Damn, you are good man, Dan Savage.
Sweet response. Courage, fella.
wonders if the fat crowd will be rushing over here to give Dan some credit for having a very measured, compassionate response to a fat man who is obviously in a lot of pain.
Dan, this made me tear up.

PHM - don't give up. Don't give up on life & don't give up on yourself. My dad was an alcoholic, didn't quite until he was in his 60's. I myself have psychological addiction problems - I share your vice, food. But I also have a hormone imbalance that was misdiagnosed for years! Definitely see a different doctor. Definitely get some kinda counseling. It's a daily battle. Famous writer & addict William Burroughs once said that overeating was the hardest of all addictions to quit, 'cause you can't quite cold turnkey. & that guy was a heroin addict!

You have an addiction. Food gives you pleasure & comfort. But food is also fuel, & you're not burning any of it off. I'm still overweight, myself, but have both learned to see what's attractive in myself, & accepted that it's always gonna be harder for me than other people to get & stay healthy.

I also love junk food & video games. I gave up most of the junk, lost 20 pounds fast. The rest will be a longer slog. & I'm only allowed a nice couple of rounds of the gaming if I've done physical stuff that day, too.

Everyone's gotta start somewhere. 15 minutes a day. Just 5. You don't have to like it, just start there. Find something you can do at home or when others aren't around.…

Dude. You can do this. We can do this.

@3 - You're making it very difficult for me to not make a fat joke. I don't want to be that guy right now.

Dan, good answer. PHM, good luck.
@3, don't know if I'm the crowd you mean, as I'm not a fat acceptance movement type, but yes. I've given Dan shit for biphobia, then praise when that seemed to change. Ditto for this. This was compassionate. Go Dan.
Been there, done that PHM. With me, my self-loathing had everything to do with self-hatred for being gay, so I had to tackle both.
Physically, it started with running around the block at about the same time I came out. Seriously, I started jogging, very very slowly, late at night so no one could see me, around the suburban block where I lived at the time. It took a year to show any improvement, but I kept at it, pushing for longer and longer distances every night. I started out with little tiny baby steps and worked to longer strides. Eventually, I stopped hating my body and started loving the runners high. Then I took up a sport, and really started loving what I could do with my body. My body became a pleasure to live in in a way it couldn't before.
I also had weight loss surgery. It has had side effects and wasn't at all pleasant, but I did lose 100 pounds afterwards and still, five years later, manage to find maintenance a lot easier. If you go this route, look into the lap band instead of stapling like I had, I hear its really improved lately and is a far, far simpler procedure.
As far as sex and relationships go, I don't know whether you are straight or gay. If you are straight, you might find that there are lots of women who love a big teddy bear. If you are gay, hell, there's an entire community of big gay dudes, and welcome to the bears. If you are worried about being humiliated, the internet is your new friend. The net allows us to meet people in a forum that is set up for our tastes; if for example you are a big straight guy who is only attracted to skinny girls (do the breeders use the term "chaser"?) I assure you there is a website for skinny girls who like big boys. It does take all types, and there's someone out there who fetishizes you!
So buck up little camper. You aren't at all alone. Lots of us have been down the rabbit hole. Earlier this summer I was standing on a street corner in Paris late at night, making out with a redonkulously cute French dude, and I remember thinking that I once had despaired of never, ever being where I am now. I still struggle, but I love the fight. Get a little success under your belt and you will to.
"Former Fat Crowder Here"

Well spoken Dan, Thank you.

PHM, take Dan's advice and don't give up hope! WLS could be the answer you need to take your life back.
@7, Yeah, my petite best friend loves larger guys. And she's a bit of a fitness freak herself.
Get that surgery. I've known people who have and it changed their lives for the better. Much better.
Perfect response.

I also advise seeing either a psychiatrist or psychopharmacologist. If you think you're experiencing a phobia and/or depression, it's worth finding out what some medications might do to help.

In the meantime, there are both men and women who are into really big guys, you just have to find them. Google.

Hang in there dude. And Dan? Well done.
I'm with Dan, if you've gotten to this very dark place the best option may be counseling and/or surgery, whatever the cost.

There are lifestyle changes that can be made, but you have to feel like you are worth something and doing something about it before they'll help.
PHM: David Smith's weight loss story was featured on TLC called "The 600-pound virgin" (though I don't like the focus on his sexual status, but whatever). I hope the episdoe is on the internet somewhere. He weighed 600 pounds and lost 401 of them in about 2 years with no surgery, just by eating right and exercising. The most important thing he did was making the choice to live, and reaching out for help. Here's a blog about his story:… You could probably even contact him directly. You can do it, PHM.
PHM, it won't happen overnight, but if you follow Dan's advice (which is pretty good), it will happen. A colleague of mine got the surgery, and she was an amazingly different person afterwards, because the maintenance required to keep the weight off was nothing like the pre-surgery efforts (always futile) to get the weight off in the first place. She was an entirely different person, and I think you will be too.

I've also always struggled with my weight, but because I'm a completely obsessive OCD-type, have been able to lose some weight on Weight Watchers combined with exercise. One of my very good friends is in a medical weight-loss program through our local hospital, and although it's slow, it's working (he's about 6'4", probably about 350-400 lbs when he started). There are resources out there, and I think your doctor is doing you a disservice by not pointing you toward some options.

Good luck, we're rooting for you!
I didn't do WLS, but I also didn't try to lose weight alone. Think about what you would pay to be thin; thousands of dollars? Then start spending it on a nutritionist and a personal trainer and a shrink. Changing your body is a huge thing to do, so buy some help and allies. You don't have to do it alone. You can get to a place where you are at peace with your body, I'm sure of it. But I wouldn't expect anybody to be able to do it alone, just by discipline. Do it with expert help, and lots of self-care.
Might want to see a dietitian as well. For the severely overweight, there are often small changes you can make that result in dropping a lot of weight. An example: a buddy of mine stopped drinking Coke and starting drinking Coke Zero, and dropped 20-30 pounds in three months. Turns out he was drinking around 9 cans per day, at 160 calories/can, so that simple change cut almost 1500 calories/day from his diet with no real effort on his part. He even likes the taste of Coke Zero more now. :)
That response brought tears to my eyes...
Seeing letters like these are both sad and haunting for me. Growing up obese myself allowed me very little growth for self-confidence during my teen years. I feel I can sympathize exactly with the self loathing and depression that PHM is going through.

While I never reached insane proportions, at my max I weighed 298 lbs. I numbed the depression through heavy opiate usage and it culminated in a suicide attempt at 18, willingly overdosing. My mother found me and needless to say I survived...after months of rehab and depression meds(which I never took) I got over my addiction but my self-loathing has never gone away completely.

My brother who is a personal trainer and extreme health nut is probably my biggest role model in life, and I finally asked him for help. Now, 6 years later, I've adopted a vegan diet (just the diet, I don't care what you eat!) and have so far lost 74 lbs and am at 224 at the moment. I still have self-confidence issues, but I am constantly reminding myself that I have the control of my weight, not vice versa. I have a girlfriend now (who, ironically weighs half my weight..haha) and while I still have bouts of depression and self hate, I don't let it control my life anymore and I seek help when needed.

