Friday, February 28, 2014

Stop telling me to eat!

It's going on two weeks that I've been on a real low dose of Effexor.  It makes me jittery and exhausted.  That's annoying.  It also has made me lose interest in food.  That's a bonus.  I'm going to ride out that side effect as long as I can.  I'm a big fat ass and anything that helps me lose weight or eat less is a plus.
Anyone who sees me, even from a distance, can see how fat I am.  It's not a secret.  I can't hide it with baggy clothes.
But what are people's reactions to hearing that I'm eating almost nothing due to this pill? "you have to eat!" "you aren't eating three meals a day? Why not?"
I'm not because, frankly, right now I can go without and not feel deprived.  I'm not eating because I'm very very fat and I'm in no danger of starving to death.
But when I say that, everyone is shocked.  I don't get it.  I'm not that type of body dysmorphic.  I know I'm fat.  Did you think I don't know?  Do you not know that I'm fat?
In 2012 when I went for medical weight loss everyone praised my willpower when I barely ate on their plan and lost weight (and was desperately unhappy).  Now I'm not eating with no willpower involved and losing weight (and not unhappy) and that's bad?  What am I missing?
I told a friend of mine who was saying I need to eat: when you can see my bones you can tell me to eat. 
When I have a space between my thighs.
When you can see my hip bones through my clothes.
When my elbow is bigger than my upper arm.
Then, and not before, you can say, "Rosie, you should eat something."
(posted from smart phone, sorry if errors)

Thursday, February 27, 2014

my 600-lb life James' story (synopsis and review)

This is the episode of TLC's My 600 Lb Life from two weeks ago...I've been so ill with my new anti-depressant I've gotten behind on my reviews.  Sorry.
I've watched how many of these shows...and yet upon seeing the opening to this one, my first thought was "wow, he's big." James Jones is 37 years old and 728 lbs.  He lives in a beautiful rural part of Texas in a house that looks like a modern church; lives with his mom who is overweight but not morbidly obese.  He fell and got stuck against a wall and the fire department had to come and break him out; the wall is still busted. 
He says he weighed about 200 in middle school and close to 300 by age 16.  As an accountant, he sat down all day and gained weight.  After work every day he eats fast food.  (Honestly I don't know how he fits behind the wheel of his car as I weigh less than half what he does and I feel cramped!)  Then he gets home and eats the meal his mom cooked him, plus dessert.  The last time he went to the doctor "a few years ago" he weighed 750 and his mom feels he blames her.  She says they have a family history of obesity; his dad died weighing 450, and he lost his sister six month later to weight-related issues (unspecified; she doesn't really look that large in the photo).  
The over-sized hospital bed belonging to the dad before his death then went to the sister, who died, and then the son moved to it.  It's like a cursed bed of overweight death.  I hope at the end of the episode they burn it or something.
Dr Nowzaradan asks James about his eating habits; he replies "I eat quite a bit and quite often" he admits to eating up to 4 times a day.  The doctor says James is "not going to survive much longer" and gives him the usual "lose 50 lbs" before surgery and surprisingly sends him home, not admitting him to get him to lose weight.
