No more hid­ing

He’s liv­ing proof that it doesn’t mat­ter where you are on life’s jour­ney – you can al­ways move for­ward. Read on as this news­pa­per reporter lays bare his strug­gle in a shock­ing and coura­geous story about tak­ing the first steps to­wards re­cov­ery from mor­bid

Diabetic Living - - Contents - DANIEL P. FIN­NEY is a colum­nist for the Des Moines Reg­is­ter. You can fol­low his ef­forts to lose 136 kilo­grams and re­gain his health on his can­did and riv­et­ing blog at desmoines­reg­is­­ing­weight

Colum­nist Daniel P. Fin­ney shares how he is re­gain­ing his health

“Do you want me to get a wheel­chair?” Re­al­ity over­came de­nial in that sim­ple, earnest ques­tion from a friend.

I was in a Des Moines hos­pi­tal for a story that in­volved tour­ing a neona­tal in­ten­sive care unit with the hos­pi­tal’s pub­lic re­la­tions man, whom I had known for years.

I was in ter­ri­ble pain. Light­ning bolts struck the base of my spine and sent shocks through my body. My legs felt like dead logs drag­ging across the floor.

Though it was a cool day in Fe­bru­ary, sweat rolled off my bald head from the sim­ple ex­er­tion of walk­ing from the el­e­va­tor to the nurses sta­tion. My navy golf shirt was soaked, the crotch of my pants damp.

In prac­ti­cal terms, it was maybe 20 me­tres. For me, it felt like 30 kilo­me­tres.

I blamed the back pain on car­ry­ing too many gro­ceries. But that was a lie I told my­self to avoid the truth I’d been dodg­ing for al­most a decade.

The prob­lem is my body. It’s prac­ti­cally im­mo­bile be­cause I am mor­bidly obese.

The turn­ing point

Mor­bid obe­sity is a med­i­cal di­ag­no­sis for some­one who has a body mass in­dex (BMI) of over 40. Mine, I learnt af­ter that day in the hos­pi­tal, was 64. Obe­sity, the more com­mon di­ag­no­sis, is a BMI of 30 or greater.

Of course, I’m not the only hefty Amer­i­can. The Cen­ters for Dis­ease Con­trol and Preven­tion (CDC) es­ti­mates about 36 per cent of US adults – roughly 85 mil­lion peo­ple – are obese. The peo­ple hit hard­est are ages 40-59, ac­cord­ing to CDC data.

Things aren’t any bet­ter in Aus­tralia – a 2015 Aus­tralian Bureau of Sta­tis­tics sur­vey found 63 per cent of Aus­tralian adults, about 11 mil­lion peo­ple, are over­weight or obese.

The risks are well-known: type 2 di­a­betes, car­dio­vas­cu­lar prob­lems, skele­tal and mus­cu­lar stress, among oth­ers.

I knew all this, of course.

I have a mir­ror at home – just the one, which I avoid look­ing into di­rectly, es­pe­cially when I get out of the shower. Still, I’ve been a mas­ter of self-de­cep­tion. I ig­nored my weight when the doc­tor’s scale – which mea­sures up to 227 kilo­grams – could no

longer mea­sure me. I ig­nored it when I stopped fit­ting into seats at theatres, sport­ing events and con­cert venues.

I ig­nored it when a walk to the mailbox – about a block

– was enough to leave me winded for nearly 20 min­utes.

I ig­nored my weight when the seat­belt in my car no longer fit with­out an ex­ten­sion. I didn’t even know ex­ten­sions ex­isted un­til I saw them at a big-and-tall cloth­ing shop, where I got mine.

I rarely rode in other peo­ple’s ve­hi­cles be­cause I wor­ried the seat­belt wouldn’t fit or I couldn’t wedge my hulk­ing frame in­side. And for­get about flying. I didn’t fit in the seats with the arm­rests down. I wouldn’t buy two tick­ets.

I ig­nored it when clean­ing my­self af­ter us­ing the toi­let be­came a painful, nearly im­pos­si­ble task. And pub­lic bath­rooms? The hand­i­ca­pac­ces­si­ble stalls might work, but a reg­u­lar stall was al­ways too nar­row. I usu­ally just rushed home, of­ten risk­ing em­bar­rass­ing accidents. Even us­ing the uri­nal was a chal­lenge.

And I ig­nored it when my doc­tor di­ag­nosed me with type 2 di­a­betes.

Re­al­ity hits

But on that day when my friend of­fered me a wheel­chair be­cause I could barely walk un­der the weight of my own body, all of the de­nial van­ished.