My mother is morbidly obese at the moment and is in a similar position to PHM...She needs help for the dependency but she wont seek it. She's almost 60 now and I fear she wont make it past 65 if nothing changes, we have also suggested weight-loss surgery but she is too afraid and will not admit it.

PLEASE PHM, you are not worthless, there ARE options, it is not hopeless and you are intelligent enough to know that. Look into the options Dan has suggested and seek a therapist/psychiatrist, they really can help if you find a good one. Keep your sister close as she seems like vital support to you, and let her know how she can help too.

A supportive family can do wonders for the hard times in your life, but you have to do your part to not only give them the dark times!

Best of luck, I'll be rooting for you too!
Compassion is not constructive when someone is being self-destructive, it is merely enabling.
PHM, it might help to try an anti-inflammation diet. They're only just now starting to become common and recognized, but they're not a crazy new fad designed by some doctor hoping for a payday. The class I took was purely science based. There's nothing fad or scary about it; it's about recognizing what food does in our bodies, what our bodies need, and correcting the balance. I don't know where you live, but the TQI Diet classes are in the Seattle area. There might be something near you. Definitely start asking around.

I'm overweight and have gained a lot in the last year, and fell into a deep depression because of it. I know how much it affects our mood and that overcoming the mental roadblocks is a big part of the battle. You should know that stress hormones are as much to blame for weight retention as anything you eat or do, so definitely work on the mental help first.

Best of luck. My heart goes out to you.
Throw your scale away. Buy a 24 hour fitness membership ($320 for 2 years at costco - great deal!). Go to gym at midnight or later, when it's completely dead in there, every night. Walk on treadmill. Hit the weights. Start slowly. Five minutes of walking, light weights. Build up until you're walking for an hour on a slope. Buy a new scale after six months of doing this. Weight loss surgery isn't the answer if you can't find discipline on your own.
No. NO NO NO. Dan, I love you and I love ALMOST everything about your response -- not needing perfection to be woprthy of love, and the turn-off of self-hate, particularly -- but please, letter writer, DO NOT try surgery until you have given a keogenic diet a shot for at least a few months. Surgery is so drastic, and irreversible, and I know that ketogenic diets aren't well-known (and aren't advertised, disparaged rather, by convention wisdom, which includes most doctors and nutritionists), but THEY WORK.

Go read the FAQ and links at Check out I might sound like a cultist fangirl and ?aybe I am, but it worked for me when nothing else did, and when I think about the emotional an I was in about my weight, I want to cry. But that's not productive, so I've turned to trying to help other people avoid that same pain, and seriously....I believe you can do this, can turn yourself into the person you want to be, without surgery.
I recommend researching the surgery. There is a variety out there from the relatively simple and reversable lap band to gastric bypass and several variations in between such as gastric sleeve. You don't have to decide right away - around here the doctors make you wait 6 months before getting the actual surgery, with lots of consultations about the surgery and on nutrition first. I've seen the surgery change people's lives where it not only helped them to lose a lot of weight, it significantly improved their diabetes and high blood pressure. It also improved pain in weight bearing joints such as knees and hips.
PHM— If Scott Kurtz of "PvP" and "Blamimation" fame can snag a girlfriend looking the way he does (or did? I hear he's taken off some weight) then you can too. But it'll never happen if you don't break this cycle of self-loathing. See a shrink, see a GOOD shrink. You can change your life, you just have to summon some strength and some patience. We're all rooting for you.
Wonderful answer - I am rooting for you too, xo

I want to share my story with you (and all of SLOG, I guess).

I was bulemic for my entire adolescence (with occasional lapses into adulthood) and it seriously fucked with my metabolism. As I got older, the issue became an even bigger one. If I eat like a totally normal person, I gain weight. Period. Of course, for the last few years, I've been eating like a fat person because it is just so exhausting to have to contantly deprive myself in order to maintain. I do also have a slightly wonky thyroid but it is very marginal so my thyroid meds are about as weak as they come. The thyroid condition didn't make me fat. I made myself fat by starving myself thin for so many years. At any rate, I have avoided mirrors, cameras, and scales altogether for fear that seeing myself heavy would cause me to spiral back into bulemia (or worse). About a month ago, I got slapped in the face with reality and had to take a hard look at myself as I had become (about 85 pounds overweight). It wasn't easy but I was forced to start making changes. Little ones at first and then building upon them. I'm choosing my foods very carefully, getting a sold 8 hours of sleep at night, and getting at least 1 hour of exercise per day (sometimes I break it up into smaller increments so it doesn't feel as torturous). I'm down 13 pounds so far and I feel so much better! I'm still worried about what's going to happen when I get down to my goal weight (will I just quit and put it all back on?!) but I'm so proud of myself. My mood has done a 180. I used to feel angry all the time because I was just so unhappy with myself but I feel so much more positive about everything now. Don't get me wrong, I can still get angry, but the world doesn't seem quite so dark and ugly anymore because that's not how I feel about myself anymore.

You can do this, PHM. The hardest part is taking a truly honest look at yourself and it sounds like you've done that. Now it is time to take step two. Do it for yourself and do it for your sister (and let her support you). Start off "easy". Pick one problem food to cut out of your diet (I recommend potatoes, if they are also an issue for you) and start moving a little bit each day (can you do just 10 minutes?). Every week, make another positive food related change and increase your exercise goal by just 5 or 10 minutes. Before you know it, you'll be feeling better and will be able to really commit to being healthier.

My last suggestion is to find a support group. Shrinks are great (I'm not saying to disregard Dan's suggestion), but sharing the experience with other people who are dealing with the same issues really makes you feel that you are not alone and it is empowering. I know of a couple of free depression support groups in Seattle but I'm not sure if there are any food addict support groups (outside of Weight Watchers, which I also hear great things about). Do a google search and I'm sure you'll find one; wherever you are.

Good luck, PHM, I'm rooting for you.
For sure, 3, people should totally get gold stars for practicing a little basic human compassion and not being an asshole to someone who's hurting. Jesus Christ, you remind me of the famous Chris Rock bit about dads who want accolades for paying child support.

Anyway, back to the point. Yeah, surgery may not be the best choice (which is why Dan tells him to do his own research, get professional medical advice, and make his own decision), but I can see how it could really work for him. Most responsible medical groups that do the surgery require some kind of counseling, and PHM will definitely need it on a lot of levels. Dropping a bunch of weight is an emotional rollercoaster even if you're NOT in hardcore self-loathing mode in advance. But it sounds like PHM does have a support system of people (at least one) who love him unconditionally, and if he gets a good medical and mental health team behind him, he can do it. Go PHM!
I'm rooting for you, too, PHM. You're definitely not alone.
Hey buddy, just want to chime in. I am an ex-obese person who lost 100+ pounds (and kept it off for a few years now) IN MY 40's after a lifetime of being extremely fat, from early childhood on. You may have further to go, doesn't matter, it will just take more time, which is not a problem. Time you've got, once you start to get healthy, but you must start as soon as you can so that you don't die of your lifestyle.

