What Does It Take to Lose 200 Pounds?

Nearly three years ago, just before her 41st birthday, Prescod woke up feeling slightly dizzy. "I thought I must be getting the flu," she recalls, "but I went to work anyway. It's a two-hour commute—three trains and a bus. When I got to the office, I couldn't remember how to use the computer." Her blood pressure was 220/160—that's considered stroke level—and she was rushed to the emergency room, where she sat like the Jimmy Stewart character in It's a Wonderful Life, thinking of the people she'd leave behind. "My father had died of a stroke, and a number of relatives had succumbed to weight-related issues," she says. "I knew I couldn't expect anybody else to take care of me, and I really wanted more from life."

The near-death experience was galvanizing, says Jonathan Waitman, MD, the obesity specialist Prescod consulted a few months after being released from the hospital. "She was lucky in the sense that her wake-up call wasn't fatal," he says. "Anybody walking around carrying 400 pounds is an accident waiting to happen." Prescod insisted on using a liquid diet formula for a few months, to achieve a quick start. (Waitman maintains that anyone attempting such a plan should be under medical supervision to ensure meeting basic nutritional requirements.) "I needed to see big numbers," she says. "I started with four shakes and a protein bar, so I was getting only about 800 calories a day. After three days, I got out of bed and fainted."

Convinced that eating a little more would be wise, Prescod started supplementing the shakes and bar with a lunch of lean protein and vegetables (foods with a low glycemic index to help keep her blood sugar stable), totaling about 1,200 calories a day. "My first meal was a turkey burger and salad, no bun," she remembers. "I saw the doctor or nutritionist once a month, and each time they'd add something, like a late-afternoon snack of yogurt." She got off to such a good start, losing up to 15 pounds a month, that she was able to discontinue blood-pressure medication, but inevitably, the weight loss slowed. "That's a tough transition," says Heather Bainbridge, the registered dietitian in Waitman's practice who counseled Prescod. "When people plateau, they feel as if they're failing." She helped Prescod understand that it was a normal reaction to what the brain perceives as starvation, causing a slowdown of metabolism and an increase in the production of appetite-stimulating hormones.

Most weight loss experts agree that long-term success is unlikely without regular exercise. But getting a 400-pound body into a fitness routine is an extraordinary challenge. "There are little things you can do," says Prescod. "Dr. Waitman told me, 'I just want you to move, maybe get off the bus two stops earlier,' and I'd make it three or four stops." But Prescod also defied the disclaimer on her stationary bicycle that the maximum weight load was 250 pounds and used a stool to pull herself on, managing at first to pedal for only about 30 seconds before becoming winded. Gradually, she built up to a minute, then two, then 10. The pain in her knees improved with much less weight bearing on them, so she could take long walks. As her endurance increased, she bought or rented different kinds of boot-camp and yoga DVDs to keep from getting bored and woke up at 4 a.m. to squeeze a workout into her schedule. "My exercise clothes are out 24/7," she says. "When I started, I had ratty old sweatpants, and I was too embarrassed to do things outside. As my body began to respond and I was losing inches, I started buying nice workout clothes. They're part of my 'treat' for myself." Another gift—a Christmas present from friends—was a series of horseback-riding lessons, something that's been on her wish list for a long time but seemed impossible at her former weight. "I would have hurt the poor horse," she says with characteristic humor.