better, lift a little heavier, and just let things go. This is how you progress and how you achieve happiness.

 

“Never, ever, ever, ever, ever, give up.” Winston Churchill

 

 

Resources: Eat Stop Eat by Brad Pillion, Fitmole Blog by Keith Lai, Muscle for Life podcast interview with Dell Farrell hosted by Mike Mathews, Shocking Fit blog by Mario Tomic, Inside Quest interview with Tony Robbins hosted by Tom Bilyeu


Donghyun John Kim

Donghyun John Kim

DO, Founder of Doctors of Steel

John Kim is a Family Medicine Resident and founder of Doctors of Steel. John is passionate about helping medical students and physicians achieve fitness and work-life balance. Learn more at DoctorsOfSteel.com