 To lose weight he appears to be eating scrambled eggs (or maybe an omelet) and toast.  To exercise he works out in the yard.  He wants to start a hay business but he can't get into his expensive new tractor.  A grizzled old farmer friend of his seems almost in tears as he says that he has to use a forklift to get James into his tractor and that ain't right and he wants James to be able to get into the tractor by himself in the next year. 
He loses 53 lbs and the doctor is very happy and schedules James' surgery for the next week.  Dr Nowzaradan said James is one of his largest patients ever and that the surgery will be challenging and risky.  James gets both the smaller stomach and the rearranged intestines for his surgery and wakes up in a lot of pain.  He gets up and walks right away, inspired by the fact that a woman he met online came to visit him in the hospital.  She is a former weight loss bypass patient herself.
A month after his surgery, he's lost about 25 more pounds, and is finally able to eat solid food.  His mother vows to feed him less.  He eats, as his first solid meal. a hot dog and beans and I couldn't tell what else was on the plate and gets sick.
He is a little pissed that a friend of his didn't come see him at the hospital or since, and when he questions her she answers that "some people work for a living" and she also seems a little miffed that James has met a new woman.  And then she starts crying.  In a voice over, he says he doesn't want to "keep getting hurt by her."
On his next visit, he is at 580, down 150 pounds in a few months with much hanging skin.  Dr Nowzaradan says when he's lost 200 lbs he can get the extra skin off.
He goes on his first date, ever, with the woman he met online and they seem to have a good time.   He is so happy he goes out for fast food and eats a huge platter of fried food in his car, saying he has "cravings."
Eight months in, he's at 565 lbs, and visits the cemetery to put flowers on his father's and sister's graves; both died in 2011.  He regrets that he wasn't able to help them.  His mother worries that Dr Nowzaradan said James could be there in that cemetery in a year if he doesn't lose weight, and James says if he died too, it would kill his mother.
He joins a gym with a pool very similar to the one I use and does water aerobics as his exercise, and gets down to 542 pounds, and decides to try to get onto his tractor.  A friend helps him get onto a platform and from there onto the tractor.
An unknown amount of time later, James is rushed to the hospital with severe abdominal pain and has to undergo an emergency procedure.  Dr Nowzaradan decides he has to do the skin surgery removal right away as he thinks the extreme weight of the hanging skin pulling on his organs is what is causing all the pain.  
He goes on another date with his new girlfriend, even going dancing, and then goes in for his skin surgery a few days later.  I can only imagine that the skin removal surgery is almost as complex as when they take off a lymphedema mass.  In this case, they take 72 pounds of skin off him. SEVENTY TWO POUNDS.  No wonder his abdomen hurt! 
At the end, he weighs 376 lbs (down 352 lbs in a year; so just about half).  "I feel like I can do just about anything," he says.  He starts house shopping and talking about marriage with his girlfriend.  Seems like a happy ending to me!

