I seldom have occasion to say nice things about television shows. I’ll make an exception for My 600-lb Life, which has a great deal of cautionary and educational value about a growing problem in society. As the name implies, it’s a reality TV program in which the guest stars usually begin around approximately 600 pounds (273 kilos). Some are less and some are more. There were two who exceeded 900 pounds; sadly, one of them died from an infection. The Where Are They Now? series provides follow-ups for some.
Since the New Year is upon us, many will be thinking about resolutions. For most, it’s likely that the first one of those is to lose the spare tire. My 600-lb Life provides some inspiration from those who have had a very long road to recovery. If your last trip to the beach was interrupted by environmentalists trying to push you back into the ocean, maybe you can use some inspiration, too.
The show starts with the following grim statistic:
Each year, hundreds of weight loss operations are performed on patients weighing 600 pounds. Their chances of long-term success are less than 5%.
The shapes of the guest stars are well beyond the sumo wrestler look, or an Earth Mother of the Venus of Willendorf type. Some have developed a large panniculus (overhanging belly), occasionally going almost to the knees. After weight loss, the skin only bounces back so much, so the excess will remain unless they get an extreme tummy tuck. There are those who develop lymphedemas, unnatural growths usually on the legs and arms, sometimes elsewhere. When this occurs, the skin surface over them can become irregular and blotchy. These too will remain until they’re removed surgically. The gut aprons and lymphedemas are heavy and painful, but any operations to remove them have to wait until the guest star is getting reasonably close to target weight.
The first episodes show the guest stars right after weight loss surgery. Newer ones begin earlier and include the backstory. There’s also some discussion about how each got into his condition. The weight didn’t pile on overnight, just as it won’t come off overnight. They do tend to be nice people (with a few notable exceptions).
Typically, they had been heavy for a long time, and eventually things got out of control after a personal crisis, or a series of them. In a number of cases, for both the women and men, sexual abuse was what sent them into a self-destructive spiral. Ruining the lives of the innocent like that is another reason that Heinrich Himmler had it right that the perps belong in a concentration camp. General family dysfunction is another common theme: substance abuse, constant screaming matches, etc. Those who can’t act like civilized human beings should, at the very least, keep their disgraceful behavior hidden from their kids.
One needn’t be a doctor to see that the guest stars are at risk of premature death. Living with that much weight obviously is very difficult. Often they describe it as being a prisoner in their own bodies. Many of them find it nearly or completely impossible to walk, and some are bedridden. Getting out of a chair might be about the equivalent of a more normal-sized guy squatting six or more plates at the gym — not fun! Then there’s considerable mechanical pressure on the skeletal system, particularly the knees. Some are even dependent on respirators. Few of them are mobile enough to work; the rest rely on the support of others, usually family, or government assistance.
The opening scene typically introduces the guest stars beginning their day. Staying clean is the first order of business, an absolute necessity. Without that, rashes could develop under the fat rolls and get infected. That in turn can develop into lesions, cellulitis, or even gangrene. Sometimes family members must assist with the cleaning, which surely is distressing. Even taking a shower or getting a sponge bath is often agonizing. For one thing, even lifting their arms may be a difficult task.
Despite that, they’re quite capable of lifting their arms to stuff their faces. The next scene tends to feature food porn. Often it’s their only pleasure in life, but the excess is also destroying them. Obviously it takes a tremendous caloric intake to maintain that kind of body; generally, about five to seven thousand Kcals per day. They’re like Leftists: They just can’t keep their cake holes shut to save their lives.
This is where Dr. Younan Nowzaradan (“Dr. Now” for short) comes in, a jowly Iranian bariatric surgeon. Part of the treatment involves weight loss surgery. However, he doesn’t give it to his patients right away. First, they must successfully complete a crash diet. There are reasons for this. First, it’s risky to operate on patients at that weight. Second, he wants to see that they have enough determination to stick to the program. Weight loss surgery isn’t a magic pill or else the long-term outcomes would be a lot better. The size of the stomach does get reduced during a sleeve gastrectomy (the usual operation featured here), but someone who keeps sucking it down will eventually stretch it out again and defeat the operation’s purpose.
