What Does It Take to Lose 200 Pounds?

A patient in a Manhattan oncologist's office was scheduling a follow-up appointment when she realized that she hadn't seen a familiar face behind the desk. "Where's that really fat girl who works here?" the tactless woman asked—which was heard by the "really fat girl," Laura Prescod, standing only a few feet away and unrecognizable after having lost more than 200 pounds. Her reaction was resignation—just as it had been to a kind of invisibility in the world when she was obese. "People can be cruel and insensitive," she says, remarkably free of bitterness. "Weight is truly the last accepted prejudice." Considering the high failure rate of dieting, Prescod's success may have less to do with what she ate, or didn't eat, than the fact that her weight loss was a team effort. She had not only a doctor and nutritionist to guide her but two office colleagues whose attitude about weight loss was: It takes a village. Obesity has been a lifelong issue for Prescod. She was raised in the housing projects of Queens, New York, in a family where food equaled love and where cultural traditions—Southern on her mother's side, West Indian on her father's—meant that meals were usually deep-fried, starchy, and served in volume. While still in grade school, she became so large she could only fit into men's shirts. ("One day I came home in tears because my teacher was wearing the same shirt," she remembers.) In high school, she fasted on diet sodas for a month and lost 30 pounds, but she regained all the weight after she started to eat again. Relatives would poke her in the stomach at family gatherings, and at 16, when she attended her mother's funeral, an aunt told her she should be wearing a girdle. But despite such humiliation, she felt the weight was a layer of protection. "I'd built a brick wall," she says. "If I didn't let you through that barrier, you wouldn't hurt me. I used the weight as an excuse not to compete, not to be accepted, and in some ways to stay a child."

With the help of a good scholarship, Prescod graduated from Vassar College, but she put aside her aspirations for medical school when she was unable to get a job in a lab to earn tuition. (Although she was well-qualified, she was keenly aware of the expressions on her interviewers' faces once they saw her in person, finally giving up after 10 tries.) Eventually, she landed the job she's now had for 20 years, running an oncologist's office, and ironically, while working in healthcare, managed to neglect her own health. No matter what diet she tried—cabbage soup, protein shakes, smaller plates—the weight crept upward on her 5'7" frame, topping out at 409 pounds. And it circumscribed her life. She stopped driving because she could no longer fit behind a steering wheel. She barely made it through subway turnstiles, finding it easier to use the gate that's designated for large equipment. Her fatigue was so persistent, she often spent weekends in bed, and on frigid winter days, she stayed home from work, afraid that her painful knees might give way on icy sidewalks. She saved enough money for a time-share in Florida, but when she went on vacation (her first plane ride), she had to book two seats and ask the flight attendant for a seat-belt extender. Laura's Daily Plan

• 4 a.m. Half hour on the exercise bike or working out to an exercise video.
• 5:30 a.m. Breakfast—bowl of fiber-rich dry cereal or oatmeal, with flaxseeds, fresh fruit, and light soy milk; cup of coffee with skim milk.
• 6 a.m. Walk to the train station rather than using jitney. Wear a pedometer, trying to tally 10,000 steps a day.
• 9 a.m. Snack—soy protein powder mixed with light soy milk and a cup of black coffee.
• 12 p.m. Lunch—if brought from home, 6 ounces of lean protein such as chicken, fish, or tofu with steamed vegetables; if ordered in, turkey burger (no roll) and salad with low-fat dressing.
• 4 p.m.  Snack—one cup of low-fat yogurt or cottage cheese with apple or other fresh fruit bought from the stand on the street corner.
• 6 p.m. Shop at the health food market on the way home from work. If a food craving hits, wait 15 minutes—chances are it will subside.
• 7:30 p.m.  While making dinner, have a Wasa cracker with nut butter to avoid nibbling. Dinner is soup prepared on the weekend or perhaps rotisserie chicken, skin removed, bought at the market and added to salad with vegetables such as carrots and broccoli. Dessert is fruit salad.
  
  Drink 2 liters of water throughout the day. On weekends, get an extra half hour of exercise and perhaps have an occasional glass of wine.

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.