image source: TLC

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Sunday, February 16, 2014

what's going on over here?

I started therapy a few weeks ago. It's group therapy. Most of the people in it are way more mentally ill than me. As in, hearing voices, on heavy-duty drugs, unable to drive or work or function. And this is the best group that I can fit in? The therapist who runs it said I have a "fierce intellect" like he has never seen before, that causes me to analyze and over-analyze everything, which is part of my anxiety. I had to go to the group a few times before I could see what they call a "prescriber" which is someone who hawks pills to you.
I spent an hour with this poor woman detailing all my problems. I felt bad for taking up so much of her time. I told her how I lost 9 pets and my dad and 2 jobs in a 2 year period. I detailed my marriage and mother-in-law issues, which are worse than ever. After paying her house taxes, she ran out of savings. Since she spends more every month that she receives, my husband has decided that WE have to pay the overflow. At least $500 a month. Because she won't sell her hoarder house. Meantime the mother is paying two loans that belong to my husband's brother and sister. So basically we'll be paying those loans off. There are no words for how angry I am. His sister "can't afford" to help out with money because she's too busy buying a new bigger house with 8 acres of land (but still no room for her mother of course) and his brother, well I don't even want to get into that. His wife is seriously mentally ill and it seems to be contagious. He was going to come back to CT and live in the house, fix it up, care for the mother, in exchange live rent free. He sent a proposal saying he wants $20k as a gift ("expenses") just to move there, $70k to fix up the house, the house put into his name immediately, plus he wants a full time salary, and his wife gets a part time salary, and no one can say anything about how he spends the $70k to fix up the house. Where all this money is supposed to come from, IDK, but when it was pointed out that his proposal was unreasonable, he and his wife basically lost their minds.
I've been really down lately. Probably my Seasonal Affective Disorder.  I get up, go to the pool for 2 hours or so, come home and go back to bed.  Get up, have lunch.  Pretend to work, really just look at lol cats and Cracked and Fark.  Go back to bed.  Repeat.
And I have all sorts of THOUGHTS.  Obsessive, bad, bad thoughts.
I'm in bed all day.  What if tomorrow I don't get up at all....and then I'm down the rabbit hole, into the "I'm gonna weigh 1000 lbs and they'll have to cut me out of the house and take me out in the whale sling."
Or, contamination.  My dishes aren't clean enough.  What if they got washed in the same water as cat dishes and they have cat food on them.  Now I'm pouring Dawn on the dishes directly and scrubbing them under boiling water but they still aren't clean so now I'm eating off paper plates because probably those aren't too contaminated.
The prescriber put me on Effexor (Venlafaxine), to replace the Wellbutrin.  It's got its good and bad points.
Substantial weight loss in patients with major depression, generalized anxiety disorder, and social phobia have been noted, but the manufacturer does not recommend use as an anorectic either alone or in combination with phentermine or other amphetamine-like drugs. Venlafaxine hydrochloride is in the phenethylamine class of modern chemicals, which includes amphetamine, methylenedioxymethamphetamine (MDMA), and methamphetamine. 
Well, half good, half bad?  Of course I've takenphentermine and it doesn't work on me for weight loss anymore so I'm not that hopeful.  And not crazy about something related to meth.  I like my teeth.
It could cause me to have a false-positive urine test showing that I'm on PCP.
It could make me depressed and anxious and suicidal, and give me migraines on top of that.  Not sure how that would be an improvement, unless I also start losing a lot of weight...