Getting an appointment at his Houston office is the first challenge. Dr. Now must be much in demand, since most patients on the show aren’t local. Some do come from Texas or adjacent states, but others travel from as far as the Pacific Northwest. The problem even for those nearby is that many of them are too large to fit into a car seat. For some, the answer is riding on a mattress in the back of a van, screaming in pain all the way. Often vehicles en route to Houston with supersized patients are shown rolling into drive-through restaurants for a junk food fix, and sometimes on the return trip as well. Like, did they get the memo?
Upon arrival, they step onto a scale capable of registering high weights; the moment of truth is often shocking to the patient. No more denial! Dr. Now will give them an exam, and typically put them on a 1,200-calorie daily diet with no carbohydrates. (I’ll add that crash diets such as this need to be medically supervised.) They’ll be told to come back in two months, by which they need to have lost a certain amount of weight.
Again, they have an enormous daily caloric intake to match their enormous bodies. Thus, going on a crash diet will cause them to lose weight faster than is possible for those who only need to get rid of a typical spare tire. That doesn’t mean it’s easy. An unbalanced metabolism really can make someone crazily hungry. Moreover, they’ve been accustomed to letting themselves go to the point that it severely impairs their health and lifestyle. A typical patient is 600 pounds or so and accustomed to a caloric intake of two or three times that of a typical adult. They are then cut down to a quarter of that or less. If all that weren’t enough, after years of bad habits, they think of pizza and burgers the way that Gollum thinks of the One Ring.
It’s therefore not uncommon for the patients to miss the target weight. Then the truth comes out. Some of them have been sneaking junk food. (I’ll add that cheating on a low carbohydrate diet will reduce its effectiveness until the carbs are burnt off, which could take up to three days. I’ll spare the lecture on the Krebs cycle and mitochondrial metabolism. You’re welcome.) Some aren’t counting their calories correctly; a common problem for dieters. Dr. Now surely has heard every excuse there is, and he has some great one-liners. They’ll get a new appointment with a new target weight. Since these people are staring down death, it’s in their best interests not to flake off the program. Still, there are some — typically those with difficult personalities — who drop out.
When a target weight is achieved, the operation is scheduled within a month. They must continue to lose weight until then, or the deal is off. On the appointed day, there’s a scene with the buttonhole surgery; that involves some blood and guts. The rest of the show is about their recovery, which typically involves moving to Houston for at least a couple of months, continued weight loss, and sometimes removal of pendulous masses of loose flesh.
The following are recaps of three shows. The most common population groups in the United States are all represented, in accordance with my commitment to Diversity, Inclusion, and Equity.
Whites still come first. Chay is a 23-year-old who lives out in the middle of Louisiana’s coon-ass country, where the trees are heavily draped with Spanish moss and the cuisine is irresistible. He had a difficult relationship with his mother, ending when she was arrested. He’s been staying with his grandparents for the last eight years and gaining weight. Chay is mobile, but has a difficult time. He weighs in at Dr. Now’s office at 597.5 pounds. He’s sentenced to lose 40 pounds in two months, which of course means laying off the potato chips.
Back home, things start to look up as his cousin helps him with an introductory workout. Then, disaster falls when Chay’s grandmother suffers a fatal coronary. He turns to food to cope, putting his hopes for weight loss on hold. He tries to get back on track, but it turns out that he’s only down eight pounds by the next appointment. He’s sentenced to lose 30 more pounds within the next two months — quite lenient for Dr. Now — and to get therapy. He starts exercising as well and meets his goal. He gets the surgery, manages to stay the course, and his last weigh-in is down 119 pounds from the first. That’s a great start, but he still has far to go. His story continues in a Where Are They Now? episode.
This one starts with a new development, though hardly a surprising one. Since the beginning, Chay had been setting off more gaydar pings than an incoming volley of fruitron bombs. Something was afoot. He now announces his intention of coming out as a woman to his family. Check it out: Chay levelled up, officially claiming an intersectionality point! That’ll be two points, for those who think he’s female. (I’ll be more inclined to believe this miracle if he gives birth.) There is even some resemblance, since our guest, despite much progress, still has a massive rack and, from the looks of it, could be carrying twins if such a thing were conceivable. Although I don’t care much for radical gender theory and its enablement, I still find it merciful that the sweater puppies are blurred for the shower scene this time around.