For my part, I saw a integrative doctor/naturopath who tested me quite thoroughly, then helped me with a regimen that normalized my appetite, helped me lose the weight and rebalanced my system. This may or may not be for you; weight loss surgery might be the right answer, or weight watchers, or a sympathetic nutritionist/personal trainer team. But take heart, there's a lot of help out there, just keep looking. I agree about seeing a counselor, I do, and it HAS helped. I also found love while fat, but it takes getting out there, meeting people. Join special interest groups, book clubs, or go see bands, or theater, or art shows, or SOMETHING. Ignore foolish hipster bullshit, most people are extremely sweet face-to-face, once they get to know you for who your are.

In the meantime, you can do this, if you take one small step at a time. Try switching out your junk foods, slowly replacing them with meat, veggies and fruit - start replacing one snack, then another, then another. Not low-fat, low-calorie crap; real food, like big fatty steaks and roast chicken and salads with nuts and oily dressings and cauliflower with real cheese. Don't even try to rein in your appetite at first, just eat all of those foods you want, and you may be surprised how much more normal your appetite becomes and how you naturally start dropping weight. Give up sugar soda for water, coffee and the occasional Zevia or Izze soda. It's amazing how much that helped me, it MIGHT work for you.

I know the comments and stares SUCK; it really hurts, drives you indoors and to the video games. Wear an iPod when you go out, listen to music you love, tell yourself that you are trying your best to live your life, let their negative bullshit bounce off you as much as you can. Do try walking, first a few blocks, then slowly build up over weeks or months, whatever it takes to half a mile, then beyond. I found walking in big wild parks, such as Discovery or Magnuson or the Arboretum (if you're in Seattle) the best, where there aren't a lot of people who could make me feel self-conscious. Walk at night to really have the place to yourself! I don't jog, run or bike - bad knees - and you don't have to in order to lose weight. I do recommend weight lifting for building/maintaining muscle mass and revving up the metabolism. People are surprisingly sweet at the gym, really supportive, as are people at the dojo I started doing healing martial arts at when at my very heaviest - try tai chi or qigong to begin with, or as a lifetime practice. My dojo specializes in helping people with health issues feel better and welcomes everyone non-judgementally - do some research, check out websites, find one like that.

If I could do this, you can too. There IS light at the end of the tunnel. I'm not "perfect", but now I'm only stared at when I'm being checked out! I never thought life could be this way. But it is possible. I had to keep reaching out to find people who could really help me help myself.
Perfect answer, Dan.

Just adding my voice to the chorus of folks rooting for PHM. You are not alone, not by a long shot! There are many thousands of folks who have been in your exact same position, and found their way out of the maze. It IS possible!

Please heed Dan's words - there is ALWAYS hope!
First of all, thanks, PHM, for that letter. It may sound like a cliche from me, a stranger, but your magnificent heart shines brilliantly and I can't help it but, you know, I'm pretty moved by it.

See, you don't have to be overweight in order to feel repulsive. You can be like me, deaf, and feel that way and I mean with the same persistent intensity that makes you not want to leave your house. I'm a big guy, too, 6'6" and I know that for you and me, our peak weight is right about 195 pounds. It took me five years to drop from 245 to 195 pounds and I tried to do that for the same reason you are trying right now - because you don't like yourself very much.

Okay, so here the bad part. Dan is right about you needing support because, see, I lost all that weight and I still don't like that guy in the mirror. He's looks okay on the outside, but his real beauty is on the inside. I've been rejected by people for a lot of reasons. I'm gay and I've had a decades long struggle with my family over that. But my deafness is what put me into the same position you are in - emotionally speaking. I've been hit pretty hard by people who have rejected me for being deaf and, like you, I don't want to go out of my house anymore. I mean, I always think that trying to go out and socialize is a certain setup for failure because I just there, and I can't engage people in conversation when I haven't the slightest idea what they are talking about, and when I do try, people sort of drift away from me.

Okay, so, maybe I did have some success with losing weight (I started with Jenny Craig and really liked it, but it's expensive) but my heart needed help no matter what my body looked like. So I *had* to go to a shrink. Look. I'm just going to tell you that after you've gone through all this pain, please don't get the idea that everything would be rosie if you replaced that body with a new one. I've been seeing shrinks for about 20 years (off and on) and it really does help a lot. You gotta work on that head, too, big guy.

You know, I'm usually pretty snarky on this site. But, Man! You got to me. Peace. You have a beautiful heart. I'm no expert on dieting but I would say that people like you and me have to be careful about seeking cosmetic solutions. Our problems are in our heads more than anything and I, for one, am a little leary about surgery because, yeah, who's going to turn your down? You have to wonder if their motivation to "help" you is a genuine concern for you or for their bank account. So, I think going to a shrink and having a VERY LONG TALK is the first step.

We big guys gotta stick together, Bro.
Dear PHM,

A lot of the advice in these comments seems quite good to me, but I want to add my $0.02, as well. I, too, would recommend a doctor's appointment to assess your physical condition and advise you on weight loss, a visit (visits, really) to a good nutritionist (in my experience, hard to find--but worth it) and finding a good therapist.

But I'd also suggest that at the same time you remind yourself of what is ALREADY good about you and start doing things--even little things--that you enjoy to remind yourself (by force of will) that you are entitled to good things in your life. I think there is a tendency for people with weight problems to think they should wait until they are thin to bring good things into their lives. There are lots of reasons to lose weight, but no reason to wait until you do that to do other good things. And the effect of doing good things and valuing yourself makes it easier to commit to doing this bigger, challenging thing (losing weight) for yourself.

So... make a list of three things you do really well. Are you a good listener? A good driver? A good gardener? A good piano player? Are you good at telling jokes? Are you the detail-oriented person at work who saves other people from their own mistakes? Are you the person who can fix any household appliance?

This doesn't have to be deep, just a reminder that you add good things to the lives of the people around you, including your sister and your colleagues. You are not just your weight.

Make a list of five to ten things you'd like to do by the end of the year. Start small and/or easy. Is there someplace you want to go, like a museum or movie theater you've never gotten to? Is there a book you've been wanting to read or an album you haven't heard in 10 years that you want to listen to again? Is there something nice you could do for your sister?

There is something about doing something fun--and checking it off a list--that is satisfying and motivational. No point in waiting for that.

Finally, if you don't already know how, learn to cook. From scratch. When you control what you are eating and how it is prepared, it's a lot easier to eat well and properly and to cater to your own tastes.

Best of luck!