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Thursday, February 13, 2014

My 600-lb life: Paula (Commentary and spoilers)

This week's episode of My 600-lb Life features 542-lb, 39-year-old Paula Jones.  They show her in the shower, and her legs are almost deformed with fat, or maybe it's lymphedema.  Her children take care of her.  Her daughter describes her mom as "handicapped" after explaining how she has to put lotion on her mom's feet and put her shoes on her.
Paula goes downstairs sideways just like I do.  It looks terrible.  I hate that I do it.  I can only imagine she hates it too.
As a child she was molested, and after that she started to gain weight, and she "was always the big kid" from then on.  She graduated high school at 220 and then says she gained "50 pounds with each kid."  "Food doesn't hurt you emotionally," she explains.  Her husband died when he was 33 years old, weighing over 600 lbs, with failing kidneys and heart, about a year ago, bedridden.  (Although the numbers don't match up, how was he only 33 with teenage children who look old enough to drive?)
Fearing she'll be joining her husband in a box on the mantle, she heads to Dr Nowzaraden, weighing in at 533 lbs.  She explains that she eats late, she eats carbs, and doesn't exercise, and that she doesn't believe surgery will change her diet, but will somehow allow her to lose enough weight so she can exercise and then lose more weight.  She says that surgery itself is not a life change, but will lead to it. That makes no sense, of course, but perhaps it was edited. 
The doctor doesn't quite agree, saying that she "has to make life changing starting now" before the surgery, including changing eating habits and losing 20 pounds in the next month.
Two weeks later, she is eating fast food and pizza and deciding to move to Houston. Enn route Paula talks about how she wants to eat hot dogs and hamburgers and BBQ (and stops to do just that, at her husband's family's house).
She gained 17 lbs in that month instead of losing 20, and says "it's a real shock to see the weight gain" even though she was eating pizza, McDonald's, hot dogs, BBQ, and burgers (on camera! so what was she eating off camera?).  The doctor says "you clearly have an eating disorder and I cannot approve your surgery now."
He looks at her hernia, a giant thing like a pregnancy, saying that it should be repaired at the same time as her weight loss surgery.  He puts her on a liquid diet and reiterates the 20 pound loss, which would still put her at 3 pounds heavier than when she started.  
A week later, she is drinking what appears to be cold canned soup and complaining how she wants to eat chips and ice cream.  But she loses 33 pounds, and is approved for surgery, and told that she she should lose 15-20 more pounds in the next week or so.
(Seriously does that work?  If I just eat 3 cans of soup a day, can I lose 53 lbs in 6 weeks?)
She dyes her hair a crazy greenish-blue color to celebrate.   She is convinced her husband would have wanted her to have the weight loss surgery rather than die and leave their children alone.  The doctor fixes her hernia and gives her a gastric bypass. 
She wakes up with  no appetite, food smells make her "nauseous" (nauseated!  nauseous means you make other people feel sick, not that you feel sick), her stomach hurts, and she can't eat, and she's already saying she "can't do it" and in the next breath "failure is not an  option."  On the way home, though, she goes through a drive through to get her kids fast food.  She still eats what looks like fried food, although very small amounts. 
The first month after surgery she only loses 10 pounds, less than she lost on the soup-only pre-surgery diet.  The doctor is upset to hear that she's eating mashed potatoes, and says she will be gaining weight soon, and that she needs to eat protein.  She claims that's she's "done everything he asked her to do and it's not working."  I am very sure that fried foods, ketchup, and mashed potatoes were NOT on his list of things to eat.
Five months in, she is only down 56 lbs total.  She goes to Atlanta on a trip and says she can "only" eat fast food on the road.  As soon as she gets to her family, she eats (chicken wings, potato salad, and other foods that I'm sure aren't approved), and her family says she eats too fast, and that she needs to exercise and go to therapy.  Paula is upset that her family expects her to help clear dishes from the table and clean up, and she sits somewhere else and says "I don't wanna" and doesn't help.
The next month, she's gained a couple of pounds, and says she was eating correctly, but the doctor doesn't believe that she "is almost eating nothing" when if that was true, she should be losing a pound a day or more.   She responds that she is eating what he said, and she's confused.  After he leaves, she says "I don't know how to succeed."
Since having surgery, the only exercise the show has shown her doing is bringing a single casserole dish into the house and then sitting in the other room having a hissy fit at being expected to help.
She decides that "working out is a necessary evil...never fun" and goes to a gym.  (You can find something you like, but not with a total defeatist attitude!)  She says she "hits a wall" whenever she exercises and her "feet are heavy" and she "can't breathe" and she's not one of the people "born to work out" and she is about to pass out after about 15 minutes of basic weight lifting.  She says she's "not quite ready for all this right now" and runs to a drive-through for a burrito.
Finally she decides to see a therapist.  He says her weight is "a symptom of something more, of an emotional obstacle."  Paula is forced to think about her weight in a different way.
At her next weight in, she is down a total of 83 pounds, 19 in the last month.  Although she did not lose a pound a day, he says she is doing well with a better attitude.
When she loses 100 lbs, she dyes her hair pink, and aggressively continues going to therapy.  At the end of a year, she's at 371 pounds.  She doesn't get any extra skin taken off.  She's going to the gym, and bringing her children with her.
Image source: TLC