Chay begins the follow-up show at 379 pounds, with just under 200 to go, after which there’ll be a sex change operation. With a pendulous panniculus, a major tummy tuck will be in order as well. There’s also considerable tricep sag. Chay gets a job at the local Wally World, which I’ll say is an excellent development. Rock on! However, there’s some backsliding involving junk food, explained as a way to save time. This causes weight gain, which puts the skin removal surgery on hold. Chay says it’s unconscious eating, realizing that the food was eaten only after the fact. Dr. Now replies, “Is that some form of sleep eating?” Epic!
The doctor delivers a sentence of therapy and 20 pounds a month of weight loss. The therapist is Lola – ironically, a name that Chay had considered using. She actually has some sensible advice. Although I’d take it farther, it’s good to see that she’s much different from the usual kind of shrinks. They nod politely and let their patients ramble on endlessly, with the idea that they’ll eventually call themselves out on their own bullshit — perhaps sometime in the next geological epoch.
Other than that, it turns out that small-town life is not Chay’s sort of thing, which is hardly a surprise. (I’d recommend moving to Montrose, Houston’s gay village. Surely it’s preferable to being the entire GLBT community of Cul-De-Nutria, Louisiana.) As for weight loss, Chay gets back on track, but it isn’t enough. Chay starts going to Planet Fitness, moves out, and gets into amateur theater. Cool deal; life is beginning to perk up! The weight loss is back on track. With enough persistence, skin removal surgery will be on the table. Then, of course, it will be necessary to find another doctor for the Big Snip between the legs.
June, a 43-year-old black lady, is at 590 pounds when she begins her journey to recovery. Things weren’t always this way; she was 300 pounds when she had her fourth child. Then tragedy struck: Her 17-year-old son was at the wrong place at the wrong time and was killed by gunfire. This was when her overeating went into high gear. All told, recovery turns out to be very difficult. Since June is local, she can fortunately avoid the drama of a cross-country ride while being squeezed very uncomfortably into a van. However, this is about the only break she gets.
She has a girlfriend; excellent, another intersectionality point for June! Sadi is increasingly frustrated by having to assume a caretaker role, however. Early on, we see a typical day beginning with her having to wash the fat folds around June’s abdomen all the way to the spine. The caretaking also includes frequently being sent on Taco Bell raids. They understand that’s obviously not very constructive, but it’s hard to resist the call of goodies like nachos with double fixings, and it seems they’ve tabled the discussion.
June has a history of some very serious health conditions, and is taking 21 medications. She’s hospitalized, as this poses an immediate danger to her life, and fortunately loses 54 pounds while on the controlled diet. She’s also not the most compliant and tries Dr. Now’s patience. Part of this involved chowing down on cheat food after being released from the hospital, causing her to gain 20 pounds when she was supposed to be losing five pounds (a goal much more modest than he orders for everyone else). Even so, eventually she pulls up and is approved for surgery. She overcomes a plateau and manages to lose a net total of 200 pounds after a year. Rock on! She’s evaded an early visit from the Grim Reaper.
The “June and Chad and Pauline” follow-up episode on Where Are They Now? captured some more of her journey. Her relationship with Sadi has deteriorated, and eventually they break up entirely. Fortunately, she is capable of living independently at that point. Other than that, she needs to lose more weight to get skin removal surgery. For one thing, she has lymphedemas encircling her legs, though luckily without the wrinkling and scaling that sometimes happens. (Pauline had it considerably worse and eventually quit the show.) For now, June gets it removed from her thighs, but the calves, especially the right one, are still a problem.
She also wants to get rid of the tricep sag and the panniculus. (This will have to wait, though she does get the arms worked on at the end.) She wants to look her best, since a new woman has entered her life. Mary is in Arkansas, but they keep up online. Eventually they meet up in person, hitting it off quite well. After a whirlwind romance, love is in the air, and Mary proposes. Their unusually long courtship of two months breaks tradition; it’s after the second date before June drives up in a moving truck. Then, a month after, the big day arrives. June is able to get a really nice dress, since she’s more than 300 pounds below her starting weight. Although I lack enthusiasm for same-sex marriage in general, I do wish the best for these Sapphic soul sisters, and they seem like a pretty good match.