I was now too fat to do my job. I’m a news­pa­per colum­nist for The Des Moines Reg­is­ter in Iowa, one of the few pub­lic faces of my home-state news­pa­per. It’s been my dream for as long as I knew there was such a thing. It’s the best job I’ve ever had. I planned to hold onto it un­til I re­tired. But sud­denly, I faced the real pos­si­bil­ity that

I wouldn’t be able to go to in­ter­views or even stand up for more than a minute or two.

On that Fe­bru­ary day, the facts were un­de­ni­able. I was well on my way to the wheel­chair. Next would come the mo­torised scooter, pos­si­bly the ceme­tery. At 39 years old, I had the mo­bil­ity of a hospice pa­tient.

The pho­tog­ra­pher and the PR man went on with the as­sign­ment. I rode the el­e­va­tor to the lobby and col­lapsed into one of its up­hol­stered cir­cu­lar benches. I keep some an­tianx­i­ety med­i­ca­tion in a gold cylin­der at­tached to my key chain; I screwed off the top, shook out two pills and then swal­lowed them with­out wa­ter to fight off a bub­bling panic at­tack. I was overwhelmed by the pain and shame.

What had I done to my­self? Would I ever be func­tional again?

I fished my iPhone from my pocket. I di­alled my doc­tor right there in front of to­tal strangers shut­tling back and forth through the lobby’s re­volv­ing door. I wor­ried they were eavesdropping, but it’s likely no one no­ticed me hav­ing one of the great­est turn­ing points of my life.

“I’ve hurt my back,” I told the nurse who an­swered my call. “I’m in ter­ri­ble pain. I think it’s time to talk about my weight.”

If my life was a Rocky movie, this is prob­a­bly where the heroic montage would start. But I think we all know that the big­gest strug­gles of our lives can’t be con­densed into a catchy pop tune. I had work to do.

The be­gin­ning

For years, my doc­tor has sug­gested I look into bariatric surgery. I al­ways said I would,

the way I prom­ise the den­tist

I’ll floss three times a day. But I wasn’t ready to com­mit.

She wrote me a pre­scrip­tion to al­le­vi­ate the back pain and re­ferred me to a phys­i­cal ther­a­pist and a di­eti­tian at a spe­cial weight-loss clinic.

I al­ready had a men­tal health ther­a­pist – I live with gen­er­alised anx­i­ety disor­der and per­sis­tent de­pres­sive disor­der. I take med­i­ca­tion to con­trol the bio­chem­i­cal mal­func­tions in my brain that cause the trou­ble, but talk­ing about the psy­cho­log­i­cal causes of my overeat­ing be­came a top pri­or­ity in our ses­sions.

This be­came my health­care team. To­gether we be­gan the long process of re­hab­bing my body – a body that, if it were a house, would be dan­ger­ously close to be­ing un­fit to oc­cupy.

Thank God I have a full-time job and health in­surance. But my in­surance doesn’t cover vis­its to a di­eti­tian, or pay for a mem­ber­ship to the YMCA or health club. It doesn’t pay for classes to teach me health­ier cook­ing or bet­ter food-shop­ping habits. All that is 100 per cent my bill. How­ever, my in­surance will pay for nu­tri­tion coun­selling if it’s in prepa­ra­tion for bariatric surgery. And it will pay for bariatric surgery.

To me, this seems in­sane. Medicine is sup­posed to be tran­si­tion­ing from re­ac­tive care to pre­ven­tive care, but most in­surance companies won’t cover an ar­ray of cheaper mea­sures that could pre­vent costly surgery when it comes to obe­sity. Ev­ery in­surance plan is dif­fer­ent, and there’s no uni­ver­sal stan­dard for cov­er­age for chronic obe­sity. But if you’re be­gin­ning your own re­cov­ery, talk di­rectly with your in­surance com­pany about what is and isn’t cov­ered. Doc­tors of­ten make rec­om­men­da­tions for care or med­i­ca­tion but have no idea how much ei­ther of these will cost you.

“At 39 years old, I had the mo­bil­ity of a hospice pa­tient ... I was well on my way to the wheel­chair”

It be­hoves us all to be in­formed and ask for al­ter­na­tives when money is an is­sue in our care.

Still, I’ll tell you this much – ev­ery cent I spent on this process was worth it. Noth­ing that I could have pur­chased, no hol­i­day I could have taken and no night out on the town would have brought as much value and hap­pi­ness to my life as be­gin­ning re­cov­ery.

Mak­ing progress

My jour­ney be­gan in earnest about a week af­ter the wheel­chair in­ci­dent.

I was still in crip­pling pain and prac­ti­cally im­mo­bile when I met with phys­i­cal ther­a­pist Stefanie Kirk. She asked me to walk a small track marked out with tape on the floor.

