6 ms·

How the world's heaviest man lost it all (2017)

36 points by whocansay 5y ago

sbierwagen 5y ago
Paul has since regained quite a lot of weight: up to 500 pounds in 2019 https://metro.co.uk/2019/05/20/worlds-former-fattest-man-to-return-to-uk-from-us-so-he-can-start-claiming-benefits-again-9618835/ https://metro.co.uk/2019/05/20/worlds-former-fattest-man-to-... and 546 pounds as of a couple months ago: https://www.mirror.co.uk/news/uk-news/worlds-ex-fattest-man-piles-25362406 https://www.mirror.co.uk/news/uk-news/worlds-ex-fattest-man-... (Apologies for the highly opinionated source, but as you might guess most of the news coverage is from UK tabloids.)
- tromp 5y ago
  Paul Mason on This Morning: https://www.youtube.com/watch?v=-pgOX0hT1G0 https://www.youtube.com/watch?v=-pgOX0hT1G0 How he lost his fiancee: https://www.mirror.co.uk/news/uk-news/how-loaf-bread-helped-cost-16461724 https://www.mirror.co.uk/news/uk-news/how-loaf-bread-helped-...
ravenstine 5y ago
> He was all too familiar with that precarious balance. In 2008, he had tried to commit suicide by taking enough codeine to kill two people, but he'd woken up the next morning with only a headache—his body had absorbed it all. I am nearly speechless. Suicide is no joke, but assuming the story here is true, it's kind of remarkable that a person's morbid obesity saved them from death in such an ironic way. If he was at a lower end of obesity he might not be alive today. Does anyone here have background knowledge to know whether this story is plausible? I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it.
- stordoff 5y ago
  I'm not overly familiar with the mechanics of codeine in overdose, but the toxicity of paracetamol (acetaminophen) can be estimated based on the mg/kg ingested, albeit with a cap at 110kg: > To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).[1] It strikes me as at least plausible that codeine could be behave in a similar way. [1] https://bnf.nice.org.uk/treatment-summary/poisoning-emergency-treatment.html https://bnf.nice.org.uk/treatment-summary/poisoning-emergenc...
- sbierwagen 5y ago
  Drugs for children are dosed in mg per kg, with calculators to suit: https://reference.medscape.com/calculator/650/weight-based-medication-dosing https://reference.medscape.com/calculator/650/weight-based-m... Adults are usually about the same size, so it's less of a problem there. Usually. https://www.nytimes.com/2018/06/08/well/drug-dose-weight-size-doctors-prescriptions-medications.html https://www.nytimes.com/2018/06/08/well/drug-dose-weight-siz...
  - Broken_Hippo 5y ago
    Drugs for children aren't only dosed per kg: Sometimes children have different bodily functions than adults [1]. Children might not clear out medicines like adults, for example, and it means they need a lower per KG dose. This is also a concern when giving children vaccines, though it is more due to the way a child's immune system operates differently than an adult's. [1] https://www.msdmanuals.com/professional/pediatrics/principles-of-drug-treatment-in-children/pharmacokinetics-in-children#:~:text=Drug%20metabolism%20and%20elimination%20vary,in%20neonates%20than%20in%20adults https://www.msdmanuals.com/professional/pediatrics/principle....
- jamil7 5y ago
  > I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth I thought it was the opposite. The effect of medication, drugs and alcohol all seem to depend at least partly on body mass.
- c22 5y ago
  Codeine isn't designed or intended to kill you, so I'm not sure we can say anything about the effectiveness of the medication in this case.
- Broken_Hippo 5y ago
  "I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it." It definitely affects it: This is part of the reason they ask you for your weight before you get an MRI with contrast (The amount of contrast changes on your weight) and IIRC, they change the dose of IV morphine depending on your weight. Realistically, this is also the case for some drugs - a small person generally gets drunk faster than a large one. But it doesn't matter as much for some drugs than others: Two adults can generally take the same amount of ibuprofen because the differences aren't really all that large. Extremes are going to change this, though.
1_player 5y ago
"He had a proper dietary routine now, he said. [...], made oatmeal for breakfast, ate a banana as a snack, had a salad or PB&J for lunch, and some pasta for dinner." Ah yes, the proper diet of carbs and sugar, little protein and even less fat. PB&J for lunch for a diabetic, seriously? We're still a few decades away before the common populace and your GPs learns that sugar, especially fructose, is one of the biggest causes of the obesity epidemic.
- ravenstine 5y ago
  I hope someday this concept of a healthy diet goes by the wayside because even just a cursory investigation makes it obvious how flawed it is. It's like people think that a food is "healthy" as long as it's not pizza or ice cream, and even most GPs don't totally know better (they're not stupid, it's just that they're not as educated in that subject). A reasonable diet isn't even that complicated. Control the sugar and choose foods lower on the insulin index and it will be surprisingly difficult to not control your weight. You won't necessarily get ripped on that alone, but it would be really unlikely to get anywhere near as large as this guy or for him to stay that way. For instance, even though oatmeal is pretty overrated to start with, it's by no means the worst thing one can be eating, so he would just need to not eat it with sugar. Oatmeal is a somewhat higher glycemic food if I remember correctly, but it's a good source of fiber. Bananas are pretty high on the glycemic and insulin indexes so they should only be eaten occasionally and as an alternative to something worse like ice cream. Salad is of course mostly fine if it has minimal dressing and no added sugar (and hopefully a good fat like olive oil). Peanuts are, surprisingly enough, very low on the insulin index and are fairly low on the glycemic index, and they're high in satiation. A peanut butter sandwich with natural peanut butter (no added sugar) and whole grain bread would be far better to a PB&J, though eating some peanut butter without bread would be optimal. Pasta probably isn't the best thing to be eating if you're 600+ lbs, but at lower weights it's not necessarily that bad relative to other things. Better to replace it with something closer to a low carb Mediterranean dish if you want a substantial dinner. If you (the reader in general) read those two paragraphs then I just saved you countless hours in reading research papers and fad diet books/sites. Metabolism is complicated, but the insulin response is the most important thing to understand for body fat control. If you don't have an insulin response, you can't gain adipose fat. The most successful diet plans usually select for foods that have a lower glycemic effect and a lower insulin response. The leptin/ghrelin balance is also important, but even that is less important in the long term than insulin. Both diet and fasting help with those, the latter being of greater help in the short term. > especially fructose I would generally agree, although I think the fructose thing is a little overstated and misleads some people to lumping food into the same category is Coca Cola. Different fruits have different insulin index values, different amounts of sugar, and usually come with fiber which helps with blood sugar spikes among other things. With some exceptions (bananas and obviously fruit juices), if you're consuming whole fruit but you're not eating refined sugars then you'll probably be fine. Even mangos, which are super tasty IMO, aren't particularly high in calories relative to many other foods people normally consume, and if your source of sugar is a mango a day then most of that sugar will be processed by your liver and it's little enough that you can burn it off with some low intensity exercise.
AniseAbyss 5y ago
- dang 5y ago
  Slurs like that will get you banned here, regardless of which group of people you have a problem with. You can make your substantive points without any of that, so please do so. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

