Seven years ago at age 44, Dot Thompson weighed 325 pounds (lbs) and found herself fatigued and battling heartburn, back and knee pain, and insomnia. “I just wasn’t feeling right,” she says. The Centreville, Virginia, woman made an appointment with her doctor for a physical, and after running blood tests, her doctor told her she had high blood pressure and prediabetes, and was at risk for heart attack and stroke. “That was the kick in the pants I needed” to make a change, she says.

After getting the okay from her doctor, she decided to start the ketogenic diet, a high-fat, low-carb and moderate-protein plan that puts the body into ketosis, a metabolic state that triggers the body to burn fat instead of carbohydrates for energy, and often leads to fast weight loss. On the diet, she cut out all grains, sugar, and processed, packaged foods, and ate green leafy vegetables, fatty cuts of meat, salmon, and eggs, and she cooked with fats like butter, ghee, tallow, and duck fat.

Thanks to her diet changes, Thompson lost 150 lbs.

Although the keto diet played a role in her weight loss, she realized throughout her journey that health means more than simply trading cookies for kale. Shifting her mindset, developing healthier lifestyle habits, and leaving a high-stress job were equally important for her. “Everything I tried in the past didn’t work,” Thompson says. “What I really need to focus on [was that] it had to be more about living my life.”

When Stress-Eating Gets in the Way of Weight Loss

Throughout Thompson’s weight loss journey, stressors have threatened her success. Last year, she became the primary caregiver for her mother, who fell and broke her hip twice within six months. Thompson’s own health fell to the wayside, and as a result of stress eating, Thompson regained 35 lbs. “As hard as [taking care of my mother] is, I still need to make my health a priority, and I didn’t do that," she explains. “It’s really hard to make good habits but it’s so easy to let the bad habits come back in.”

In spite of the challenges she faced, Thompson realized changing her mindset was just as important as changing her diet, and the key to sustained weight loss. “It was actually the hardest part when I first started to lose the weight, and it is sort of now, too,” she says.

One of the reasons was that she had to overcome her hyper-focus and fear of the scale, and instead look at more meaningful metrics, like her energy level, sizes lost, and amount of muscle mass. “For me right now, it’s getting back into the mindset of using all the different tools I used to keep me distracted from the scale and putting the scale in a proper perspective. That’s tough because everything you hear about weight loss involves getting on a scale,” she says.

Still, Thompson found creating new, healthy habits and staying consistent were key to keeping off the weight and improving her other markers as well.

Making Diet Changes Kick-Started a Better Sleep Schedule

A former insomniac who would sleep only two or three hours a night, Thompson found that changing both her diet as well as her eating habits allowed her to get between six and seven hours of quality rest a night. For example, if she wanted to indulge in a glass of wine, she would consume it earlier in the evening so it wouldn’t affect her sleep later on.

She also found that using blackout blinds, keeping the temperature in her bedroom cool, and getting ready for bed an hour before she wanted to turn in helped her fall asleep better.

Without adequate sleep, levels of leptin and peptide YY, two hormones that promote satiety (the feeling of fullness) decrease, while ghrelin — the “hunger hormone” — increases, which can lead to overeating and weight gain, says Caroline Apovian, MD, professor of medicine at Boston University School of Medicine in Massachusetts. “People who sleep less than seven hours a night [tend to] have higher body mass indexes (BMIs),” she says.

A study published in September 2013 in the American Journal of Epidemiology found people who slept less than five hours a night had about a 40 percent increased risk of developing obesity compared with those who got seven to eight hours of sleep. In fact, seven to nine hours is how much sleep the National Sleep Foundation recommends for adults.

Thompson also found that making her phone’s display dim at night, and powering down her devices when the sun set, or at least one to two hours before bedtime, also helped her fall asleep. It’s true that blue light emitted from TVs, tablets, and smartphones suppresses melatonin, the hormone that’s responsible for regulating sleep-wake cycles. A study published in October 2013 in the journal Chronobiology International found people who wore glasses that blocked blue light produced more melatonin, slept, and performed better at work than those who didn’t while working night shifts.

Curbing Social Media Use Improved Her Self-Image as She Lost Weight

Scroll through any of your social media feeds, and you’ll be bombarded with politically charged news, photos of mouthwatering food, and others’ seemingly “perfect” lives — all things that can raise levels of the stress hormone cortisol. A study published in March 2018 in the Journal of Social Psychology found that people who closed their Facebook accounts had lower levels of cortisol and felt more satisfied with their lives.

Social media use also promotes unhealthy body images and can make people feel bad about themselves, Dr. Apovian says. According to a study published in March 2019 in the journal Body Image, after engaging with attractive peers on social media, women reported feeling more dissatisfied with their bodies.

Instead of getting sucked into social media, which is something Thompson says negatively affected her ability to wind down at night, she did relaxing activities, like knitting and reading, instead.