@30 GREAT advice to swap in real food instead of junk food. They sate the appetite so much better than the Cheetos. I often grill up an 8oz steak and can't finish the thing.
I think perhaps PHM would benefit from antidepressants...he may then be able to find the motivation to eat right & exercise without giving up, because he'll be able to envision a positive future for himself, instead of going to that "dark headspace" he mentions.
I have a friend who's lost 70 pounds this year, bringing him under 400 lbs for the first time in nearly a decade-- what did it for him was a good nutritionist/personal trainer team. So why not try to build your own "Team PHM" while you consider the surgery question? No need to do it alone!
Two small additional thoughts, PHM:

1) Your motivational foundation will be built on a lot of things: encouraging words, love from your family, hope via science, etc. Fear is also a part of motivation, and at least one brick's worth of that should be job security, from a purely practical viewpoint. You're lucky enough to have a day job in this economy, you said, but obesity-related medical issues could easily make you sick often enough that you're seen as a liability by your employer. Lose your job, and there goes your insurance. Overweight people are also often passed over for promotions and raises. Let this knowledge be galvanizing rather than paralyzing.

2) Love and partnerships are great, but they're not everything. It's possible to live a happy, fulfilling life alone and unpartnered, so don't make "finding someone" the focus of your existence. Get better for YOU, first and foremost; and maybe look for volunteer opportunities to get you out of the house, take the place of a dating life, and focus on the needs of others--it will paradoxically do you some good. Do something wildly out of character--take a master-gardener class through your county extension, for example. Find clubs to be involved in--Audubon, native-plant societies, whatever. Some have regular outings in addition to monthly meetings and presentations that can add gradual physical activity without exhausting you.

People care, PHM. Don't build your self-image around what cowardly jerks and unthinking brats might shout at you as a stranger.
@22: I'm with you re: surgery only when all benign alternatives have been exhausted. Eating different food? Agreed.

Hey PHM: Get rid of your car! Learn to walk/bicycle and take public transit. You will save thousands of dollars which can then be redirected into a substantial dating budget. You will burn calories, pollute far less and actually have have an opportunity to meet strangers.

Good luck.
Dan, I'm glad to see compassion in your response, but surgery should NOT be the first step -- therapy is first and foremost here. PHM, you need to make the decision to value yourself and be your own first priority before anything else matters. Once you've cleared that hurdle, the next one won't seem quite so impossible.

You CAN lose weight, but it's going to require commitment and support. Do not fool yourself into thinking you can do it alone, and absolutely DO NOT allow shame or apathy get in the way of asking for the help you need; keep asking until you get it.

You are loved, and you will be loved, but first you need to love yourself.
PHM, if the only doctor you saw was your primary care doctor, think about seeing an endocrinologist. Most GPs only test TSH levels when testing for thyroid disorders - endocrinologists will go further. GPs sometimes also use outdated reference numbers when determining hypothyroism, so if you are borderline, your GP might say you are fine, but an endocrinologist might look at your symptoms and treat you.

Additionally, there are numerous other endocrine conditions that can cause weight gain (or the inability to lose weight).

And yes, antidepressants might be a good idea. Before I was first diagnosed hypothyroid, I started taking them. I was able to stop after my thyroid was under control (depression is a symptom of hypothyroidism), but they allowed me to function in a much better place than I was, and to focus on what I needed to do to get out of the lousy headspace I was in (and yes, it was therapy with a fantastic clinical social worker).

The best thing I can say is don't give up. You can find happiness, whether alone or with a partner.
If you can afford it, hire a personal trainer. (You can try a planet fitness-type place to start, so you won't feel as intimidated).

The combination of paying for sessions (motivation of not losing money), having someone waiting for you to work out, and that individual knowing how to get you healthy - and what will let you see results - was one of the only things that really worked for me. It's so easy to say "tomorrow" but when you will lose money today by putting things off until tomorrow, you tend to show up for the gym.

Good luck!
PHM has tried valiantly to address his physical problem and he should continue to try, but what about this?

PHM should focus on something that reminds him of all the good stuff about himself, his intelligence and goodheartedness. He should volunteer at an organization connected to a cause he cares about or used to care about--homelessness, the arts, inner-city education, animal rights, historical preservation, whatever. His fellow volunteers will see him for what he is, a guy who gave up his free time to do good. After he sees his reflection in THEIR eyes for a while, he won't care so much about the one in the mirror.

This might mean giving up the video games to get the time. (I'll be the first to admit they're a legitimate art form, but the types of intellectual and social stimulation that we get from them are only one step up from TV; they're not very rewarding.)
PHM, I can't pretend to know what you're going through. But I do know a guy who changed his diet and started to exercise, and has dropped a lot of weight. He went on an Atkins-type, very low carb type diet. Also single, and didn't like himself very much. He's bright, funny, and caring; now, he's starting to like himself more.

One of my favorite columnists is Joe Posnanski. His brother has also lost a lot of weight though lifestyle change. Tony's blog is here:

This would be a long and difficult road, with a lot of setbacks. Sounds like it's a road you've started before, and it hasn't worked out. Once you get information about various surgery possibilities, you can make choices about which path is best for you. Whichever you choose, enlist help. Your sister, a support group, a website you check a few times a week. You're not alone.

Heck, there's 40 people right here, who've never met you, and are wishing you well.
Go, PHM, go! I'm one of many who are cheering for you. I'd give you a hug if I could.
By the way, I'm sure a lot of us here are somewhat on cruise control in life (I include myself), whether in a few areas or many. We should be taking more of our own advice, which is in abundance above (yay for a much broader list of volunteer arenas @42) and probably will be below. I intend to.

So you see, PHM, you're a catalyst for positive change.
Research weight loss surgery. Only 3-5% of morbidly obese people who lose weight through diet and exercise can keep it off long-term. WLS is not easy, cheap or something to jump into, but it offers a way out of morbid obesity.

I had gastric bypass 2 years ago, have lost over 200 pounds and life is good.

Good luck.
You can make the changes, PHM. Everyone here is rooting for you.
@42: well said.
First step should be to get a therapist. If you don't like them or can't tell them *everything* by the end of the 4th visit, that is not the therapist for you - go and find a new one. Shop around until someone clicks. You want one with a PhD in psychology, which will cost you, but believe me it will be worth it. I was seeing a psychologist when I was working minimum wage and had no insurance - and it helped my self-esteem enough to get a better job [$65k/ year when I retired at 43] with the insurance to pay for it.

It really sounds to me as if you need antidepresents, just to take the load off. To get them, see a genuine psychiatrist, not just your general practitioner. My antidepresents have literally saved my life. They could save yours too.

Once you work on your addiction, depression and self-loathing, the weight will begin to fall off on it's own. That does NOT mean you shouldn't explore other options, of course. Lap-band surgery will make you feel full faster and over-eating will hurt. If you think that will stop you from continuing your self-destructive habits go for it, but see a therapist anyway.

You are a worthwhile person. Your sister loves you. Your life is worth living - or it will be worth living once you get help.

