My 600 lb Life – James King – Weight Betting Odds

Moral of this story: If someone you care about needs a cross-country medical transport to Houston to enter Dr Now’s care, and you intend to fund that transport, you should verify their starting weight and consult Dr Now before they leave their house.

You can do that with sufficient accuracy (+/- 40 lb or better) by having the medical RV weigh in twice at a local truck scale such as this one (there’s on right off of Interstate 24 in Paducah, at Exit 3). Get the first weight while en-route to the house, and the second one after the patient is loaded onto the transport.

Unfortunately, James’s father Don Sr. failed to do this. He mortgaged his house so that James could be transported to Houston. Dr Now had ordered James to follow his diet and lose some weight before traveling, but was taken aback at his size when he arrived—he figured that James had actually gained weight since they had their video call. But had he obtained the rough data point from the truck scale, he likely would have told James not to bother coming until he cleaned up his act.

The other person I feel a bit sorry for is Lisa’s ex-husband, who had to raise son and daughter without knowing they were not of his progeny. It’s bad enough to find out you’re a double cuckold, but to find out the real father is a 500 pound man-child 2 doors down from you. must be a special kind of ego blow.

He must have been a real asshole to deserve that. And he may have indeed been—although I’m not quite ready to take those abuse allegations at face value. Either way, I expect he’s had a little schadenfreude from watching this episode and the Where Are They Now followup. At least the daughter Bayley seems to be a good kid, so he probably had a hand in that.

In a lot of ways, this is one of the worst patient cases on this show. James and Lisa are worse than the Assantis—I think even Steven could have been redeemable if he had the right support, and Justin is inspirational; I’ll write about them soon.

I’ll summarize this spsiode and the WATN one in chronology. I will break off for commentary occasionally.

James K’s Story

Introductions

James is introduced as a bedridden man of indeterminate weight, with extreme cellulitis. His common-law wife Lisa and daughter Bayley take care of him full time. Lisa cooks for him constantly and buy him fast food every night.
In the backstory, James describes growing up poor with an alcoholic mother. He grabbed whatever food he could and became obese early in childhood. He met Lisa at age 20, when she was married with 4 kids and an abuse husband. They had a long-term affair which produced a son and daughter out of wedlock that the husband raised in his house. They divorced when James was 32 and he took over raising his 2 kids. But of course he needed to be cared for himself by Lisa and the kids as his weight ballooned and he became bed-bound.

Consult with Dr Now and transport to Houston

James and Lisa had a video call with Dr Now, who estimated his weight as over 700 pounds (James figured 750) and put him on a 1,200 calorie daily diet and an upper body exercise regimen. He ordered Lisa to stop enabling James with over feeding. The goal was to get to 600 pounds and move to Houston, which would likely require supervised medical transport.
James and Lisa struggled to get funding for the medical transport, because insurance refused to cover it. (Prescient!) They launched a GoFundMe effort, but that was unsuccessful. Meanwhile, Lisa is shown cooking James some strip steaks, with the fat left on because of the taste of it.
James’s father visited and lamented that he doesn’t have James’s help on his farm. He had some dizziness and the paramedics came and take him to the hospital—it was a minor stroke. James resolved to get to Houston as fast as possible. They explored transporting him in Lisa’s “van” (it appears to be a Chrysler SUV), but the fire department told him there was no way they could load him into the cargo bay because his legs were wider than the rear van opening—putting aside the medical risks of transport in that manner even if they could get him in there. A moving van would not work, either, because James could not be secured.
James’s father agreed to mortgage his house to pay for a proper medical transport. James fussed a lot when being extracted from the house—the cellulitis complicated things greatly—but there appeared to be no major issues once he was in the ambulance.

Arrival in Houston and initial hospital care

Dr Now chewed out Lisa for continuing to enable James, as he appears to weigh more than what he appeared to weigh in the video call and his cellulitis looks worse as well. He weighed 735. Fortunately he did not suffer any complications from the travel and is in stable condition.
Dr Now gave James an 800 calorie controlled diet, and kept him in the hospital for a month. He lost 50 pounds during that month, getting down to 685. He is discharged and is moved into an apartment nearby that Lisa secured previously. His goal is to lose 85 more pounds and drop to 600 in about 2 months, and at that time he may qualify for bariatric surgery.