Learning How to Cope With Stress Also Aided Her Weight Loss

When Thompson decided she needed to make her health a priority and lose weight, she was working a high-stress job that required her to clock 15 to 18 hours a day as well as weekends. She found herself eating at her desk, grabbing a soda or a snack to keep up her energy levels, and ordering in dinner. “I was very unhealthy, and I was very unhappy with the job,” she says.

After talking to her husband, she realized the only way she would get healthy would be to quit her job. Although it was a difficult decision because Thompson was the breadwinner and insurance provider in her family, it turned out to be the best decision for her health and happiness.

In the past year, when Thompson had been dealing with caregiver stress, she realized she needed to ask for what she needed, such as requesting that her husband make dinner or suggesting coffee rather than lunch dates with friends to prevent derailing her weight loss efforts.

Stress and lack of sleep both lead to increased levels of cortisol, stress eating, and weight gain. “Stress alters all of those hormones that promote a higher body weight,” Apovian says. A study published in February 2017 in the journal Obesity found chronic high levels of cortisol were associated with being overweight and carrying extra weight, including the dangerous visceral fat, around the waistline.

Recent research may point to a cause worth further scientific exploration. A study published in April 2018 in the journal Cell Metabolism, which was conducted in mice, suggested that glucocorticoids, or natural steroid hormones, increase with chronic stress and can cause a type of cells known as progenitor cells to turn into fat cells and cause weight gain.

Exercising Helped Her Inch Toward Her Goal After Losing Some Weight

When Thompson started her weight loss journey, she attempted to exercise. But after getting injured, her doctor suggested she focus on eating right and losing at least 50 lbs first.

When she hit that goal and continued to lose weight, she incorporated light exercise, like walking and yoga, and made a point to include more activity on a daily basis, like getting up every hour to walk for 10 minutes. “It got to a point where I could move a lot easier,” she says. Eventually, she would challenge herself to walk longer, faster, and greater distances, working up to a run and competing in endurance events.

When Thompson gained back 35 lbs this past year, however, her hip began to hurt, and she started to work with a trainer and physical therapist. Although she has goals to participate in endurance events again, she’s realistic about what she can do now and focuses on activities she enjoys. “If you don’t like the exercise or physical activity you’re doing, you won’t want to do it,” she says.

The National Weight Control Registry shows that people who exercise at least 2,500 calories worth each week maintain weight loss, Apovian says. “They stop exercising, they gain the weight. Prioritizing exercise means organized exercise and doing it [faithfully], like brushing your teeth,” she says.

According to a study published in March 2019 in the journal Obesity, people who lost 30 lbs or more and kept it off for over a year found physical activity did more to maintain weight loss than diet. In other words, diet can help take the weight off, but exercise appears to help you sustain that weight loss.

Drinking Plenty Of Water Helped Her Stay on Track With Making Healthy Choices

“I used to drink Coca-Cola all the time — that was my water,” Thompson says. Over the course of a month, Thompson made the switch to drinking half her body weight in ounces of mostly water, with some unsweetened ice tea or flavored, unsweetened carbonated water thrown in.

Studies show drinking plenty of water is one of the keys to weight loss. A study published in the July–August 2016 issue of the journal Annals of Family Medicine found staying hydrated by drinking water and eating water-rich fruits and vegetables can help manage weight, especially for those who are overweight or obese.

“Some people who get dehydrated can’t distinguish dehydration [or] thirst from hunger, so they will overeat. Also, if you drink enough water, your stomach will get full and so you’ll aid your satiety,” Apovian says.

The National Academies of Sciences, Engineering and Medicine recommends women get about 2.7 liters per day and men get approximately 3.7 liters per day from all beverages and foods, and more for those who are very physically active or live in hot climates.

Why Just Doing Keto, or Any Diet, Isn’t a Quick Fix for Weight Loss

Although Thompson continues to follow the keto diet, and incorporates intermittent fasting and some “carnivore,” or all-meat, days into her diet, she isn’t doing so under her doctor’s supervision.

However, working with a doctor when you’re trying to lose weight on any diet — but especially on keto — is a good idea because they can make sure you don’t get dehydrated and your potassium levels are optimal, Apovian says. “A lot of things can happen that your doctor can monitor for you so that you do it right and healthy and there’s less of a chance of gaining it back,” she says.

Thomspon says through her journey, she has learned that long-term weight loss lies in making small, consistent changes and being kind to yourself. “Weight loss is 99 percent nutrition, 3 percent exercise, but 100 percent mental. The mental part of it is way more important than anything else, because it’s so easy to tell yourself, ‘Just this one time' or 'I’ll start tomorrow.’”

How a Mindset Shift Helped 1 Woman Lose 150 Pounds on the Keto Diet