You have no idea just how much better your life can be once you aren't depressed and self-loathing - I know I didn't. Getting help was the best thing I have ever done in my life. I bet it will be the best thing in yours, too.
I would generally agree that surgery is a last resort, but from the tenor of this letter, this man is pretty fixated on suicide right now. I'm not sure he has time for any but the most serious measures. Good luck, PHM. I hope you can find a way to be in the world that will work for you.
I second the Atkins plus exercise routine mentioned in @43. You will see real results, and a diminished appetite, in just a few weeks, which will boost your confidence. I do this if I have to lose weight fast (like for a recent wedding I was in), or if I've gained weight quickly recently and want to be extra aggressive about it. It's hard to be on it for months or years though, at least for me, and it's kind of expensive and complicated. Usually, once I lose the ten pounds or so, I go back to eating my normal bread and rice-based diet. But anyway, low carb is a good way to break your addiction to food temporarily.

I also play a lot of video games. Which, gosh, are such time-sinks, aren't they? It was such unhealthy, compulsive behavior for me (along with the moderate amounts of wine and pot that sometimes accompanied playing, hah!), that I decided I had to do something about that. Well, I switched all my games to kinect games (or very active Wii games would be good) and now I get a fairly good workout if I want to play a game. Also, no more drugs of any kind, since they all stimulate the appetite somewhat and make you careless. I'm not saying you're self-medicating your unhappiness, but if you are, you will feel much better if you stop.

Incidently, I LOVE big guys. The bigger, the better. Especially if a man is confident and seemingly at home in his body, which it sounds like you are not so much. I've known really fat guys who moved gracefully and were brilliant, and had they asked me out, I would have said yes. I know I'm not the only normal-weight female who likes the embrace of a big man-bear. But, like someone said above, maybe you shouldn't be focusing on dating right now, until you get things right in your mind. Take care, my friend.

Dan, well-done.

I feel the need to chime in after the Atkins recommendations and point out that many leading cardiac authorities have serious concerns about how unhealthy that diet can be for your heart. There are other regimens that more responsibly balance vegetable and animal proteins and monitor fat types and quantity. Talk to a good nutritionist and consult with your doctor about your personal health risks.
milemarker @32, could you explain a little more? It's upsetting to hear you say:

>> I don't want to go out of my house anymore... Trying to go out and socialize is a certain setup for failure because I ...can't engage people in conversation >>>

Assuming you know ASL, why not socialize in that community?
Did the people decrying Dan's suggestion about researching and contemplating the use of surgery even read the letter?

"That should ALWAYS be a last resort!!!1!!1" you all say. But if I'm reading this letter properly (and I am) Dan isn't saying anything different. This man says he's tried nearly everything to no avail. Simply saying "well try harder!" doesn't always work. And while I agree that it's best to try to alter yourself naturally if you can- this man seems to have tried and completely given up.

So when Dan suggests researching the various surgeries and consulting a therapist/nutritionist/professional that isn't his primary care doctor- he's suggesting exactly the same thing. And to get angry about it shows more your desire to find something wrong that isn't there than it is to actually call out Dan for something incorrect that he advised.

To the Letter Writer- you have the full support and sympathy of the interwebs. Myself included. And I say take Dan's advice on all counts.
Is this guy in Seattle?

I've helped get a lot of people into shape over the years (I'm a former kickboxing and boxing coach with about 20 years experience in training).

I'm not saying I can make anybody into Brad Pit. But I know I can help this guy feel better.

Here's my offer: Since I need to get back in shape myself I'd do it as more of a work-out "partner" than a personal trainer. Which is what he needs. IOW: For free.

Dan, If he's interested in talking about it - get my bonafides - he can get a hold me through SLOG.
PHM, your suffering really touches me. I've had to fight similar feelings -- not obesity-related, but believe me, there are many ways in this universe to hate oneself and everything that one is, being fat is only one of them. There are others.

It really took help to get out of it. I often considered suicide, actually tried once but failed -- a cry for help. I actually did get some, from an unexpected source. I saw shrinks, got help from friends, from family members.

I would never have been able to do it on my own.

Dan's advice is spot on. I have nothing to add, except that things can get better, and life can become a source of enjoyment rather than torture.

Good luck. Honestly, good luck.
Get a new doctor, and then a psychologist or psychiatrist. For most people, depression is treatable, and then you'll be in a better spot to do the weight loss.

I'd recommend a psychiatrist, or a psychologist that works with a psychiatrist, because you're probably going to need anti-depressants, and a psychiatrist can prescribe and knows more about the side effects of various antidepressants than your general practitioner (one side effect can be weight gain, which would be bad)

I'd avoid the weight loss surgery, if possible, but if the weight is making you lose too much mobility that it's driving you to have a less active lifestyle, than go for it.

And, can we get a fun freak tomorrow? This letter was sad.
FYI, "many leading cardiac authorities" have been thoroughly debunked. Not saying that's definitely the way to go, but it's not unhealthy. Psychologically hard to do long-term in this culture, maybe (for some including me), but the freedom from overwhelming hunger and craving couldn't be beat.
Great response, Dan. My father had gastric bypass surgery after decades of struggling with his weight. His weight had become so out of control that it led to arthritis, diabetes, cardiovasuclar disease and severe knee and back problems that forced him to go on permanent disability. Two years after the surgery, my father has lost 150 lbs., has had two successful reconstructive knee surgeries, no longer shows any signs of diabetes and has begun looking for work.

And this was all thanks to Medicare. It paid for my father's surgery. My father tried to get the same surgery 10 years earlier and the HMO he belonged to managed to put up enough red tape that my dad was laid off before he could get the surgery. Yes the surgery cost tens of thousands of dollars, but the money that would have been spent over the next couple decades supporting my father and covering his medical expenses would have been far costlier.
No advice to offer. Just letting you know that I'm in your corner too. We care. Stay with us.
@ 58, no, they really haven't. Nor have specialists and organizations who deal with kidney and liver issues, bone loss, or metabolic concerns, nor the nutritionists who point out problems with long term limitations on fruits and vegetables, foods that ARE actually known to promote good health, unlike animal fats. In fact, it's been repeatedly shown that Atkins is effective for weight loss, but no more so than any other diet plan that, overtly or covertly, reduces calorie intake. Unlike other balanced diets, it has not been shown to promote long-term health. Those two things are not synonymous.
You know, the way evidence is pointing us in pediatrics is to reward doing the right thing, rather than getting the right results. For a bedwetter, you reward timed toilet breaks, not drinking a lot at night, etc, rather than dry sheets. For an overweight kid, you reward exercise, keeping with in a calorie limit, etc, rather than lost pounds. I suspect this would apply to adults, too. Make healthy changes in your life (food diary, calorie limits, exercise, switching to whole grains/leaner meats/diet soda), then indulge yourself in other areas (movies, music, whatever) as a reward for sticking to those changes rather than based on the scale.
@57 this!

Get your head treated first.
Oh man, PHM, I'm so rooting for you. I agree with Dan: your first stop should be getting a therapist. You need to sort out what's going on inside your head before anything else is likely to change. (Which is not to say you can't start exercising & eating better today, just that you're going to need a lot of support if you're going to turn your life around.) It sounds like there's a lot of depression in the mix as well. Please tell your sister how you feel if you haven't already.