36 points by whocansay 5y ago

Paul has since regained quite a lot of weight: up to 500 pounds in 2019 https://metro.co.uk/2019/05/20/worlds-former-fattest-man-to-return-to-uk-from-us-so-he-can-start-claiming-benefits-again-9618835/ https://metro.co.uk/2019/05/20/worlds-former-fattest-man-to-... and 546 pounds as of a couple months ago: https://www.mirror.co.uk/news/uk-news/worlds-ex-fattest-man-piles-25362406 https://www.mirror.co.uk/news/uk-news/worlds-ex-fattest-man-... (Apologies for the highly opinionated source, but as you might guess most of the news coverage is from UK tabloids.)

tromp 5y ago
Paul Mason on This Morning: https://www.youtube.com/watch?v=-pgOX0hT1G0 https://www.youtube.com/watch?v=-pgOX0hT1G0 How he lost his fiancee: https://www.mirror.co.uk/news/uk-news/how-loaf-bread-helped-cost-16461724 https://www.mirror.co.uk/news/uk-news/how-loaf-bread-helped-...

ravenstine 5y ago

> He was all too familiar with that precarious balance. In 2008, he had tried to commit suicide by taking enough codeine to kill two people, but he'd woken up the next morning with only a headache—his body had absorbed it all. I am nearly speechless. Suicide is no joke, but assuming the story here is true, it's kind of remarkable that a person's morbid obesity saved them from death in such an ironic way. If he was at a lower end of obesity he might not be alive today. Does anyone here have background knowledge to know whether this story is plausible? I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it.

