Confined to his wheelchair, his 510-pound body drooping around him, Jimmy Allmond thinks often of things his weight won't allow him to do.
Lately, as his younger daughter's wedding approaches, the Rossville man imagines himself walking her down the aisle.
"I couldn't do it for my other daughter. I had to use my wheelchair," said Mr. Allmond, 50, while sitting in that chair in his small living room, family photos lining the wall behind him.
There is a long list of things he wishes he could do. He would love to walk with his wife on a Florida beach again. His wife would enjoy quiet time in their garden together.
Even helping his family load boxes as they moved earlier this month would have been a treat, he said.
But carrying one-quarter of a ton on his 5-foot-9-inch frame makes him too heavy.
Mr. Allmond is too heavy to walk long distances, too heavy to work and too heavy to leave the house without assistance. He's too heavy to do most of the things he thinks he should be doing.
"It kills me to see my family doing things without me," Mr. Allmond said. "I feel like I should be helping. This isn't the way it's supposed to be."
Despite all that, Mr. Allmond has hope. He talks about when he loses weight and even says he doesn't want to be "too skinny" one day.
Mr. Allmond is one of about 127 million adults in the U.S. who are overweight. Sixty million are obese and 9 million severely obese, according to the American Obesity Association. Tennessee has the nation's third-highest number of obese residents and Georgia ranks eighth, according to the U.S. Centers for Disease Control and Prevention.
People such as Mr. Allmond, with a body-mass index of 75, fall into a special class called "super, super obese," said Dr. Jack Rutledge, a local gastric surgeon.
"We are talking about a very small percentage of Americans who fall into this classification," he said.
Surgical intervention is not available to very large patients such as Mr. Allmond, Dr. Rutledge said.
The only option is for Mr. Allmond to lose a significant amount of weight either on his own or through a medically supervised program and then have gastric surgery to keep the weight off long term, the doctor said.
"I operate on super-obese patients, those individuals in the 50 to 60 BMI range," said Dr. Rutledge, who will perform about 20 such surgeries this year. "For people with BMIs above 60, it's just a nightmare to operate on (them)."
PUTTING IT ON
It's been about 20 years since Mr. Allmond had a job. He estimates it's been more than a decade since he physically was able to work, and that's mostly because of his size and the health conditions that come with obesity.
A workplace injury first tied him to home, and then subsequent weight gain caused him to become increasingly less mobile, he said.
The weight didn't come overnight. Like half the Americans classified as obese, Mr. Allmond gained it slowly over most of his adult life. Always a heavy child and raised by overweight parents, he began putting on large amounts of weight after high school, he said.
"I played football in high school, and I was about 200 pounds and in really good shape," Mr. Allmond said.
But after graduation he got a good -- but fast-paced -- job delivering ice cream for Flav-O-Rich dairy. Snacking between meals, he added a few pounds and his waistline began to grow.
"Sometimes I'd be in a hurry and I'd eat ice cream to tide me over to the next meal," Mr. Allmond said. "There wasn't any time to stop and eat something good for you."
Then he drove big-rig trucks, grabbing unhealthy meals and staying sedentary most of the time, leading to more weight gain. By this time, his weight was somewhere in the 280-pound range, but he was still active, said his wife, Valerie.
Mr. Allmond changed jobs again, starting to deliver furniture for a local store. Despite his size, he was able to get in the back of trucks and move furniture.
Then an accident changed everything. While in the back of a truck, he fell on top of a glass jewelry case, the shattered glass knifing through his knee. The injury required months of bed rest and led to a series of infections that required even more time in bed.
"It seemed like every time I would go back to work, there would be another infection and I would have to get back in bed," he said.
That's when the weight really piled on. By the time he recovered, he weighed about 350 pounds, he said. His record high was 630 pounds.
"Every time I started to get to working, I'd get sick and have a setback," Mr. Allmond said. "Sometimes I was too sick to get up and do anything, and other times I was too lazy."
Then depression set in. Mounting doctors' bills, the needs of a family and the fact that Mr. Allmond couldn't provide compounded the problem, he said.
"I don't think it was as much laziness as it was a depression," his wife said.
Mr. Allmond said trucking company representatives saw his large size and would deny him employment, fearing he'd suffer a heart attack or other health problem while on the road.
Diabetes, high cholesterol and high blood pressure are common health problems for obese Americans, and Mr. Allmond has them all.
He reports eating large portions, but his food intake is not so large that people would be shocked, he said. Both his daughter and wife back that up.
"He and I eat the same thing," said Mrs. Allmond, who is slightly overweight for her height. "I'm overweight, but why don't I look like him? I make our plates for supper, and they are made the same way."
It's not uncommon for very obese individuals to underestimate their daily food intake, said Mary Jo Rapini, a psychotherapist for Methodist Weigh Management Center in Houston. She regularly counsels patients about to have gastric bypass surgery.
"Most of the people with very high (body-mass indexes) will underestimate what they eat," Ms. Rapini said. "If they aren't able to ambulate, they really don't have much in their lives except for food. That's all they look forward to."
Like Mr. Allmond, many people who are extremely heavy are homebound, unemployed and sometimes alone for large chunks of the day.
"All you can do is use the computer, watch TV and then eat. When we get them in our center, they often say, 'We were really underestimating what we actually ate,'" said Ms. Rapini, who has been featured on the TLC series "Big Medicine," which follows two gastric surgeons.
On top of that, since Mr. Allmond is very sedentary, it's easy to maintain his current weight and even gain some without eating massive quantities, one doctor said.
"At the very extremes of BMI, when the individual is highly sedentary, they need far less caloric intake to maintain their weight," said Dr. Julie Dunn, an endocrinologist who works in surgical weight loss clinics at Vanderbilt University Medical Center. "In many cases, they physically can't do the things necessary to get healthy."
