Earlier this year, BBC Knowledge broadcast a really scary TV programme called The Half Ton Man. The man in question, Mr Patrick Deuel of Nebraska, weighed 476kg and had gained so much weight that he was literally drowning in his own body fluids. In imminent danger of congestive heart failure, a special transport was arranged to move Mr Deuel to hospital for urgent treatment to induce weight loss and save his life.
According to Dr Harris, who was responsible for treating Mr Deuel, Patrick had gained so much weight that the 91kg of accumulated liquid in his body was preventing his heart from beating and made it impossible for him to lie on his back. Patrick’s skin had also stretched to the point that his body was leaking fluid and he could no longer move out of his bed.
Dr Harris described this case as “a person where the desire to eat, is greater than the desire to live”. Patrick had literally reached a point of no return. According to Edi, his wife, Patrick was always hungry no matter how much food he ate. In general, patients who weigh more than 200kg are regarded as medical emergencies, but at 476kg, Patrick weigh more than double this amount.
Surprisingly Dr Harris mentioned that Patrick was suffering from malnutrition despite his gargantuan food intake. Although this sounds impossible, the fact that Patrick ate mainly take-aways and fast foods rich in fat and processed carbohydrates, with practically no fruit, vegetables, or high-fibre grains, was responsible for his vitamin and mineral deficiencies. He certainly did not have an energy deficiency. The foods he ate which turned him into a half ton man, were energy-dense, but not nutrient-dense, thus causing so-called micronutrient deficiencies.
Dr Harris prescribed a diet with a drastically reduced energy content. Patrick’s energy intake was cut down to 1/10th of his previous kilocalorie intake. After 8 weeks on this diet, Patrick was able to get up off his bed for the first time in years and move around a bit. Within 4 months, he had lost half his weight or approx. 238kg - proof that energy restriction, even without exercise, can cause pronounced weight loss.
Despite this improvement, Patrick immediately regressed after returning home and regained all the weight he had lost in hospital. Dr Harris decided that the only way to save Patrick’s life and give him a better chance of sticking to a lower energy intake, was to do bariatric surgery. Dr Harris reduced the size of Patrick’s vastly expanded stomach to the size of his thumb and attached it to his small bowel, thus circumventing part of the digestive tract where most of our food is absorbed.
After this second, more drastic intervention, Patrick Deuel lost 279.4 kg in 6 months and started to move around his house more freely. He is still very large, but hopefully he will be able to sustain his weight loss and no longer be called The Half Ton Man.
Fat gene theory
Dr Harris believes that people like Patrick who cannot stop eating even if it means that they risk dying, are genetically programmed to eat and eat. In the past, when humans had to face millennia of food scarcity, those individuals who had a gene that encouraged them to eat when food was available and store as much energy as possible in the form of fat for the lean times, were more liable to survive famines. Alas, this gene that ensured human survival for thousands of years, is now the downfall of the people who carry it. In our western culture with an overabundance of rich, fatty and sugary food, being programmed to eat non-stop is no longer a strategy for survival, but a recipe for disaster.
The BBC Knowledge Programme also explored other theories of why people overeat to the point where they run the risk of dying. One patient called Rosie or the World’s Largest Woman, who spent 10 years in bed, and reached a weight of 539.8kg (even more than Patrick), used food as a comfort. She had been abandoned by her mother as a baby and turned to food for the emotional support. Unfortunately, her source of comfort, became a direct threat to her life. Rosie received assistance from Richard Simmons, who is known as The King of Keep Fit. Simmons encourages his patients to become active and to adhere to their exercise through thick and thin with his Farewell to Fat Programme. Rosie managed to lose 412.5kg in 10 years of sticking to her reduced-energy diet and exercise routine.
Researchers are now trying to identify why some people are food addicts and unable to stop eating. Brain scans were conducted on obese volunteers with food addiction. When these patients were shown examples of their favourite foods, their brains released a chemical called dopamine, which creates feelings of pleasure.
Dopamine is called a neurotransmitter and has previously been linked to cocain and heroin addiction. It would seem that people who are addicted to food, eat to boost their dopamine levels so as to experience pleasurable sensations, in similar fashion to cocaine addicts who use cocaine or other drugs to heighten their sensations of pleasure.
It has now been suggested that individuals with a tendency to get hooked on cocaine, alcohol and/or food, have fewer dopamine receptors and experience less pleasure than people who have a normal number of these receptors. By overeating, drinking alcohol or using cocaine, these dopamine receptor-deficient people are able to increase the number of dopamine receptors in their brains and boost their pleasure levels. No wonder they get addicted to drugs, food and alcohol.
The sensible approach
I was pleasantly surprised that the therapies that were used to treat these problem cases of mega-obesity in the BBC Knowledge Programme, were all sensible and down to earth. No fad diets or slimming pills were used. Each one of the patients who had eaten him- or herself to the brink of death, was treated with simple measures: an energy-reduced diet and exercise. In some cases, like Patrick Deuel, bariatric surgery had to be used to ensure adherence to a low-energy diet, but some of the other patients lost massive amounts of weight by following a simple energy-reduced diet and doing exercise.
The BBC programme was an example that it is possible to lose in excess of 200kg of weight without having to resort to fad diets or slimming pills. If energy restriction and exercise worked for the subjects in this TV programme and brought them back from the living dead, then it will also work for people who have to lose smaller amounts of weight. Losing 20kg compared to 200kg, is therefore, possible and attainable.
- (Dr IV van Heerden, DietDoc, April 2011)
(The Half Ton Man. BBC Knowledge, 16 April 2011.)
Any questions? Ask DietDoc
Watch this video clip of the The Half Ton Man, as first aired on Channel 4:
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