People of all shapes and sizes find love, but it's impossible to find love as long as you hate yourself. I absolutely believe you can do it. Don't get overwhelmed by it, just take it one step at a time. Good luck.
In the immortal words of St. Ru of the Paul, "If you can't love yourself, how in the hell you gonna love somebody else, can I get a amen?"
He should see the shrink before he considers surgery. Sounds like he might have an eating disorder, and therapy could help him without resorting to invasive procedures (and like Dan said, there's clearly psychological things he needs to work on regardless).
PHM, I am one of those women who lusts after the "round in shape" guys, and there are more of us than you'd imagine. I say this not necessarily as a solution to your problems, but to preface an important fact that all mature humans come to: No one is attractive to everyone, and no one is repulsive to everyone. If Johnny Depp came to my door looking for nookie, I couldn't do it. He's about as sexually attractive to me as a lamp. You, on the other hand, would likely be ravished within an inch of your life.

ANY ADULT PERSON you see on the street has been sexually rejected by someone. It sucks, but eventually you learn "your mileage may vary". Oddly enough, most rejection is not personal, any more than the Orange Crush on the grocery shelf should feel badly that you chose the Dr. Pepper.

You are in a much harder position emotionally than most. I have to agree with most posters here - anti-depressants and good therapy before you make any decisions about your body, either surgery or otherwise. I hope you choose to stick around this world, because I have little enough eye candy as it is. :)
1. Love the things about you that ARE good.
2. Read some of the wonderful fat-acceptance pages out there.
3. Find a person to love who's as fat as you are.
4. Live.

I second Dan's advice that you see a therapist, but I think the goal of your therapy should be self-acceptance, not weight loss. Of course you can't lose weight if you have to eat constantly in order to kill the pain of hating yourself. Once you love yourself the way you are right now, you might or might not lose weight, but even if you don't, it won't be a tragedy.

PHM- I'm not morbidly obese, but I can sympathize b/c my life is pretty fucked-up. Sometimes I feel as if no one is going to want me unless they're one of the following: a jerk looking for easy prey, really desperate or down on their luck, or have major problems of their own (drug and alcohol issues for instance).

However, I tried dating a really big guy, thinking that maybe he'd be a bit more sincere or caring than some of the vain bastards I've dated in the past. And actually, I felt really judged by him because he had a very successful career and mine was kind of shitty. He basically did just enough to string me along so that he kept getting laid while making me think there was relationship potential. I felt like he was slumming or something, like getting as much pussy as he could before he went on to date someone he considered "worthwhile" or "marriage material".

Just because you're big doesn't mean that you can't manage to judge someone harshly or hurt their feelings. Thinner people have feelings too. You still have power in the relationship to either make your partner feel good about themselves or shitty and pathetic. So maybe don't just categorize the women that want to date you into "loser" or "manipulative bitch" so quickly and reconsider some of the women you judged as not having relationship potential. If you expect women to be understanding about your weight problem, then you're going to have to be understanding about their problems too.

Here's to the first time when you're walking outside thinking,"Yeah everybody, look at me"!**

You aren't alone, and as you've read, you aren't all that unusual in your problems. At 2+ meters, you will always stand out in a crowd, no matter what. That doesn't mean you can't find a group of like minded compatriots, and start making the life you want.


** (and all the rest of the times as well)
@55, tkc, you are the change I want to see in the world.

Thank you, thank you, thank you.
My story: I felt hopeless and despaired of ever losing weight. One day I thought, "I'm going to walk to the end of the block and back." I did, very slowly, needing to rest along the way a couple of times. Very slowly, over time, I increased the distance. Soon I was walking 4 blocks, then 5, then 6. I rested when I needed to, but over time I became stronger. I tried to always walk with a close friend because doing that made me feel safer: people weren't as mean and didn't yell at me as much when there was another person with me. I very actively told myself how proud I was of myself for the little goals I was achieving.

Another piece of the puzzle for me: some people's bodies are very sensitive to sugar, and mine is one of them. I love sweets, so I began looking for healthier alternatives to candy and desserts. I began frequenting the health food aisles of grocery stores. I began buying health food bars instead of candy bars (some of the health food bars are actually quite good). I did all of this because overdosing on sugar was contributing to my depression and anxiety big time. Our bodies get used to what we eat. So if you add a bit of fruit to your diet, even though at first it may not taste good to you, your taste buds will change within a few weeks, and you'll begin liking the fruit.

I would encourage you to try to say nice things to yourself. The way you talk to yourself -- would you ever talk that way to your sister? No, because you love her. Even though it's going to feel false at first, please try saying positive things to yourself. You could even ask your sister to help you see some of the good, beautiful stuff about yourself, and then repeat that to yourself every day, throughout the day. Your sister would not lie to you -- she loves you. So you must believe what she says about you. YOU HAVE WORTH. You may feel like a piece of crap, but YOU ARE NOT A PIECE OF CRAP. You have worth. You must believe that about yourself because it's true.

And if the people in the medical community you're seeing are not helping you, try other avenues: acupuncture or an integrated health specialist (someone who's open to thinking outside the box).

Best of luck and hugs, my friend.
There is a 12-step fellowship for overeaters-Overeaters Anonymous. I am a member. I too could never lose weight/keep weight off. I'm not sure where you're located, but there are phone and online meetings.

I'd like to give you a couple of role models, as far as appearance and demeanour are concerned. They are Brian Dennehy (I know him best from Cocoon) and Gérard Dépardieu (the last role I saw him in was that of a brilliant though eccentric chef in Last Holiday). Here are two undeniably big men. When I see Brian especially, I think he's solid. Dependable. Supportive. Protective. Would not back away from a crisis. And who cares if I can't reach around his waist with my two arms.

So, you see there are good adjectives that can be applied to a man of size. As you work on your weight-related self-esteem issues, see if you can begin to incorporate more positive adjectives to describe yourself, unique to only you. Good luck in discovering the man you were meant to be.
Dan- Wow. What a compassionate response. Thanks
A good friend of mine made some really important breakthroughs in her struggle with anorexia and bulimia when she joined overeaters anonymous. It's a 12 step program like AA, but for people with food addictions. Having the support of a community in staying "sober" - ie, eating in a way that was healthy for both her mind and her body - made all the difference for her. I know 12 step programs aren't for everyone, but you might try googling them to see if there's a group in your area.
I almost never disagree with you, Dan, but you messed this one up. The guy may need surgery, but that shouldn't be the first option. He has a food addiction and surgery won't break that, same as no surgery can help an alcoholic stop drinking. To the writer, have you heard about Overeaters Anonymous? It's modeled on AA and I've seen it work. Dealing with your addiction will go beyon your weight to all those other negative feelings. Go to a few meetings and give it a shot.
Hey PMH,

I have one or two things to say to the intelligent, good-natured, depressed guy inside you:

- First, I am one of those skinny-ass girls who loves bigger guys. Nothing feels as wonderful as being held by a big teddy bear. Right now you're looking at your body like it's something you want to throw in the trash - well, dammit, stop that! One person's trash is another person's treasure. For all us fat-lovers' sakes, don't waste it!

