Matt Wolf: Dieting in Japan

Alongside dietary supervision, increased exercise was part of the six-month process required before I could be prescribed tirzepatide.

Six months of nutritional guidance and activity targets — and, if the results are deemed insufficient, medication becomes an option.

Through my commute and movement during the workday, I usually manage at least 7,000 steps. For a man of my current dimensions, that is not insignificant.

I have also read — repeatedly — that some form of resistance training, even bodyweight exercises, is advisable during weight loss to minimise muscle loss. I intend to add this gradually and cautiously.

More vigorous exercise, however, requires restraint for two reasons.

The first is mechanical. At 150 kg, gravity is not theoretical. Knees, ankles, calves — all operate under substantial load. Until I lose a meaningful amount of weight, enthusiasm must remain subordinate to structural reality.

The second is cardiac. I have dilated cardiomyopathy — a condition in which the heart becomes enlarged and pumps less efficiently. It is stable, and since having a pacemaker implanted, my heart functions considerably better.

My doctor believes more intense exercise — swimming, for example — may be possible. But before offering formal approval, he would like me to complete a monitored treadmill test.

At present, I exceed the weight limit of the treadmill.

This creates a mildly circular problem: I need to lose weight to qualify for the exercise test that would confirm how much exercise I can safely do.

For now, walking will suffice.

I will write more about cardiomyopathy in future posts.