WEIGHT LOSS EFFORTS
Losing weight is the only way to set things right, medical professionals say. Surgery can help, but doctors agree Mr. Allmond is about 100 to 200 pounds too large for safe surgical intervention.
There simply isn't enough room in the abdomen for the surgeon to maneuver safely, Dr. Rutledge said. And such people often have excessively fatty livers, which can harden after surgery and make long-term weight loss even harder, he said. The liver regulates fat metabolism, and an unhealthy liver can make weight loss difficult.
"Those patients really need to lose about 100 pounds before surgery," Dr. Rutledge said. "When you tell them that, they look at you like you might not have a brain."
Two surgeons ordered Mr. Allmond to lose weight before they would operate, and neither could guarantee he would survive the surgery. One surgeon said he should lose 300 pounds before surgery.
"If I could lose 300 pounds, I'd be pretty close to my goal weight," Mr. Allmond said. "I wouldn't need the surgery anymore."
Scared by the risks, Mr. Allmond has focused on losing the weight himself, but success has been limited. After spending a year at a now-defunct weight loss clinic in Cleveland, Ohio, he lost about 100 pounds.
1978: high school -- 190-200 pounds
1978-91: ice-cream delivery man -- 225
1991: furniture delivery man -- 300
1992: recovered from injured knee -- 350-400
2007: underwent yearlong weight loss treatment -- 630
2010: signs up for Weight Watchers -- 510
Jimmy Allmond's diet
Mr. Allmond says most people would be surprised that he doesn't eat all day or even eat very unhealthy foods. Last week he ate the following in one day, he said:
2 pieces of bacon
3 whole wheat pieces of toast
Two ham sandwiches, 3 to 4 slices of meat
A slice of cheese per sandwich
2 pork chops
1 serving of two types of vegetables
100-calorie snack pack of chips
18.5-24.9: Normal weight
40.0-49: Extreme obesity
50-59: Super obesity
60-above: Super super obese
Source: U.S. National Institutes of Health
What is BMI?
Body mass index is a measure of body fat based on height and weight that applies to both adult men and women, according to the U.S. National Institutes of Health.
Jimmy Allmond wants to form a support group for other obese individuals. Anyone who would like to contact him may do so at firstname.lastname@example.org.
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Working out is a challenge, because Mr. Allmond tires so quickly. He can hardly stand for the amount of time it takes to dry dishes, much less get vigorous exercise.
He said he works out regularly in his small kitchen using a Body by Jake home training system, which focuses on his upper body. He sits in his wheelchair for the workouts. Even walking up the slight hill in front of the Allmonds' home is too taxing, he said.
Mr. Allmond imagines a program like his Ohio experience in the Chattanooga area, and he has gone so far as to contact building owners who might be willing to offer space.
He says local gyms aren't equipped for very heavy individuals.
"You just feel funny going into a regular gym with all those skinny people," Mr. Allmond said. "They look at you like 'Why are you here?' But I need to be there."
He believes there are dozens of people like himself who are too heavy to get away from home regularly, shunning care because they are embarrassed.
But he continues to try. Last week he signed up for Weight Watchers at Memorial Hospital's Heart Institute. He figures the program can guide him on a proper diet.
"I don't think I can do it by myself," Mr. Allmond said.
Mr. Allmond's family is fearful about his health. His wife makes him keep a cordless phone in his pocket at all times because she fears he may fall while she is at work and he would not be able to get up without help.
On trips to various doctors' offices, Mr. Allmond uses a medical transport service with a wheelchair ramp. His wife also drives him in their Dodge minivan, which has special rails to load his oversized chair.
Weight-loss experts say his medical conditions and lack of mobility create a very dangerous health outlook.
"If you have all this weight on you, plus diabetes, which attacks the blood vessels, plus the high blood pressure, the high cholesterol, you just have a very bad combination," Ms. Rapini said. "You're just sitting and waiting for the bomb to go off."
The seriousness of the problem isn't lost on Mr. Allmond's family, who all want him to get to a healthier weight.
"He's missed so much because of the weight," said Mr. Allmond's daughter Diana Hughes, who is 23 and planning her wedding. "When I was younger, I remember him always being outside with us, and then he got to the point where he couldn't really do anything."
She moved out of the house into her first apartment while Mr. Allmond was at the weight-loss clinic in Ohio, but since returning he hasn't been able to visit her because the apartment is up a flight of stairs, she said.
Family members say they are patient and understanding about Mr. Allmond's condition, though Ms. Hughes confesses some frustration.
"While he was in Ohio, he missed my high school graduation," she said. "He was working his tail off up there, but then he came back here and didn't work as hard. It's like that year was a waste."
NOT A HOPELESS SITUATION
Ms. Rapini said there is hope. She's counseled dozens of patients of Mr. Allmond's size who have gone on to lose large amounts of weight, she said.
"There is a vicious cycle here, but the first step is to lose weight with medical supervision and then have surgery followed by very good after-surgery care," she said.
At times it does feel hopeless, Mr. Allmond said.
Any public outing results in stares, snickers and insensitive comments, he said. He recalls an incident on Christmas Eve at Walmart when a man called him out in front of everyone for being too large for the aisle.
"When I hear people saying those things, I go up to them," Ms. Hughes said. "I tell them that they don't know all that my dad has been through."
"Anything can really set you back," Mr. Allmond said.
And when he's depressed, Mr. Allmond said, he's more likely to turn to food as a comfort, a common response in obese people.
"What we don't know is if the depression comes first or if their lack of mobility and weight gain causes their depression," Ms. Rapini said. "But obesity is highly impacted by depression."