Trainer Chris Powell, left, works with Dana Baker on “Extreme Makeover: Weight Loss Edition.” (Greg Zabilski, ABC / June 27, 2011)
Dana Baker is a 44-year-old gospel singer who weighs 498 pounds. He freely admits to a regular diet of cookies, Hawaiian Punch and donuts. He sweats when putting on his shoes, gets short of breath just standing or sitting and says he takes “eight to 10 painkillers every morning just to function.”
Baker’s plea for help is answered by Chris Powell, the 33-year-old personal trainer who works with experts from the California Health and Longevity Institute in Westlake Village. Baker enters weight-loss boot camp, a one-week crash course followed by a year of intense exercise and dieting. At the same time, Powell attempts to teach Baker to “learn to love himself.” Baker loses 110 pounds in three months, but then his progress slows after he injures the anterior cruciate ligament in his right knee, which limits his ability to lift weights.
Contestants on the show can qualify for a surgical procedure to tighten their skin if they lose 100 pounds between months six and nine, but Baker loses only 40 pounds. Though he cheats on his diet with pizza, ice cream, ginger ale and chocolate, he still manages to lose 203 pounds over the course of the year and ends up weighing 295 pounds. Along the way he battles his personal demons and builds his self-esteem, telling Powell that he was sexually abused as a child and is gay.
The medical questions
Is it common for people who are morbidly obese to require so many painkillers? Are they usually short of breath and are they at a heightened risk of tearing knee ligaments? Is it medically safe to lose 200 pounds over the course of a year while exercising vigorously? Is dramatic weight loss necessary to justify a skin-tightening procedure? How frequently does child abuse lead to self-punishing behaviors such as extreme weight gain?
Back pain and knee pain are very common in patients with severe obesity, and painkillers such as non-steroidal anti-inflammatory drugs (including aspirin, Advil and Aleve) are used for this, but opiates are generally avoided, says Dr. David Heber, director of the Risk Factor Obesity Program at the UCLA Center for Human Nutrition. Opiates must be used with caution, adds Dr. Theodore Friedman, chief of endocrinology at Charles Drew University in Los Angeles, because obesity and opiates decrease testosterone levels, lowering libido and causing erectile dysfunction. Opiates are also highly addictive.
Shortness of breath is extremely common in the severely obese because fat in the upper body acts like a girdle around the lungs, Heber says. Orthopedic problems such as arthritis and torn ligaments are also more common in obese patients, Friedman adds.
Patients treated in UCLA’s Risk Factor Obesity Program routinely lose more than 200 pounds while engaging in vigorous exercise, Heber says, but they require close medical supervision and a restriction on heavy weight lifting early on. Friedman says that without this kind of supervision, it is neither likely nor medically safe to have a 200-pound weight loss in a year. He says that losing “a pound a week” is more realistic and that regain of weight is common.
A skin-tightening operation called a panniculectomy is frequently performed after dramatic weight loss, Friedman says, and there usually isn’t a cutoff for how many pounds must be shed first. The surgery isn’t just cosmetic — Heber points out that after massive weight loss, an apron of loose fat and skin weighing 20 to 30 pounds can cause lower back pain and skin rashes.
There is a significant link between post-traumatic stress disorder — especially PTSD caused by sexual abuse — and addictive disorders, including compulsive eating behaviors, says Dr. Stephen Ross, director of the substance abuse division at Bellevue Hospital in New York. Several large studies by Dr. Vincent Felitti, founder of the California Institutes of Preventive Medicine in La Jolla, and others have linked childhood sexual abuse to later development of obesity. One study examining data from California HMOs concluded that people who had been sexually abused as children were 30% more likely to be obese than the general population.
Dr. Alicia Ruelaz Maher, former psychiatric liaison to the Cedars-Sinai Center for Weight Loss in Los Angeles, says that the great majority of people she saw applying for weight-loss surgery have been sexually abused. Maher believes that the link is loss of control, where not having power over their bodies as children leads them to feel they don’t have the power to follow a healthy diet and control their weight as adults.