On his own in Houston

James spent a few days getting into the new routine, with Lisa and Bayley caretaking for him. Unfortunately, James had chest pain and had to call 911. He was treated for congestive heart failure at a hospital that Dr Now did not have staff privileges at.
We are led to believe he did not know his weight at this hospital. But he did admit to cheating on his diet “a couple of times” in his voice over during this subsegment.

Typically on this show, when a patient talks about cheating “a little bit”, or “moderation” or “balance,” it is almost certain that the next weigh-in they do is gonna suck. This foreshadowing is a trope. But usually the patient ends up losing only a couple of pounds or perhaps gains a few. As you will see, James was a notable exception. And as you will see, it won’t be the only time he was.

Once he got home, Lisa’s car broke down on the road—a tire came off, apparently (not sure if this was the van they wanted to transport James in originally—if it was and they had that failure en route, he’d be jolly well fucked). So Lisa couldn’t drive for groceries, and they were ordering takeout all the time. Because Houston doesn’t have grocery delivery services, apparently.
The combined stress of a non-functioning vehicle and the congestive heart failure was too much for James. He begged Lisa for Chinese egg rolls and fried rice. Lisa gave in pretty easily. She walked out to a Chinese takeout place nearby and brought it back. He got some cheesecake or pie or something like that for dessert.
In the voiceover, he explains that he is going to skip his followup appointment with Dr Now the next day, because he has too much going on right now. He also says: “Life is meant to be enjoyed, so I just have to find a balance between what I enjoy and what I need to do.”

Before I continue, I do have to say that in this scene, Lisa offered the standard chicken or fish that they had on hand, but when James complained about the monotony of it all, she felt she had no good option other than unhealthy takeout because of the car issue. Proper support would have involved getting groceries delivered until the car got fixed—which shouldn’t be that much more expensive than getting takeout all the time. So Lisa let him down in this way. But as you will see later, the enabling she was engaged in is far more overt than failing to find creative solutions to challenges like this.

Follow-up weigh in

James blew off multiple appointments with Dr Now. He continued to slack on the diet and Lisa started complaining about being stuck in her situation of having to take care of James, and not being appreciated by him.
Dr Now made a house visit! He looked at James and figured he looked bigger than when he had arrived in Houston. He ordered James to come back to the hospital so he could be weighed again.
At the hospital, James weighed 382.6 kg, which the nurse translated to 840 pounds (it’s actually 843.5—Dr Now said it was 844). That was a gain of 158.5 since leaving the controlled diet 3 months or so earlier, and 108.5 greater than what he weighed when he arrived in Houston.

I’ll break here to comment.

Normally when the people fuck up on this show, it’s either a small weight loss or a small weight gain. So while they’re clearly not following the diet, I can understand that it’s a typical struggle to deal with food addiction. They bullshit themselves about cutting corners on the diet when they are actually still consuming large amounts of calories, particularly the carb and sugar that drives up their insulin and prevents them from burning off their fat storage.

But James gained a ridiculous amount of weight. This is after his father mortgaged his house to pay for his medical transport, after one month of inpatient care, and 10 days of hospital care for congestive heart failure. He clearly does not want to lose weight—he doesn’t mind continuing to gain, and Lisa does not mind continuing to allow him to gain.

With all the talk about motivation, I can’t see how there can possible be enough to get him to change at this point.

Next weight loss goal

Dr Now read James and Lisa the riot act, but in the end he put James on another 800 calorie controlled diet. In a month, he was brought down to 786. Dr Now gave him a 100-pound weight-loss goal over the following 2 months. This would be his last chance to stay on the program.

Two months later

James returned to the hospital for a weigh in. He was 788: 2 pounds greater. Dr Now cut them off and told them to get under 600 before ever being considered for the program again. He recommended that they move back to Paducah.
The family decided to stay in Houston to keep trying, rather than return home. He worked with a physical therapist to sit up for the first time in 3 years.

Where Are They Now? Episode

This episode is shared with another patient named Cynthia. I’ll cover the James parts here. Poor Cynthia and her story are overshadowed by the train wreck James is.