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Saturday, February 08, 2014

my 600-lb Life: Christina's story (Commentary, review, spoilers)

 This week's episode of My 600-lb life focuses on a 22-year old woman , 639 pounds, named Christina.   She's got giant lymphedema thighs (two of them--last week's episode featured a guy who had just one).
She complains that she can barely walk, can't leave the house, can't drive.  In 7th grade she weighed almost 300 lbs and at 17 she was almost 400, eating because her parents fought all the time, and feeling like she had to  protect her younger siblings from the household discord.
When she was 18,  the lymphedema tumors started--both legs and her belly.  Her husband and mother take care of her.  She gained 300 lbs since her marriage and she admits it's "out of control."   Her mother says "my full-time job is taking care of Christina."  Her husband says "it's a calling from god to take care of somebody" like he does his wife.  He says he gives her whatever she wants and he doesn't want to make her mad so he doesn't say no.  Her mother goes through a drive-through and gets 16 "Nibblers" which look like some kind of small sandwiches, for her daughter.  Sixteen sandwiches. 
I'm a big fat ass and I can say with some confidence, don't eat 16 sandwiches no matter what size they are.  No matter how yummy that sandwich is, 16 is too many. I've eaten four sliders (by themselves) as an entire meal and felt like a pig doing it.  I couldn't stuff 16 of those into me if you paid me.
She sees Dr. Nowzardan, who weighs her at just under 640 lbs.  He finds out that Christina's mother and husband don't work, spending all their time caring for her, cooking for her, bringing her food.  (I always wonder, where does all the money come from?!)  Right away Dr. Nowzardan says he has to separate mother and daughter as the mother will sabotage the weight loss and the mother is indignant, saying "no I won't."  He says "she is in bad shape, surrounded by enablers" and gives her the standard, "you have to lose at least 30 lbs in the next month to get the surgery."  She gets sent home for this weight loss, not admitted to the hospital like other cases have been.
The family moves into a trailer in Houston to be closer to the doctor and she can't get up the stairs to get into it.  Family includes her parents and grandma and at least one sibling.  It takes all of them to get her up into the trailer.
On the way to her 1 month weigh in she talks about how little she's been eating, as she's not hungry, so she's been sticking to fast food. 
Somehow I don't think that's what the doctor meant.
I have to digress here and say I must have gone about my attempt at weight loss surgery all wrong.  I actually tried to lose weight, to eat more healthful food, and told the truth during my nutrition and psych sessions.  I should have crammed myself with fast food and said "it's not my fault!" gotten a TV deal and I'd be thin right now.
She gained 17 lbs instead of losing 30 lbs. 
The mother jumps in saying "we can't cook proper food" and he says "that's typical of an enabler, I ask the patient a question and the enabler answers with an excuse."  He says it's a "dysfunctional family dynamic" and "very disturbing."  He asks Christina to describe what her husband gives her and she says fast food, a hamburger with a "couple" of fries (orders, I presume) or 3 slices of pizza and the doctor replies that she has to say no, that she can't eat that way.  The mother admits they might be part of the problem.  The doctor estimates her intake at 7,000 calories a day, and Christina starts to cry.  The doctor admits her to the hospital, to "separate her from her enablers and give her a chance,"  adding that "she's not too far from imminent death."  He said she could die from a simple cold at this point and her only success will come from being alone, and on a 1,000 calorie a day diet. 
But she refuses the food and her husband eats it instead.  So the mother makes fast food runs for her while she's in the hospital.  She loses only 4 lbs in a month.  Next to her hospital bed are fast food wrappers and cans of (non diet) Coke.  She should have lost 50 lbs and is innocent about how she could have only lost 4 lbs and who knows where those fast food wrappers and soda cans came from? 
I don't understand, if the doctor wanted to separate her from her enablers, why he allowed them to visit her all day every day in the hospital and bring in food. 
The doctor decides to do the surgeries in reverse and take off her lymphedema so she can lose weight through exercise instead of diet.  He explains how it's caused by "lack of drainage in the leg" and how dangerous it is to remove the tumors, how it can be life-threatening with all the blood vessels that need tying off.
He takes just off one mass, and it's 19 lbs.  He wants her to lose 50 more pounds before she can have the weight loss surgery.  She wakes up crying in pain with her enablers huddled around her, probably thinking she needs a milkshake.
She goes home and is able to walk easier, although she's still out of breath, and barely able to go up the ramp her family's built in place of the stairs she couldn't manage.
She's on 1000 calorie low carb, low fat diet, and she loses 61 lbs (including the 19 lb tumor).  She's six months into the 1 year of the show when she gets the bypass surgery.
She gets a traditional bypass, the very reduced stomach and the re-routed intestines.  Dr Nowzardan feels that she's going to do well because her family has rallied around her.  She goes home after 2 days. She's at 572 lbs when she leaves and her mother says she's going to encourage her daughter on the liquid diet.  Right away they are talking about biscuits, waffles and pancakes, and eating them in front of her.
At her next weigh in she's only lost 2 lbs and her husband's trying to make a joke about it.  The doctor is convinced that she's lying when she claims that she only eats once a day.  She complains about pain when eating, and stops eating all together, and ends up rushed to the hospital, with a gall bladder attack, so the organ gets removed.  Then her mother gets nervous about this surgery "I found out she could die"--well she could die from weighing almost 700 pounds too yet you kept buying her 16 sandwiches at a time.
She doesn't recover well and spends 3 weeks in the hospital, missing the birth of her sister's child.  Once she gets home, she can go for a walk in the park (with her dad behind her pushing her empty wheelchair) and she can dress herself, and sleep in the same bed as her husband, and she doesn't need round the clock care from her husband or mom anymore.
At the end of a year, she weighs 390 lbs, and she wants to go to college and become a nurse, even though she has to tour the facility in a wheelchair. 
Image source: TLC