stordoff 5y ago
I'm not overly familiar with the mechanics of codeine in overdose, but the toxicity of paracetamol (acetaminophen) can be estimated based on the mg/kg ingested, albeit with a cap at 110kg: > To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).[1] It strikes me as at least plausible that codeine could be behave in a similar way. [1] https://bnf.nice.org.uk/treatment-summary/poisoning-emergency-treatment.html https://bnf.nice.org.uk/treatment-summary/poisoning-emergenc...
sbierwagen 5y ago
Drugs for children are dosed in mg per kg, with calculators to suit: https://reference.medscape.com/calculator/650/weight-based-medication-dosing https://reference.medscape.com/calculator/650/weight-based-m... Adults are usually about the same size, so it's less of a problem there. Usually. https://www.nytimes.com/2018/06/08/well/drug-dose-weight-size-doctors-prescriptions-medications.html https://www.nytimes.com/2018/06/08/well/drug-dose-weight-siz...
- Broken_Hippo 5y ago
  Drugs for children aren't only dosed per kg: Sometimes children have different bodily functions than adults [1]. Children might not clear out medicines like adults, for example, and it means they need a lower per KG dose. This is also a concern when giving children vaccines, though it is more due to the way a child's immune system operates differently than an adult's. [1] https://www.msdmanuals.com/professional/pediatrics/principles-of-drug-treatment-in-children/pharmacokinetics-in-children#:~:text=Drug%20metabolism%20and%20elimination%20vary,in%20neonates%20than%20in%20adults https://www.msdmanuals.com/professional/pediatrics/principle....
jamil7 5y ago
> I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth I thought it was the opposite. The effect of medication, drugs and alcohol all seem to depend at least partly on body mass.
c22 5y ago
Codeine isn't designed or intended to kill you, so I'm not sure we can say anything about the effectiveness of the medication in this case.
Broken_Hippo 5y ago
"I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it." It definitely affects it: This is part of the reason they ask you for your weight before you get an MRI with contrast (The amount of contrast changes on your weight) and IIRC, they change the dose of IV morphine depending on your weight. Realistically, this is also the case for some drugs - a small person generally gets drunk faster than a large one. But it doesn't matter as much for some drugs than others: Two adults can generally take the same amount of ibuprofen because the differences aren't really all that large. Extremes are going to change this, though.

1_player 5y ago

"He had a proper dietary routine now, he said. [...], made oatmeal for breakfast, ate a banana as a snack, had a salad or PB&J for lunch, and some pasta for dinner." Ah yes, the proper diet of carbs and sugar, little protein and even less fat. PB&J for lunch for a diabetic, seriously? We're still a few decades away before the common populace and your GPs learns that sugar, especially fructose, is one of the biggest causes of the obesity epidemic.

ravenstine 5y ago
I hope someday this concept of a healthy diet goes by the wayside because even just a cursory investigation makes it obvious how flawed it is. It's like people think that a food is "healthy" as long as it's not pizza or ice cream, and even most GPs don't totally know better (they're not stupid, it's just that they're not as educated in that subject). A reasonable diet isn't even that complicated. Control the sugar and choose foods lower on the insulin index and it will be surprisingly difficult to not control your weight. You won't necessarily get ripped on that alone, but it would be really unlikely to get anywhere near as large as this guy or for him to stay that way. For instance, even though oatmeal is pretty overrated to start with, it's by no means the worst thing one can be eating, so he would just need to not eat it with sugar. Oatmeal is a somewhat higher glycemic food if I remember correctly, but it's a good source of fiber. Bananas are pretty high on the glycemic and insulin indexes so they should only be eaten occasionally and as an alternative to something worse like ice cream. Salad is of course mostly fine if it has minimal dressing and no added sugar (and hopefully a good fat like olive oil). Peanuts are, surprisingly enough, very low on the insulin index and are fairly low on the glycemic index, and they're high in satiation. A peanut butter sandwich with natural peanut butter (no added sugar) and whole grain bread would be far better to a PB&J, though eating some peanut butter without bread would be optimal. Pasta probably isn't the best thing to be eating if you're 600+ lbs, but at lower weights it's not necessarily that bad relative to other things. Better to replace it with something closer to a low carb Mediterranean dish if you want a substantial dinner. If you (the reader in general) read those two paragraphs then I just saved you countless hours in reading research papers and fad diet books/sites. Metabolism is complicated, but the insulin response is the most important thing to understand for body fat control. If you don't have an insulin response, you can't gain adipose fat. The most successful diet plans usually select for foods that have a lower glycemic effect and a lower insulin response. The leptin/ghrelin balance is also important, but even that is less important in the long term than insulin. Both diet and fasting help with those, the latter being of greater help in the short term. > especially fructose I would generally agree, although I think the fructose thing is a little overstated and misleads some people to lumping food into the same category is Coca Cola. Different fruits have different insulin index values, different amounts of sugar, and usually come with fiber which helps with blood sugar spikes among other things. With some exceptions (bananas and obviously fruit juices), if you're consuming whole fruit but you're not eating refined sugars then you'll probably be fine. Even mangos, which are super tasty IMO, aren't particularly high in calories relative to many other foods people normally consume, and if your source of sugar is a mango a day then most of that sugar will be processed by your liver and it's little enough that you can burn it off with some low intensity exercise.

AniseAbyss 5y ago

dang 5y ago
Slurs like that will get you banned here, regardless of which group of people you have a problem with. You can make your substantive points without any of that, so please do so. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.