One lap was 50 me­tres.

“Just do as many as you can,” she said. “I’ll be right here with you. Stop at any time.”

The first few me­tres went easy enough, but at the quar­ter­lap point I started to hurt. By half a lap, I was sweat­ing and wanted to stop. I forced my­self to fin­ish the lap.

Stefanie brought me a chair, a cup of wa­ter, and a towel.

“On a scale of one to 10, how would you rate your pain?” she asked me.

“Ten,” I said, and hung my head. Stefanie crouched down and her eyes met mine. “Hey,” she said. “This isn’t go­ing to be easy, but you are go­ing to get bet­ter way faster than you think.”

The hard way

The next day I met Jacque Schwartz, my di­eti­tian. The first thing she had me do was step on a scale.

The kind of scale needed to mea­sure a per­son my size looks like some­thing you’d find at a cat­tle yard – a black plat­form about half a square me­tre with handrails that meet in the mid­dle, where a com­puter panel dis­plays your weight.

I stepped on. For the first time in more than a decade, I knew my ex­act size – 255 kilo­grams.

“That’s hor­ri­fy­ing,” I said. “I’m more than a quar­ter-tonne.”

I en­vi­sioned hav­ing to be moved around by fork­lifts like cargo in a port. I felt com­pletely in­hu­man, just a mas­sive thing. Yet there was some re­lief in ac­tu­ally know­ing that num­ber.

“What did you think it would be?” Jacque asked.

“I fig­ured it was up over 600 pounds [272kg],” I said.

Jacque laid out the op­tions the weight-loss clinic of­fered. One was a meal-re­place­ment plan. The cost was ab­surd: US$6000. I ruled that out – I just don’t have that kind of money, and I had a sink­ing sen­sa­tion it wouldn’t work any­way.

Jacque told me I could also choose bariatric surgery. She said the clinic doc­tors typ­i­cally per­form a gas­tric sleeve pro­ce­dure, cut­ting out about 80 per cent of the stom­ach. The idea was that I would feel fuller faster, and my stom­ach would pro­duce fewer of the hor­mones that stim­u­late ap­petite.

“What do you think about that?” she asked.

“I hate it,” I said to her. “I’ve never even had my ton­sils taken out. I’m ter­ri­fied of cut­ting away most of a healthy or­gan.”

There was one fi­nal op­tion – the hard way.

Eat less. Move more.

Keep­ing the ledger

Be­cause my back was man­gled, mov­ing more would come later. Eat­ing less started at once.

Jacque sug­gested us­ing an ap­pli­ca­tion for my phone to track kilo­joules. There are lots of them. She used a free app called MyFit­nessPal. The app al­lows me to scan the bar­codes of packaged foods and pro­vides good es­ti­mates of kilo­joules for fresh pro­duce, meat and other items.

You’ve prob­a­bly guessed by now that this makes me kind of a pain at restau­rants. I pester servers about the in­gre­di­ent amounts, prepa­ra­tion and if they can grill some­thing rather

“No hol­i­day

I could have taken and no night out on the town would have brought as much value and hap­pi­ness to my life as be­gin­ning


than fry it. I try to add to the tip if I’m par­tic­u­larly ob­nox­ious.

But the more I know about a meal, the bet­ter I can es­ti­mate kilo­joules and the more com­fort­able I feel eat­ing. It can make me an an­noy­ing din­ner com­pan­ion, es­pe­cially to my less-pa­tient friends, be­cause I take so long to choose and spend a lot of time punch­ing food into my phone. But it’s worth it to me.

I had long avoided count­ing kilo­joules be­cause I thought it would be te­dious. But the mem­ory of the wheel­chair was so in­tense, and I was des­per­ate to get bet­ter. Kilo­joule-count­ing be­came like keep­ing a bank ledger. My daily goal was how much I had to spend. Go­ing over was akin to be­ing over­drawn. It helped me make bet­ter choices.

Hit­ting a road­block

The process takes prac­tice, and I make a lot of mis­takes. I tend to overeat less out of hunger and more be­cause of emo­tional sit­u­a­tions. Re­cently, a friend suf­fered a hy­po­gly­caemic at­tack while we were out hav­ing lunch. He’s lived with di­a­betes for 10 years, mostly in se­cret. But hav­ing never wit­nessed any­thing like that, I was badly shaken. I thought my friend was hav­ing a stroke – I called emer­gency ser­vices and his wife, and in the end, ev­ery­thing was fine. But on my drive home, I started shov­ing left­overs in my face as fast as I could. Manic eat­ing at its worst.

