Man sheds more than 400 pounds
FARGO, N.D. - When Charles Elliott hit rock bottom, he couldn't get much lower.
He was already lying on the ground.
In April 2007, the 730-pound man fell down outside his Fargo apartment with bags of candy in his hands and couldn't get back up.
He called 911.
"I felt like an idiot, you know. The fire department came over, they got me back on my feet, and they carried that highly nutritious stuff back into my apartment," he said, poking fun at the candy. "I still feel like an idiot."
But, more importantly, Elliott feels lighter these days - a lot lighter.
The 35-year-old who used to stay up all night watching TV because he feared he would stop breathing in his sleep has shed a staggering 409 pounds in the past 18 months.
"I've lost more than half of myself," he said.
Dr. Brent Hella, who is board-certified in bariatric medicine, said Elliott was by far the heaviest mobile patient he'd ever seen when Elliott lumbered into his Fargo office in June 2007.
"He kind of walked in here that one hot June day and basically said, 'If you don't help me, I'm going to die,' " Hella said.
Now, at 321 pounds, Elliott has found freedom in his slimmer 6-foot-2-inch frame.
He's able to walk and bike miles at a time. He no longer needs to sit in the aisle at the movie theater because the seats are too small. People react differently to him.
"Before, no one would even talk to me. They would always look at me, but no one would talk to me," he said. "Now, I go sit down and play cards, people talk to me. I've met friends. I've talked to people."
Appetite 'gone wild'
Elliott was larger than his two siblings at birth, weighing more than 8 pounds, but he wasn't always a chubby baby, said his mother, Emily Elliott of Moorhead. He would gain weight, grow a few inches and thin out, she said.
Charles Elliott said he weighed 100 pounds in kindergarten, though his mother doesn't recall him being that heavy.
Still, obesity runs in the family, she said.
"I think we're all overweight right now," she said.
Charles Elliott's eating habits changed after he had his tonsils removed at age 5, his mother said.
"After that, it was like he started eating, and the first time I noticed that his appetite had really gone wild was he came home from school and he went to the kitchen and he made himself six pieces of toast. And he wasn't making them for his brothers or sister, either. And when I said he had to share them, he was mad," she recalled.
"That's first when I noticed that it's just like he had no appetite control anymore. He ate and ate," she said. "When they're little like that, you can still pretty much control what they eat. But you know as the years go by, they're out, they're at friends', they can get into what they want."
Scientists have not definitively linked tonsillectomy to weight gain.
In one study, a University at Buffalo researcher found that among 54 children ages 6 to 12 who had their tonsils and adenoids removed to treat sleep-disordered breathing, it resulted in less fidgeting and other non-exercise motor activity, according to ScienceDaily.com. The drop in activity led to an average 13 percent increase in excess weight, according to results of the study, which appeared in the February 2006 issue of the journal Pediatrics.
A 1988 study by a hospital in Scotland also noted "much controversial evidence that children gain weight to a significant extent following tonsillectomy, usually associated with a general improvement in health."
However, Hella cautioned that there is no concrete link between tonsillectomy and weight gain.
A geneticist examined Elliott to see if something was wrong with his pituitary gland that might help explain his obesity, but the specialist found nothing to explain his obesity, Hella said.
"I think 10 years from now we'll find out what it was," he said. "There's all sorts of new stuff we're finding out about the pathology of obesity."
Getting out of hand
Elliott continued to overeat and gain weight after he graduated from Devils Lake High School in 1992 and went to work for a corporation that assisted developmentally disabled people.
He would stop at a fast-food restaurant before work and buy three or four sandwiches, knowing he'd be eating again when he got to work, he said.
The cycle continued when he moved to Fargo in 2000.
"I remember the first time he admitted that he was over 500 pounds, that was when I really started having great fears for his life," his mother said.
Elliott developed Type II diabetes and fell into a vicious cycle of eating too much, injecting insulin to bring his blood sugar down and then eating more to elevate his blood sugar again.
The typical diabetic injects 50 to 80 units of insulin per day; Elliot was taking more than 500 units, Hella said.
"The more insulin he needed, the more he needed to eat. The more he needed to eat, the more insulin he needed. It just got out of hand," Hella said.
Elliott said he would buy a box of candy bars, and "It'd be gone by morning."
A two liter of pop: "I could suck that down no problem."
"I even got kicked out of a buffet because they thought I ate too much," he added.
He said he overate "just because it tastes good and I could get to it."
Eventually, it got to him, affecting his everyday life. At the movies, he had to sit or lie on the floor. Friends and family didn't want him sitting on their furniture, fearing he'd break it. He paid to have the driver's seat of his Nissan pickup moved back into the extended cab just so he could fit inside. He went on the Internet to find clothes in size 10-XL. He had to be weighed on a shipping scale. His bed caved in.
