“E” is for Effort (& Excellence): Weight Loss & Missed Opportunities

Last night I got an unusual text from my sister.  She was watching the same rerun of My 600 lb Life that I was, although it was new to her.  I’ve mentioned before that I watch the show, reruns and all, because they are my version of a 12 Step meeting.  They remind me of some of my old bad habits (ugh! so reminded last weekend!) and overall they keep me motivated.  This particular episode was James K.’s story.  In so many ways, James is both motivating and incredibly frustrating.

We’ve all heard the expression that ‘water sinks to its lowest level’ and the same is true of our efforts.  If we don’t put forth any effort, we shouldn’t be surprised when we get no return, but usually we are shocked when we don’t get amazing results.  We’ve somehow gotten it into our heads that we can phone in the effort and get what we want without a lot of work. James puts forth nearly no effort at all but expects to get awesome results and is repeatedly disappointed when he fails to make any progress at all.

To recap, James is approximately mid-forties, weighs about 800 lbs and has been bedbound for nearly three years when we meet him. He lives with his girlfriend Lisa and their teenage daughter Bayley, who are his caretakers.  Both Lisa and Bayley are afraid that his eating will kill him because he gains about 30-40 lbs every year, and James himself is afraid that he’s going to die in his bed soon. Besides his super morbid obesity, James also has severe cellulitis infections in his legs, but he still wishes that his days “would start with food and end with food.”  He admits that if he doesn’t get what he wants to eat as soon as he demands it, he gets angry. Giving him something healthy only starts a fight.

James sets up a phone consultation with Dr. Nowzaradan, who advises him how dangerous it is to be super morbidly obese and immobile (bedbound).  He sends him a 1200 calorie diet, tells him to begin losing weight now and come to Houston.  If he is under 600 lbs when he arrives and there are no major health issues, he will schedule him for bariatric surgery as soon as he can.

My issue with James isn’t that he’s gained about 800 lbs: my issue is that he does as little as possible to help himself or improve his situation. He was well over 500 lbs when he fell and injured his ankle, landing him in the bed three years ago.  Since then, he’s continued to gain weight and it isn’t hard to see why.  When you aren’t being active and continue to eat as much as you did before, it’s an obvious result.  However, James has made no effort to change his eating habits, nor has he made any effort to get out to the bed.  He tells everyone he wants out of that bed and he’s ready to get back to his old life, but to make change, you need to put out some effort!

He and Lisa had initially planned to load him in the back of her van and drive to Houston but because of his weight and longtime immobility, both Dr. Nowzaradan and the EMTs they later call advise against it.  The EMTs also tell him he is wider than the van is so driving that far would be extremely painful (why ultimately James vetoes the idea.) James tries to get a bariatric ambulance to transport him from Kentucky to Texas but when the plans fall through and his fund-raising efforts (an online campaign) also fail to generate enough money, he uses this to justify his continued calorie consumption. Basically, it’s a depressing situation and the insurance company has given him a ‘death sentence,’ and the only thing that brings him any happiness is eating everything he wants to eat, so that’s what he’s going to do!

In this case, James is not even putting forth minimal effort: Lisa and his daughter set up the online campaign and Dr. Nowzaradan is fighting with the insurance company over the ambulance.  The least James can do is work his hardest on losing weight.  This is what the doctor had instructed him to do and frankly, it’s the best thing he can do for himself, but he doesn’t do it. He makes no effort to help himself.

Later, when he finally arrives in Houston, he weighs in at 791 lbs and continues to gain weight, ultimately reaching 843 lbs.  At the end of the year, James has gained back any weight lost while hospitalized on a controlled diet and has been told that he has congestive heart failure and his body is barely functioning.  Throughout that year, he blames circumstance for his lack of progress and ultimately accuses Dr. Nowzaradan of not helping him.  The simple truth is that he refuses to make any effort to help himself.  This dismal lack of effort is what makes James so frustrating but also so motivating.  His story is full of missed opportunities to help himself: he announces again and again how he’s ‘fired up’ to lose weight, but when his daughter offers to bring him his dumb bells, he waves her off.  When Lisa protests that the Chinese rice he wants isn’t on his diet, he has a tantrum, demanding it anyway. “I’m tired of fish and chicken!”

Anyone who has changed their eating habits can commiserate with this tantrum.  My dad actually jokes that I’ve eaten so much chicken, he expects me to sprout feathers any day now! There’s been more than a few days that the thought of eating more salad, veggies, chicken or anything else healthy makes me want to gag. There’s also been many days I’ve wanted to blow off my exercise classes because I’m tired, I don’t feel like it or I just want to do something else! We have all been there! But watching James give in over to his whims is also what makes his case so motivating.

We all have opportunities to improve our health and weight loss.  None of it comes easily to any of us. Change and progress require effort and if we want to make the most of our opportunities, then we have to put forth our maximum effort! Blowing off the opportunities is always easier but then we have to live the results of our lack of effort.  We can choose to blame circumstance and everyone around us for our lack of progress, but ultimately the choice to work as hard as we can is our own.  We can do what we want, like James, or we can do what’s best for us as hard or as uncomfortable as it may be.  In the end, giving in to our whims and blowing off efforts to help ourselves only seems easier.  Living with the extra weight is not only hard on our self-esteem: it’s hard on our health. For some of us, it means we have to go back to our “fat pants” or loosen the belt another notch instead of tightening it up.  In James’ case, his lack of effort landed him in the ICU with sepsis, fatty liver disease and kidney failure.  [At last report, he recovered enough to be discharged.]

We all have been disappointed with our results at times.  It’d be nice if they were always amazing and fabulous.  The least we can do is make the best of the opportunities provided to us by giving it our best effort.  When we don’t even do the least that we can do, we have no one to blame but ourselves for our failures. Watching James throw away opportunity after opportunity reminds me not to do the same.  It is a sad and scary lesson that James presents to us and hopefully we’ve all learned from it.

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