- Second, have you ever heard that fear is the mind-killer? It's a lie: self-pity is the mind-killer. Yes, your life sucks and people stare at you; yes, your body makes it impossible to do normal things; yes, there's a chance that things will never change and that is very depressing. This is all true.

Now snap the hell out of it. Self-pity and self-loathing are the two most absolutely useless emotions on the face of the planet. It's a waste of your time alive to sit around feeling that way. You may have plenty of reasons to give up in despair, but that's no excuse for giving up in despair.

Life is not all about you and whether or not you have love/an attractive body/good health/a reason to be happy. Get off your butt and find something constructive to do - NOT because it'll make you lose weight or because it'll make you happy, but because Just Do It. And do it again tomorrow, for the same reason.

You have your sister's love, and everybody here on Slog is rooting for you. Regardless of if you're fat, there are still plenty of ways you can use your head and two hands to make the world a better place - try volunteering. Instead of video games one day, try reading Thich Nhat Hanh's "Peace Is Every Step". Try a martial art. Try anything, as long as it gets you out of your rut. Just do it.
@53, it isn't always that easy. Don't assume every deaf person knows ASL. I didn't start learning ASL until a few years ago , and I was born profoundly deaf. I don't know milemarker's complete story, obviously, but there are many possible scenarios.

Oddly enough the older I get, the harder it gets -- people are starting to consider my hearing loss as more probably age related and actually do react differently than they used to. One thing to deal with a deaf kid or young woman, I guess, than with a distinctly middle aged woman. We'll see what happens, but it's not fun that's for sure.
PHM - start by loving yourself in whatever body you have, then go from there.
PHM - I'm a gay man that is only attracted to bigger fellas. Trust me, there are ALOT of us out there. Post a profile on, you'll very likely get some attention.
PHM, there's some great advice here about making healthy changes to your lifestyle, starting to get more exercise, eating healthier food, etc. But I want to double down on the headgame part of this thing, as some others have as well. It doesn't matter how much you weigh, you need and deserve to have a good life right fucking now, starting today. Take a look at this essay:…

This is not to say that you can't lose weight, or shouldn't try. I'm sure that you can, in fact, and I believe in your power to change your life. But your happiness doesn't have to be contingent upon it. Give yourself permission to live the good life no matter what the numbers on the scale say.
PHM, see if your sister can shop for women's self-defense classes on your behalf.

Kids harass you because that's all they know how to do. People who know how to actually beat us up know it's easier to beat us up if they keep that information to themselves. Going out on the street in the face of harassment is your civil rights challenge. We need you to address this.

The easiest way for you to beat someone up is for you to pick them up and throw them to the ground, essentially beating them up with the ground. When you sit in on a self-defense class, you can get a guess of how people move in attack-mode, and how you need to time tripping them, then formidably body-checking them into the concrete.

If kids harass you, look at them and start punching your palm (or if you're me, give them the finger). Then they're the ones running away from you. If they stop the car TAKE DOWN THE LICENCE PLATE NUMBER. Take a photo of it. The driver will abandon anyone looking for enough trouble to get out of the car. Taking down license plate numbers flips drivers out. He's driving because he's already the most accommodating of his group. He has to think about junking the trust he's nurtured to drive around some asshole harassing fat people on the street. He'll run away, then make all of the rationalities to establish the habit for him. He needs the lesson of the trouble his asshole friends will get him into.
Awesome advice, and good luck to you, anonymous guy!!

Ignore the haters, you're young enough that when you get out of this hole you will be able to look back on this whole experience and feel like you dodged a bullet, that life was and is worth living.
When I saw Dan picked a letter about obesity to respond to I groaned and thought "Haven't people learned not to come to Dan for weight advice?" But Dan, you impressed me with your kindness and gentleness. Thank you. I was 330 lbs and am now 200 lbs. I had insulin resistance (a treatable medical condition). Who knew? Once I found the right doctor, weight loss followed.
Like #72 and others have said, even tiny baby steps towards physical health will help you, and that will help your mental health too. Honestly, whenever I see an overweight person out clearly getting exercise - in sweats and running shoes, slowly walking or very slowly jogging - I send a little silent mental "Rock on!" message to that person for getting out there and trying, and it makes me smile at how we humans can be so strong. Ignore anyone who would laugh or joke about your appearance - they are completely not worth your energy. Good luck.
I don't understand some of these comments stating "NO, how dare you tell him to lose weight??!! he just needs to accept himself as he is!"

While I agree you should be working towards acceptance of yourself regardless of your circumstances, this completely undermines his health and longevity. While WLS should be the last option, it is viable and is proven to help people drop the weight. So what if he's completely happy and loves himself, having a heart attack at 50 or perhaps younger, fucking sucks. Working out and losing weight is a great confidence boost no matter who you are... Not everyone needs medications for depression as not everyone is depressed because they are born with chemical imbalances. Some have just shitty situations, and being obese your whole life is a really shitty situation that really takes a toll on someones confidence and well being.

Regardless of how you do it PHM, it'll take time, to both drop the weight and to accept and love yourself. But both are reversible, and it just takes a lot of courage and hard work.

From a WoW player to a fellow nerd, I'll still be rooting for you!
I just wanted to add a comment to the letter writer -

Being stared at isn't always a bad thing. If you feel uncomfortable with your appearance, it's easy to interpret all stares as hostile or judgmental, but the end result of you achieving an appearance you're proud of isn't that no one will look at you.

I mention this because I had a friend who lost a lot of weight and it took her a long time to wrap her head around that. If you're 6'7", it's probably only going to be more noteworthy.
PHM, you've self-diagnosed yourself, both body and mind, into a corner. New doctors, including a shrink, can help you get closer to figuring out what your problems really are - and what they aren't - and how to start addressing them. If money is an obstacle, ask your loving sister for assistance. From the way you describe her, it doesn't seem as if she'd begrudge you the help. She'd probably be proud of you for taking active steps to improve your life.

Seek professional help. You sound like you're worth it.
Doctors are mostly idiots. Go to a qualified nutritionist.

Really fat people who have no obvious medical problems may be fat because of a particular nutritional deficiency. This makes your body (very sensibly) try to make up the malnutrition by eating lots of foods with trace amounts of the missing vitamin or mineral.

Some potential candidates: Omega-3 fatty acids, MSM (sulfur), iodine, Vitamin D3. Especially if you are rather agoraphobic, you undoubtedly have a Vitamin D3 deficiency. Try to get out in the sunlight for about twenty to thirty minutes every day around noontime, with no sunscreen. Uncover as much skin as possible. I know for an agoraphobic that could be difficult, but maybe you could find someplace outside and secluded?

Trust your instincts. You know it's not a psychological problem, it's a medical problem. And you are probably correct. Think of all the people with ulcers who got the ulcers blamed on psychological problems, for decades, when all they needed was an antibiotic.

And before people jump on me, I'm not talking about people who are twenty pounds overweight. Somebody who is really really fat, nutritionally deficiencies should be examined--the body wants to keep itself in balance and gaining that much weight the body generally has some reason.