"And I just figured it was a matter of time before I destroyed the new bed that I've got now," he said.
Afraid to sleep
But, by 2007, Elliott wasn't using his bed a lot.
"I was scared to go to sleep," he said.
His sleep apnea worsened with his weight gain, so he tried to stay up all night watching TV.
"When I'd finally get too tired where I can't stay awake any longer, then I'd pass out for a few hours," he said.
In May 2007, Elliott was admitted to MeritCare Hospital in Fargo for congestive heart failure. He spent more than a week being treated with diuretics and pills to help his kidneys get rid of excess fluid.
By that time, doctors had already talked to Elliott about having gastric bypass surgery. But he was too heavy for the procedure and couldn't lose the necessary weight on his own to safely undergo the surgery, he said.
"Nobody would touch him," Hella said. "At 700 (pounds), they said the risks are too high. There's too much skin to go through. It's just a technically difficult surgery."
About three weeks after Elliott was released from MeritCare, Hella admitted him back into the hospital for congestive heart failure. Because his heart had to work harder to support his weight, it had grown to twice its normal size, Hella said. Elliott retained 20 to 30 pounds of fluid in just a few weeks.
Elliott, who had balked at gastric bypass surgery in the past, now saw it as his only means of staying alive.
North Dakota's medical assistance program agreed to place Elliott in a nursing home, Hella said.
In June 2007, Elliott entered ManorCare Health Services in Fargo. His diet was restricted to 2,000 calories or less per day, compared to the 5,500 or more calories he had been consuming daily, Hella said.
The difference of 3,500 calories is the number of calories in a pound of body fat, and Elliott lost about a pound per day during his five months at ManorCare, Hella said. His insulin intake also dropped from 500 to 150 units per day.
Valley Bariatric & Wellness Clinic staff were concerned Elliott would return to his old eating habits, Hella said. Elliott said he put on a little weight after his father, who also had health problems related to obesity, died on Dec. 13, 2007.
"We knew that if we didn't keep seeing him on a regular basis, weighing him in, keeping him motivated, seeing our dietician, that he might relapse, and that's what we didn't want (him) to do," Hella said. "Impressively enough, he kept at it."
Elliott said he left ManorCare on Halloween 2007 because he no longer required skilled nursing services.
The University of Minnesota Medical Center agreed to perform the gastric bypass surgery if Elliott weighed less than 550 pounds, Hella said.
Elliott entered the surgery room on Jan. 22, 2008, weighing about 530 pounds.
Surgery a success
Gastric bypass surgery seals off a small section of the stomach and allows food to bypass part of the small intestine. The smaller stomach pouch makes patients feel full more quickly, and the intestine absorbs fewer calories, leading to weight loss.
Elliott's surgery was free of complications, and he was out of the hospital in three days.
During the 11 months and one week that followed, he lost more than 200 pounds - a dangerous amount of weight to lose in such a short time, Hella said. Such sudden weight loss carries a slight risk of sudden cardiac death, when the heart just suddenly stops, partly because of the fat that accumulated in it.
"That fat changes the electrical conduction of the heart, so you can short-circuit quicker," Hella said.
The biggest risk from sudden weight loss is developing gall stones, he said. Some patients lose their hair, and osteoporosis is another possible side effect.
Elliott hasn't experienced any of those problems so far.
He weighed in at 321 pounds on Monday. Of that, about 30 pounds is excess skin, which Elliott hopes to have removed.
Patients usually have to wait a year after gastric bypass to ensure their weight has stabilized before having skin removed, and even then the invasive procedure carries risks, Hella said.
Elliott said he'd like to get down to 280 pounds and find a job. He's been living on Social Security payments and, prior to his surgery, had picked up scrap metal for extra cash.
His newfound mobility should make finding work easier, he said. He bikes or walks more than four miles at a time now, going from his south Fargo apartment to the doctor's office or downtown, where he likes to play poker. He's able to drive a car again without his stomach squished against the steering wheel. He no longer takes insulin.
His successful weight loss also has his 61-year-old mother thinking about having gastric bypass surgery. She said she's proud of her son's accomplishment.
"If anybody gets credit, it's him and all the effort he put in getting it all lined up, because it was a lot of work," she said.
Charles Elliott said he wants other people in similar situations to know: "There is hope. I mean, there's a lot of people out there that need help that just don't know where to go get it.
"I was to the point where I didn't know what I was going to do. I was afraid I was going to die. But right now, you know, I'm able to enjoy what I'm doing. Hopefully I'll eventually go back to work. That's what I want to do, get some training for something. I mean, there's lots of things out there I'd like to explore."