Obesity
The most personal prison
By DOUGLAS KALAJIAN

Palm Beach Post Staff Writer

Sunday, August 15, 2004

We read about the sad end of Gayle Laverne Grinds and wonder: How could
anyone live like that?

Immobilized by obesity, the 480-pound Martin County woman hadn't left her
house in years. Struggling to breathe, she had to be carted to a hospital
on a couch that had become fused to her skin. She died early Wednesday at
age 39.

We wonder — but Peter Kefalides knows.

Kefalides, 33, weighed 500 pounds at age 16. He soared past 600 in his 20s
and spent much of that decade in bed at his mother's home in West Palm
Beach. He made local news in 1997, when fire-rescue workers had to break
open a wall to get him to a hospital. He made national news three years
later, when he nearly died. Doctors who treated him then said he weighed
more than 1,000 pounds.

"You get lonely," Kefalides says of his years in bed, "but eating helps you
feel better. You feel like food is your friend."

He had fewer and fewer of the human kind before finally shutting himself
away.

"You get to a certain size and people treat you different," he says. "You
get tired of all that, of the embarrassment. It's just easier to stay home
and not deal with it. You don't want to go out, and eventually you can't go
out. You wind up being in your own prison."

Did he wish for someone to rescue him?

"No, not really," he says. "When you're big, hospitals don't want to help
you. They treat you and send you home. It happened to me over and over. You
get tired of going through all that pain, dealing with all the machines and
doctors. I felt like I was better off just lying there."

There's an even stronger reason he wanted to remain locked away.

"You know that anyone who tries to help you is going to take your food
away," Kefalides says. "A drug addict doesn't want to go into treatment,
because he knows they're going to take his drugs away. It's the same thing.

Luckily for Kefalides, he was rescued anyway when he became too weak to
protest. He was hospitalized four years ago in critical condition. His
treatment included a series of operations, followed by a year in a
rehabilitation hospital. He emerged less than half his former weight. He's
since managed to lose a bit more. "To me, the most important thing is that
I haven't gained," he says.

Kefalides and Grinds represent the extreme of American's burgeoning obese
population: the super obese, who have a body mass index (a measure of
weight in relation to height) over 50. For someone 5-foot-8, that's more
than 325 pounds. Doctors who treat super obesity often perform an
aggressive form of gastric bypass surgery that radically reduces the body's
ability to absorb calories while also reducing stomach capacity.

Kefalides had the surgery in January 2001, but only after losing at least
300 pounds on a supervised, in-hospital diet. His treatment was directed by
Dr. Caroline Apovian, who specializes in treating the super obese as
director of the nutrition and weight management center at Boston Medical
Center. Apovian says there's no way of counting the number of super-obese
shut-ins who may be invisible to neighbors and even some relatives.

"They don't see doctors, and doctors don't see them," Apovian says.
"They're lost to surveys, but don't kid yourself. There's lots of people
like that out there. There may be 50 for every one who seeks treatment."

Many obese shut-ins are women

From a study of patients she could identify, Apovian knows many obese
shut-ins are older women.

"Men at that weight tend to die of heart attacks at a young age," she says.
"Women last longer, but they develop severe arthritis in their knees and
can't move."

Patients are often referred to her only after they're hospitalized in a
crisis or when they're persuaded to seek help by spouses or other
relatives. When she explains the treatment, many balk for the reason
Kefalides suggested.

"They don't want to stop eating," she says. She recently treated a
600-pound man with heart disease who initially refused the surgery but
reluctantly agreed when he realized the alternative was imminent death. He
survived but now says he regrets giving in.

"He misses his food," Apovian says. "It's a powerful drive these people
have, very much like drugs or alcohol. The analogy isn't exact, because you
have to eat, but they're certainly psychologically addicted to food."

The causes of super obesity are emotional and genetic. "You have to have
both elements," Apovian says. Most moderately active people burn 12 or more
calories per pound each day, meaning the average man can eat about 2,500
calories and the average woman about 2,000 without gaining weight. The
super obese may eat two or three times as much for years until they become
immobile. It's usually a collaborative effort.

"Often there's a spouse feeding this person muffins," Apovian says.
"Usually, they're nice people. I've learned to judge less. You find a
dynamic in the relationship, like the enabler who gives alcohol to an
alcoholic."

The super obese can be as manipulative and demanding as any addict, Apovian
says. "Think about it. The person you love is screaming at you, 'I'm
hungry! Feed me!' What do you do? You feed them."

As mobility diminishes, so does the need for calories. "They're not burning
many just sitting there," Apovian says. "It doesn't take nearly as much
food to maintain the weight."

At that point, medical intervention is the only solution. Patients do best
when seen by obesity specialists. For Kefalides, emergency trips to
hospitals became a dreary, annual ritual that merely staved off disaster.

He would come down with pneumonia or other respiratory problems and find
himself tugged and towed by rescue workers. He'd lose weight during each
hospitalization and temporarily regain some mobility. At one such point in
his late 20s, he moved across country to the state of Washington, hoping
for a fresh start. Instead, he wound up alone and eating more than ever.

He lay wrapped in sheets, because he was too big for clothes, calling out
for pizza and fast food that he charged to a credit card. He couldn't bathe
or go to the bathroom. It was far from a comfortable existence.

"When you're big like that, everything hurts," Kefalides says. "You feel
like there's no help. You give up on life."

Disability benefits paid for a caregiver to empty his bed pan, but he got
no real help with his weight until he was rushed to a Washington hospital
on a flatbed truck in July 2000. He was barely breathing. His hospital case
manager contacted obesity centers around the country, but only Boston
Medical Center was willing to help.

The Palm Beach Post told Kefalides' story in September 2002, when he'd
moved to Casper, Wyo., after recovering from surgery. He was having
difficulty breathing in the thin, mountain air and needed an oxygen tube.
He also needed a walker to get around. Soon after the story ran, Kefalides
moved back to West Palm Beach.

He's breathing better now and moving more easily. He gets out for daily
walks, using only a cane. "I'm at a much happier place in my life," he
says. He's still disabled but says he hasn't given up hope of getting a job
some day. Still, at about 430 pounds, he weighs nearly as much as Gayle
Laverne Grinds did. Kefalides said he felt sad but not scared when he heard
about Grinds' predicament and her death.

"It brought back memories," he says. "I felt very bad for her, but I didn't
think, 'That could happen to me.' I know what I need to do. I'm not where I
need to be yet, but I'm getting there."