Having struggled with his weight his entire life, 25-year-old Joshua Diggs knew that he needed sound medical advice to change the trajectory of his health — especially after he was officially diagnosed with type-2 diabetes in January 2018.
“It shook my world. I thought I'd be a lucky pre-diabetic, I tried to play it cool, but that was the moment I realized that I needed to take my weight loss seriously,” said Joshua.
Then, going on a family cruise later that year was the official breaking point for him. Joshua wasn’t able to participate in all the activities that he wanted to do and faced many challenges on the vacation.
“I weighed almost 500 pounds at that time. I was so excited about the cruise but everything was exhausting. I couldn't even carry my bags. My feet hurt. My back hurt. It was tiring getting from one part of the boat to the other. By the time the party was starting, I was already tired. This was devastating to me,” said Joshua, “I was young! That’s when I thought to myself —’you know what? That’s it. I'm going to sign up for bariatric surgery or something to get this weight off me. It’s literally killing me.”
Therefore, In September 2018, Joshua consulted Renee Rusnak, MD, who is board certified in obesity medicine and internal medicine and is part of Atrium Health’s Weight Management Team. He was initially interested in bariatric surgery, but at the time he weighed 482 pounds and had a BMI of 75.
“In order to qualify for bariatric surgery, he needed a BMI of under 60 (equal to 383 pounds), which meant he had to lose over 100 pounds just to be a candidate. I had to break the news that he wasn’t a candidate for surgery at his current weight. It was overwhelming, but Joshua understood,” said Dr. Rusnak.
To complicate matters, testing showed that he had a very slow metabolism and he was burning 28% less calories than men of similar age, weight, and height. He also had poorly controlled diabetes with an A1C of 9.0. For reference an A1C below 5.7 is normal; a 5.7-6.4 is prediabetic; and any figure above 6.4 is diabetic. The goal for a diabetic is to have an A1C less than 7 to reduce their risk of complications. Therefore, Joshua was prescribed a medication that would help control his diabetes and also reduce his appetite.
Joshua also immediately quit consuming fast food, chips, and soft drinks and traded them out for healthy foods like protein shakes, salads, grilled foods, vegetables, and water.
Small but consistent changes started presenting results in a relatively short time. Just 2 months after he started his weight loss program, Joshua had lost 26 lbs and was down to 456 lbs. However, the most amazing change was that his A1C improved to 6.4% — which meant his diabetes was now considered very well controlled.
Encouraged by the results, Joshua eased exercise into his routine in April 2019. He started by walking the hall during his 15-minute work break. Initially, it was hard for him, but by October 2019, he was walking for two 15-minute breaks and he was going up and down 5 flights of stairs. By August 2019, Joshua was down to 400 lbs. and had lost a total of 82 lbs.
The Power of Consistency — in Spite of Obstacles
The excellent momentum of Joshua’s weight loss was threatened when he turned 26. He was no longer a dependent under his father’s insurance plan. He had to switch plans, which meant paperwork and a potential lapse in coverage for his diabetes medication.
Joshua was very nervous about gaining weight after getting off the medication. However, he stuck to his diet and exercise plan. To his surprise, he came back for a checkup in October 2019 and lost 12 more pounds — now down to 388 lbs. This was the first time he was below 400 lbs since high school.
As the months went on, he continued to lose weight. By meticulously food journaling and counting his calories through apps like MyFitnessPal and exercising consistently, he successfully managed his diet plan according to Dr. Rusnak’s guidelines.
Then, another obstacle happened. The COVID-19 lockdown made it harder to stay active and disrupted life as everyone knew it. But Joshua was determined to stay on track. When stay-at-home orders were in place, he started to walk and jog outside. By June 2020, he was down to 289 lbs.
Right now, he’s 27 years old and hasn’t been considered diabetic for over a year. Changing his diet and being consistent with simple exercise transformed his health and changed the trajectory of his life. He now weighs 270 pounds and shows no sign of slowing down his amazing progress.
“I’m running now — something I never used to do. I’m running upstairs, jogging, even doing sprints,” says Joshua. “I’m like… wow. I came a long way. I used to have a hard time just walking. Now look at me— I’m running!”
Having done so well on diet and exercise alone, he has made lifelong, lasting changes for his health. His A1C continues to report non-diabetic ranges since January 2019.
Weight Loss Benefits
When people look to lose weight, the allure of a “lose weight quick” plan is tempting. But for long-lasting wellness, Dr. Rusnak stresses that patience and consistency is key. And as we have seen Joshua’s story, it doesn’t take much weight loss to start seeing health benefits.
“In general, weight loss as little as 10% has significant health benefits. For a person who weighs 250 lbs, that’s a loss of 25 lbs,” said Dr. Rusnak, “Even this small change can reverse a lot of their medical conditions. A lot of people have the misconception that they have to lose over 100 lbs. to see a change — but even small changes can have profound benefits. We focus on long-term sustainable changes. Most are lifestyle changes like diet and exercise — but medication can be also utilized if necessary. It’s a team-based approach. Between our bariatric medicine physicians, registered dietitians, and exercise physiologists, we have a lot to offer.”
Bariatric medicine isn’t just for patients that need to lose a lot of weight. Individuals struggling with losing an extra 20 lbs can also benefit from the support of Atrium Health Weight Management’s team. Through this support, they can get sound medical advice to counter the misinformation out there. There is no “one size fits all” dietary approach. This is why the team does a thorough evaluation so that they can tailor a plan specific to the individual’s needs.
“I give them the skills to be self-sufficient. They have to take initiative. It requires the patient to make significant changes and to stick with it. Joshua is a testament that if you follow the plan and are determined, you can do it even if it is overwhelming in the beginning,” said Dr. Rusnak.
When asked about what advice he would give to others who want to start their weight loss journey, he says:
“First, start small. If you can lose 5 lbs. in two weeks, that is more an accomplishment than you think. Your goals have to be small. If you can eat healthy for two weeks, see how you feel, then do another two weeks. That progress is going to be rewarding. Second, don’t compare yourself to others like triathletes or people losing a ton of weight on Instagram. They each have their own journey and had their struggles too. And finally, never forget where you came from and why you started. For me, I remember my low point: the cruise. I think about how I was tired and couldn’t walk far. Ask yourself — do you want to be that person again or to push forward?”