Here's a link on MSM, for example:…
LW, Honey, you are clinically motherfucking depressed. You've got knots in your head. Your mental health is inextricably tangled up with your physical health, and to change one you are going to have to change the other, too. Get a shrink - a GOOD shrink, and don't be afraid to shell out some cash for a good one, it will be the best money you ever spent - and start untangling those knots while looking into surgery and other options.

and check this out:
Why not make lemonade of the humongous bowl of lemons life has handed you? Sign up for one of those "The Biggest Loser" type contests. You get to spend time at a place where you receive professional oversight of your diet and exercise program. And the larger and fatter you are, the more weight you have to lose, and thus the more likely you are to win (even if measured by percentage body fat.)

At best, you win some cash and notoriety. At worst, you lose a boatload of weight, meet a bunch of new friends, and then go home to resume your life in your new, slimmer body.
@79 BEG, I apologize for my ignorance. I do appreciate that some hearing parents don't facilitate their deaf child learning ASL, but I don't understand why an deaf adult wouldn't learn ASL (particularly an adult who was depressed and felt out of touch). Is it a huge investment, more like learning Chinese than like learning a romance language? Both you and milemarker seem fluent in written English, so I gather language acquisition itself is not the problem. Why not pick up a language that lets one talk to many other deaf people?
Erica: ASL is a relatively easy language for English speakers to pick up and I encourage everyone to learn it. But the capital-D Deaf - those who were raised in Deaf culture and grew up with ASL as a first language - sometimes turn a cold shoulder to deaf adults who were acculturated in the hearing world and learned ASL later.
Also, LW: you are neither greedy nor lazy. Here is how you can tell: you are miserable. Truly greedy and lazy people are quite happy; they're usually executives of hedge-fund-management companies, or career criminals, or both. I've met plenty of them. What you are is depressed and self-medicating with food. Very different.
This guy should lift weights. At 6'7", and obese, he could have the potential to become hugely strong. True, he might still be very fat, but I imagine it would do wonders for his self confidence to be able to look around in just about any room, and be able to say to himself "I'm stronger than everyone in this room".

It may seem silly, but I say use whatever physical traits you have to your advantage. It's much easier to gain muscle and get stronger when you've got lots of extra weight. And even if you're fat, shifting some of the weight to chest, thighs, and arms, can turn your proportions into a much more masculine look. You can be "big, strong, fat guy", rather than "flabby, pathetic fat guy".

I say this as a big, strong, fat guy.
PHM--Investigate bariatric surgery and see if it might be for you. My wife had a gastric bypass nearly a year ago after years of trying and failing to lose weight and being ground down by the sort of psychological pain you so eloquently describe. My wife has lost over half her bodyweight in less than a year and seeing the look on her face as she fit into a size 12 for the first time since college was worth it all.

I wish you the best, PHM, whatever you decide to do.
Bariatric surgery is a big step to take, especially the Roux-en-Y procedure. In Greece it is allowed for morbid obesity, or obesity with diagnosed health risks such as heart disease or diabetes AFTER two years of weight loss efforts through traditional measures with no effect.

Thing is, just because you don't have hypothyroidism doesn't mean that your thyroid is not involved. A sharp reduction in caloric intake sends the body in a defensive mode and one of the results is higher ratios of reverse T3, which means that your thyroid production is less effective. And for the body to get used to a lower caloric intake, it takes more than a year (that's why people gain everything they lost from crash diets).

I know you are fed up, but making the effort with a medical team is worth it. Even if you end up having bariatric surgery, the amount of weight you would have lost, no matter how small it may seem to you, would be less of a burden to your cardiovascular and respiratory systems, which you will both need on the operating table.

Two things already mentioned I would like to stress again: 1. Stay away from low fat or low sugar products. There is emerging evidence that they aid and abet weight gain, plus, non-low-fat foods make you feel sated 2. Seek therapy. A common theme with patients in my country is that they bypass the bariatric surgery by drinking microwaved ice cream cartons, or continuing to buy the same amounts of food at the office cantine even though they could now barely eat half of it.

As for exercise, I would advise against running, as it is very stressful for the knee and ankle joints to begin with. Swimming would be ideal, but if it's not an option, start with walking-and do not spare the money on the sport shoes!
I have a friend who sounds very similar to the poster - was fat, ate junk food and played video games all day. He was around 315 pounds.

At some point he simply became sick and tired of it and decided to lose weight. He sold his car and began walking EVERYWHERE - several miles to and from work. He replaced TV and Video games with walking (for walking sake). He would not eat for a day on a frequent basis.

This isn't the best, healthiest way to lose weight, but it worked - he's 6'1, around 195 pounds, and maintains that weight easily without any special dieting [he continues to walk everywhere, play a lot of sports which he couldn't before, etc].

Along with anything else, try adding as much exercise (especially passive exercise, like walking to work) and see what type of results that gets you.
To the OP--

The Australian national health service has recently had a couple of bombshell revelations. First, that changing diet and exercise only work for a very small portion of the morbidly obese, and that at best you can expect a person to lose 10% of body weight. For a person who only needs to lose 10-15lbs, fine. For a person who needs to lose 200, it's a nearly impossible proposition from the word go. They've recommended bariatric surgery (usually a lap-band) be made easier to get. Their point of view is that cost and quality of life are both better served by surgery earlier, especially if it keeps the patient from getting severe chronic conditions later.

Second, there is mounting evidence that the centres of the brain that control willpower are fed by sugar. If you try to lose weight and cut out sugars, those get starved, and if they are starved, your ability to say no goes away. In other words, the very thing you are doing to lose weight is sabotaging your body's own means to stay on that diet. You fall off the wagon, because your brain can't keep up, and then you feel depressed like it's your fault, self-loathing, and the downward spiral starts. And once it does, you get shamed or scolded by people who are supposed to be helping you, which makes you feel worse.

Food for thought.

And a personal anecdote about surgery to correct a problem that wouldn't go away...last year in April I'd finally had it with a condition in which I was in pain constantly, was causing infections, was impacting my work, and was starting to cause arthritic changes to my spine. I'd been to two regular doctors, an orthopedic surgeon, two physical therapists, and heaven only knows how many chiropractors before I said to heck with it and went to a surgeon. I had to pay for it out of pocket, and I got a lot of static from my friends and family. My mother the nurse gave me chapter and verse on risks, getting progressively gorier and gorier, until I told her enough. Another couple of friends called me crazy....I wasn't crazy, I was in pain.

I woke up from the surgery and as soon as I could walk, I realized my neck didn't hurt, for the first time in a decade. I nearly cried. Since then, I haven't been getting the infections, my neck and back may still hurt but it's controllable, the pre-arthritic damage is still there but the progression has stopped, and I feel like my life is my own. I wish I'd had the money and support to get the procedure done 10 years earlier.

The upshot of all of this is, surgery may be an option that you've not wanted to consider, but it may also be an option that could do a 180 on your life.

Dan's advice is very good. Find a different physician, one who specializes in treating the morbidly obese, and find a psychologist who will work with closely with that physician.

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