I made it home but I felt wretched. The scare was bad enough, but the eat­ing – the pure des­per­a­tion of it – rat­tled me more. I was con­vinced this was the mo­ment I would lose con­trol and undo any good I’d done up to that point. I called my ther­a­pist.

“You called emer­gency ser­vices and had the pres­ence of mind to get a hold of his wife and put her in touch with the medics?” he asked.

“Yeah,” I said.

“Dan, do you re­alise you have ter­rific sur­vival in­stincts? Not ev­ery­body can do that.”

“What about the eat­ing?”

“So you did some emo­tional eat­ing,” my ther­a­pist said. “Are you still eat­ing?” I wasn’t.

“Do you plan to keep eat­ing that way for the rest of the day or longer?” he asked. I didn’t.

“Then you’re go­ing to be OK,” he said. “In­ci­dents hap­pen. You deal with them. Whether you know it or not, your cop­ing skills are ex­cel­lent. How do you feel?”

“I’ll make it,” I said. And I did.

No cold turkey

The things Jacque taught me about food were not shock­ing. Eat fresh fruits, green veg and lean meats. Avoid junky carbs and sug­ars. But the day-to-day process is slow.

I didn’t go cold turkey on any­thing. I slowly gave up my beloved liq­uid candy, Moun­tain Dew, fi­nally wean­ing my­self from it en­tirely af­ter a full month. I switched from low-fat milk to skim. I let go of my morn­ing or­ange juice.

I started mea­sur­ing things.

If I wanted some baked potato chips, fine. But I was go­ing to mea­sure out a sin­gle serv­ing – 30g – and stick to that.

Some­times it’s te­dious, but I feel good when I’ve stayed be­low my kilo­joule goal. I feel

bet­ter when I see a smaller num­ber on that scale at my monthly weigh-ins.

The food changes aren’t as stress­ful as I’d imag­ined. I en­vi­sioned my­self dash­ing to a ser­vice sta­tion at night, hold­ing my face un­der the Moun­tain Dew tap, gulp­ing down as much as I could un­til the po­lice hauled me away to the hos­pi­tal for a men­tal health eval­u­a­tion.

The truth was less dra­matic. My overeat­ing tends to be driven by feel­ings rather than crav­ings. So a lot of the things I ate and drank were out of habit and rou­tine. It’s morn­ing – have a glass of OJ. Any­time is a good time for a Dew. But I found other sub­sti­tutes. In­stead of OJ, I eat a grape­fruit. Zero-kilo­joule sports drinks sub in for soft drink. But it can be frus­trat­ing.

My par­ents host an an­nual In­de­pen­dence Day party with all the fix­ings – home­made pork and beans, grilled pork and brisket, coleslaw, my mother’s mag­nif­i­cent potato salad, a ta­ble of desserts so sweet they could melt a blood glu­cose mon­i­tor.

My ther­a­pist and my di­eti­tian re­mind me of mod­er­a­tion. No foods are banned, just lim­ited.

So last In­de­pen­dence Day, I care­fully planned what I was go­ing to eat. I fig­ured a cup each of my favourites. But I for­got the home­made pineap­ple sher­bet, a once-a-year treat that’s tied to so many fond mem­o­ries of my child­hood.

When I thought I couldn’t have that dessert, I nearly cried. Then I re­mem­bered: not banned, just lim­ited. So I had a cup. And I still lost weight at my next weigh-in. That’s a win.

I’ve been do­ing a lot of that since this re­cov­ery started. I think it has to do with see­ing a ther­a­pist. He helps me try to fig­ure out the emo­tional hole in­side of me and why, for most of my life, I’ve tried to fill it with food. I’m deal­ing with all of it. I’m a work in progress.

Keep on mov­ing

Since this process be­gan, I’ve lost more than 34 kilo­grams. Peo­ple say I look slim­mer. My pants are bag­gier. My belt is so loose it’s use­less. And I do feel stronger. I can make it up a few flights of stairs. The walk to the mailbox won’t crip­ple me.

Yeah, I’m still obese, but my BMI has dropped from 64 to 59.

I fig­ure it’ll take four years or more to hit my tar­get weight and the rest of my life to stay healthy. That’s why I use the word ‘re­cov­ery’ in­stead of ‘diet’.

I may one day be fit again, but I have to re­mem­ber that I will al­ways have the po­ten­tial to re­lapse. That is some­thing I am de­ter­mined to pre­vent.

Sure, some days I would give any­thing for a pizza. Many days, if not most, I want to blow off ex­er­cise and sit in my house and not be seen. And again I think of the wheel­chair.

Then I stand up and get mov­ing. Be­cause there’s just one di­rec­tion I’m headed right now – for­ward.

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