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Sunday, February 02, 2014

My 600-lb Life: Chuck (synposis, commentary, spoilers)

The newest episode of TLC's My 600-lb Life is about Chuck Turner, of Beaumont Texas, who is 45 years old and weighs 693,  the biggest so far this season.
At almost 700 lbs, he can still walk, but with great difficulty, mostly because of the lymphedema tumor on the inside of his leg.  I'm not sure why so far every person on this show has consented to being filmed naked and fat in the shower, but Chuck is no exception. I'm also not sure why TLC covered his hip in that way, but I added the arrow that points to his lymphedema tumor.
He was a cute little kid, not fat.  He said he didn't start to gain weight until he was in his 30s.  When he got to around 300 lbs, something unrelated happened:  his wife was murdered.  He says "I shut the world out...and ate fast food three times a day."  So very sad.  Then he weighed himself at a scrap metal scale and he was 698 lbs.  
He met his new wife when he was around 600 lbs (she's very overweight herself) and they have a baby boy they adopted.  He can't play with his son because he gets winded.   He relies heavily on his wife to do things for him and feels bad.  He is sitting on the floor with his child and a cell phone near his foot starts to ring and he can't reach it to answer it; his wife has to come from the next room. 
She is very unhappy and complains about how difficult it is to be married to a 600 lb spouse.  I don't doubt that at all...but he weighed that when they got married.   It's not like he doubled in size after their marriage, from 300 to 600... She says their marriage is caregiver/patient, not intimate.  She's his servant, "a single mom with someone else there."
Chuck admits that he's got to lose weight "or I'm gonna die."
He heads to Houston to our friend Dr. Nowzaradan, with his wife nagging him the whole way.  "You're gonna have to change everything.  You're gonna hafta exercise."
Lady, can I tell you something?  Your husband weighs 700 pounds.  He knows he's fat and he knows he  has to change.  Being mean to him isn't going to help.  I'm less than half his size and I know that about myself.   Here is a big secret.  FAT PEOPLE KNOW THEY ARE FAT.  They know they need to eat better and eat less, and move more.  Nagging will not accomplish anything except maybe a secret chocolate cake binge.
Dr Nowzaradan asks Chuck what he thinks surgery will accomplish.  His answer?  "If you eat too much it's gonna hurt" and the doctor corrects him:  "it only does one thing.  Keeps you from eating a lot at one time.  You can still eat all day and gain 10 lbs."  He asks Chuck's wife about what she eats, and she says it's "fast food all day"  breakfast sandwich, donuts, apple fritters.  The doctor says if that doesn't stop, the surgery won't do anything.  He says "we have to figure out what kind of eating disorder you have" which is interesting because I don't ever think I heard Dr Nowzaradan mention eating disorders before.  
As soon as the doctor leaves, Chuck says they are going for fast food, "for the last time" while the doctor is saying that if Chuck doesn't stop eating fast food, the surgery won't work.  His wife says "he eats enough to feed 20 people" as they sit down at an all-you-can-eat buffet, straight from the weight loss surgeon's office, with his admonition that Chuck must lose 30 pounds before he can have surgery.
I'm sure 20 people is an exaggeration, but clearly Chuck does not work.  Who is paying for all this food?  For this really expensive surgery?  And how did he adopt a baby at that weight?
At the buffet, their table is loaded with full plates of food and he's eating from all of them.  In a voice over, he's complaining that he's a person "that don't like change."
After that, he goes on a liquid diet, eating only chicken broth while his wife eats chicken Alfredo.  He swears he's not cheating.  He goes down to 667 lbs in a month and his surgery is scheduled.  He says "surgery for me is like closing the casket on that 700 lb man" which is an interesting, if morbid, way to look at it.  
He believes if the surgery fails, he's a failure, and this is his last chance at life.  He wants a job, to be a provider. 
He gets a classic bypass, a small pouch of a stomach and his intestines re-routed.
I'm not sure why different people get different surgeries.  The last few got most of their stomachs removed but no intestinal bypass.  (I know that a second surgery can be done to reroute the intestines later but none of those other patients had that done.)