Isaac is 23 years old and living in a Dallas suburb — a remarkably young guest, much like Chay. He is the largest of a large (in both senses of the word) Hispanic family. Only the father appears to be in good enough shape not to be at risk of the doctor reading him the riot act. His mother has had some very severe health problems; she has recovered from a bad stroke but now is now battling cancer. This is one of several contributing factors to Isaac’s overeating as a dysfunctional coping mechanism.
All told, he’s a good kid, and certainly didn’t deserve to have to deal with one tragedy after another. He unfortunately chose the wrong way to cope with some very difficult circumstances, and it’s brought him near the point of ruin. He’s mobile, but needs a granny walker. He cooks for the family of seven, something that predictably may complicate his personal recovery. He knows what the stakes are; he’s already survived a close brush with death even at his young age.
Isaac takes a van taxi to Houston, as he’s unable to find anyone else who can bring him to the appointment. The cab fare one way turns out to be the diabolical amount of $666.51. Obviously that will double after the return trip. He weighs in at 661 pounds; a little short of the inauspicious number, but not much to be happy about. Dr. Now sentences him to exercise and to lose 80 pounds in two months. Upon returning, he gets right to it and begins cooking healthy meals for the family as well as exercising. The follow-up appointment has to be delayed another month, and he needs to lose an additional 20 pounds by then. Then he has to delay it once more, making the total sentence 120 pounds.
Then there’s another cab ride to Houston. (Ouch! Why not get a rental?) Although I can see signs of improvement, unfortunately he’s only down 40 pounds — a third of the goal. It turns out that there’s been some cheating going on: Sunday breakfasts and pizza nights on Friday. Again, Isaac is sentenced to lose 80 pounds in two months. Thus, that trip was a disappointment. He returns home, determined to redouble his efforts and cut out the cheating days.
The next appointment is delayed by another month, so he gets an additional 20 pounds to lose as usual. Upon arrival, he’s down ten pounds rather than a 100. In addition to the usual sentence of 80 pounds in two months, he also must get therapy. Isaac and his parents visit the shrink (who looks tiny compared to them), and it turns out to be productive.
On the following trip, he’s down 34 pounds; under half the goal, but definitely better progress than before. His total weight loss is starting to add up. Receiving some mercy, the new sentence is 50 pounds in two months and more head-shrinking. He does drop 34 pounds by the next visit, and in total has lost the size of a waif. Dr. Now approves him for surgery in a month, with a final sentence of 30 pounds by then to seal the deal. The program ends not long after, and there has been no follow-up since then, but hopefully he’s been staying on track.
The show has a lot of cautionary value for what can happen when someone has an overeating problem and loses the will to resist it. Surrender is not an option! Being overweight doesn’t make someone a bad person, but eating oneself into an early grave is a real danger. Why be unhealthy and miserable? Fortunately, for those who are wavering or need extra motivation, My 600-lb Life is just the thing.
There are some other lessons underneath the surface. One is the power of persistence. Another is that there are good and bad ways to cope with problems. A good way works without creating other problems. Finally, there’s the power of the will as the mind’s ultimate executive force. Obviously, all the featured stars have eating disorders. (Lately, that sort of thing might be taken for a “wooden leg” excuse, or even as a badge of honor in some circles.) Still, as bad off as they are, the situation is not hopeless. When they learn to do it the right way, extract their heads from their posteriors, and put their minds to the task, they really can get on with it. If someone who begins at around 600 pounds can make tremendous progress, then there’s lots of hope for everyone else!
That said, I do have one quibble with the show. Most of the guests eventually manage to butch the hell up, push the fork out of their faces, hit the gym, and get with the program. Then they start losing a fantastic amount of weight. In that case, why not skip the operation and just keep doing what they’re doing? A sleeve gastrectomy forces someone not to eat large amounts at a single time. One can simply grow a pair to get the same results. Bariatric surgery has its risks; in some cases (depending on the type) involving a 2% death rate. The recovery doesn’t look like much fun, either. Again, it’s not a magic pill, and getting one’s guts rearranged is a decision that should be considered carefully.
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