Dr Now did another house visit with James upon Lisa’s request. It appeared he has lost some weight and his cellulitis has improved, so Dr Now arranged for James to come to he hospital for a weigh in and admitted him back into the program.
At the hospital, he weighed 350 kg, or 770 lb. He had lost only 18 pounds since getting kicked out of the program before.
Dr Now kept him in the hospital for a month on a 1,200-calorie-a-day controlled diet. His weight dropped to 638. Dr Now sent him home to lose more on his own.
In an interview, Dr Now speculated that James and Lisa deliberately put in just enough effort to get medical care for his vast array of health issues.

I’m wondering if he was actually substantially less than 770 at the house visit—maybe closer to 720–and he actually had some moderate progress after James and Lisa “sacrificed” a great deal when it came to eating.

So in the time between that visit and the transport to the hospital—figuring that they “won” the reinstatement into the program and all the health care that comes with it—they “celebrated” and went back to normal eating habits—and gave back a lot of that weight loss.

I just don’t believe Dr Now would have acted so positively at the home call had James actually lost only 2.5% of his body weight.

In any event, my scenario becomes more plausible after you learn what happened next.

Dr Now gave James a goal of 50 lb in 1 month and sent him home. Lisa keeps lying about what James is eating and how much. Dr Now warned Lisa to fix the diet or he may intervene “in a way she won’t like.” James vows to lose the weight.
James took an ambulance to the hospital for severe leg pain. He weighed 750—a 112 lb gain over the past month.
Dr Now read them the riot act again, chastising Lisa for continually lying about how much food she is feeding James. Lisa claimed not to understand that poor circulation is the cause of the severity of his cellulitis.
He then told James privately that he needs to separate himself from Lisa to save his life. When he refused to do so, Dr Now filed a case with Adult Protective Services, suggesting that Lisa is overfeeding James to keep the disability money flowing.
APS refused to intervene because James is voluntarily eating the food he is offered.
James was kept in the hospital on another controlled diet, and he dropped to 695. Dr Now then instructed the staff to lift enforcement of the ban on outside door, to see if Lisa would take advantage and bring food in to James.
A few days later, Dr Now weighed James and found that he had risen to 771. Lisa admitted to bringing food in and assured Dr Now she would not do it again.

James came back in because of a further leg infection. He was 804–gaining another 42 pounds.
Dr Now told James to send Lisa away for 5 days to prove to him that Lisa is causing the weight gain, but James refused this. So Dr Now severed James from the program permanently.

So, what to make of all this?

Was the transport to Houston and car under Dr Now for 18 months a total loss? In other words: had James and Lisa stayed in Paducah, how would things have turned out?

Well, he did gain 69 pounds on net—he was 735 when he arrived in Houston, and 804 when Dr Now booted his ass out of the program for the second and last time. (He was actually 788 when he was kicked out the first time—so in both times under Dr Now’s care he gained weight when the intended result was to lose weight.

I’m going to guess that James would have not survived one of the emergencies he had in Houston—his congestive heart failure or his cellulitis infection—if he had stayed in Paducah, for he was not under a doctor’s care there. Even if he had, he probably wouldn’t have been put on a controlled diet in the hospital, which likely contributed to keeping him alive.

So he survived—and apparently he is still alive and under the care of a different bariatric doctor now. There has been no news of his death since the episodes.

I have to say that Lisa is the worst enabler I have seen on this show—although Sean’s mother came in close to second. Sean ultimately died of Munchausen’s syndrome by proxy, in my layman’s opinion, with a delayed effect. Even Steven Assanti Sr. wasn’t that bad.

I think James really wanted to lose the weight. He could do it when the people around him were properly supporting him. On the controlled diets in the hospital, the staff obviously came through—but he also lost weight at home after getting booted from Dr Now’s program, when Lisa was trying to get him back in and get the benefits train moving rolling again.

Otherwise, Lisa was always fattening him up for some damn reason. It wasn’t just ordinary fucking up—if that was going on, you’d see meager weight loss or small weight gains. James was gaining HUGE amounts of weight in short periods of time—and he was doing it over and over again. She had their daughter Bayley bamboozled, too—she didn’t do much to intervene that anyone could see.

Lisa talked about abandoning James at one point, because she couldn’t deal with the stress of the caretaking. To be honest, the best thing for James would have been for Lisa to ghost him and leave a call with Dr Now’s office before leaving town. That way, James could be put in a safe environment somewhere. Obviously it would be emotionally devastating, but with Bayley’s help he might have a slim chance of survival.

My 600 lb Life – James King