As soon as Chuck gets out of surgery, his wife goes home and leaves him alone.  Chuck is very upset.  His wife says "I'll call you tomorrow" (implying that she's not coming to visit) and Chuck says "Don't bother."
Unlike the person on last week's show, Chuck gets up and walking right away.  He says he doesn't care about food, he only cares about his wife and family, and even calls to apologize to her.  When she sees him again she complains that he was "grouchy."  Right after major surgery, after a month on a liquid diet.  I can't imagine him being grouchy.
 Chuck gets to go home right away, even though the doctor thinks he's not going to follow the rules, and he's concerned that his wife's focus is only on when Chuck can go back to work.
On the way home they are fighting and squabbling, with Chuck in terrible pain.  His wife  says "I can't handle it anymore."
Chuck says the surgery hasn't taken away his cravings.  He says "I'm eating less but I like to eat good food."  He goes for fast food and gets eggs and bacon, and then vomits into the fast food bag while eating it.   He says he had "a pork chop and french fries" the night before, and he makes his wife bring him medicine because he's so sick from something he ate.
A month post surgery, he's down to 635 lbs, 21 lbs in a month, which is not as much as the doctor wanted, which was at least 30 lbs a month.   The doctor says "Chuck is one of those patients who will never tell the truth about what he's eating."
Then, out of nowhere, his wife, who works full time and who is in nursing school, decides to also get weight loss surgery.  At that point her husband is down to 611 lbs.   She cries because her husband won't be able to take care of her like she did him. (Oh, like leaving him for days as soon as he gets out of major surgery?)
Chuck says he'll do the dishes and take out the trash.  He's eating a huge bowl of popcorn and his wife asks for her pain medicine and he says "you want me to make a special trip?"  He is upset that losing 100 lbs means nothing to her.  She says, he's lost 100 lbs and nothing has changed.  He goes to the drive through and gets 4 pieces of chicken and a large coleslaw, saying "I'm eating better, she just doesn't see it." 
At 526 pounds, he still isn't doing anything around the house, and she serves him with divorce papers, saying she is miserable, but he says it's about money and he'll put new tires on the car.  He claims, rightly so, that his leg (the giant lymphedema tumor) handicaps him.  She just yells at him.  He says if they are divorced, he'll have no insurance, he won't be able to visit the doctor, get his lymphedema and his skin removed.
His wife packs and leaves him alone, crying, saying he has  no reason to live.
It is honestly very sad and I felt my throat tighten up.
Although I'm not sure they needed to show his whole sobbing conversation with his wife on the phone after she's left.
He finally figures out it's not his weight, it's other issues.  He has anger and lashes out for no reason.  He goes swimming in a lake by his house, the tumor hanging down, huge and horrible, and thinks about how he has to deal with his first wife's murder.
 He revisited the doctor, and is down to 419 lbs.  The doctor looks at the lymph edema, and says he'll take off the tumor.  Chuck says how much it grosses people out.  Well, look at that picture, it looks like he has elephantiasis of the testicles.
His wife gives him a second chance at the time of the second surgery.  The doctor talks about how difficult the surgery is to remove the tumor, that every blood vessel (400 blood vessels!) and nerve has grown into the tumor, and if he messes up the removal Chuck could lose his leg and even his life.  It ends up weighing 25 lbs once it's off.  Imagine walking with a 25 lb bag of meat attached to your inner thigh.
After the leg surgery, he's down to 343 lbs.  He puts together a big wooden play scape for his son, and he's able to interact with his son more and play with him, and he's able to sit at the table and eat. 
His wife lost 90 lbs and went down to 218 lbs.  At the end, he's 268 lbs, down 425 lbs, and he's happy, and his face looks very handsome and content.
The doctor warns him that his eating disorder might come back and to be careful the next five years.
I felt really good about Chuck and his outcome.   This is one of the happier shows, even with the almost divorce in the middle.

image sources:  shower & bathing suit/TLC


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