Through all the effort, what kept Prescod going was the support of her co-workers Sharon Politano and Olga Mazanov—she calls them her training wheels. When patients brought in cookies or candy, the two women kept the contraband out of harm's way, and for lunch at their desks, they ordered salads, urging a taste of soy nuts or removing the yolks from Prescod's hard-boiled eggs. (The diminutive Politano couldn't understand why her cholesterol was going up, until she realized she was eating all the extra yolks.) One of Prescod's regular minefields were the elaborate lunch spreads provided by pharmaceutical reps; her friends helped her navigate the tables laden with pastas and potato salad. They also chronicled her weight loss with photographs and engineered a style makeover after she'd spent years hiding under black or brown camouflage. "I didn't know how to go shopping," Prescod says. "If it came in my size, I bought it. I didn't own a pair of jeans, didn't know what to buy. I had clothes with the tags still on because I was too embarrassed to try them on in a store and too embarrassed to return them." Mazanov brought in stacks of fashion magazines and said, "This is your homework," then suggested that Prescod hang a pair of size 10 pants in her closet as a goal. Politano took her to buy makeup, insisting on a consultation to achieve the most flattering effect, rather than a drugstore purchase, and instructing the saleswoman to emphasize Prescod's new cheekbones.

While shopping at Whole Foods one day, Prescod chatted with a man who said he'd like to introduce her to a friend. A couple of pleasant e-mails and phone calls with the friend followed, until he suggested that they meet for dinner and, ostensibly for purposes of recognition, asked for her age and weight. "I told him my dress size," she says, "but I teased him, 'Do you ask all the women you date that question?' I had no point of reference—I hadn't had a date in five years." Unnerved, Prescod asked the girls, "He wants to have dinner—what am I going to do?" and they assured her she was going on the date, then announced, almost in unison, "You do realize, we're going with you." They made a reservation at the same restaurant and enlisted the help of an empathetic hostess in securing a table that provided a discreet vantage point. Romance did not blossom for Prescod, but fortunately, the blind date was a nice guy, because there was only an inexact plan for handling the situation if he was rude or inappropriate—then again, Politano, all 5 feet of her, feels sure she could have taken him.

Having shed a total of 235 pounds—cutting her weight by more than half—Prescod maintains the kind of dedication necessary for such a life-changing weight loss. Since she arrives home from work late and tired, she cooks on weekends, making enough healthy and reheatable food to last a week, including lunches at her desk (gone are the days of ordering from a thick stack of takeout menus). Filling salads and soups such as lentil or split pea are favorites, and she enjoys scanning cookbooks for recipes that add big punches of flavor without much fat, like chicken breasts rubbed with ancho chili powder or low-sodium soy sauce, ginger, and garlic. For breakfast, after a half-hour of exercise, she has high-fiber cereal with ground flaxseed, fresh fruit, and light soy milk. "I try to eat every three to four hours, and I try not to count calories," she says, estimating that she consumes between 1,200 and 1,500 a day. "I always carry something like a protein bar or trail mix so I don't get too hungry, but I'm not often tempted to eat it—I keep it in my bag so long that the packaging gets battered. If I'm going to a restaurant, I look up the menu online so I have some idea of what I will order, and I automatically ask for a take-home container. It's about choices: If you're going to have the potato, make it a sweet potato, or if it's a white potato, make it baked, not scalloped or au gratin."

For her last birthday, Prescod put two candles on a Kashi bar. At a barbecue with friends, she turned down the "lite" beer bought specially for her in favor of club soda, but she's learning how to incorporate an occasional indulgence—a policy endorsed by Waitman. "When you look at data about who is successful at keeping weight off," he says, "you find the diet that works is the diet that someone can stick with. She came to us extremely motivated, and she embraced a lifestyle change, not just a fad diet that she would do for two weeks or two months."

Prescod's odyssey is not complete, still 14 pounds away from her personal goal of 160. Yes, she's wearing orange instead of black, buying off-the-rack, walking the length and breadth of New York City, even wondering if it's too late for a medical career, hoping to defy F. Scott Fitzgerald's adage that there are no second acts in American lives. But her new body is marred by the loose excess skin that is often the vestige of dramatic weight loss, and the only remedy is undergoing a panniculectomy, a plastic surgery procedure that is expensive and not covered by her insurance. She is plagued by fluid retention and swelling in her legs due to compromised lymph nodes—a painful condition related to years of obesity that requires compression bandages and physical therapy. And at times her weight loss feels fragile, as if her body could revolt and resume its former shape. But there are also thrilling reassurances. When Prescod, known as the office mama, stopped ordering lunches for herself and her friends, the delivery boy who used to bring them greasy fried chicken stopped by with a free meal. "I hadn't seen you for so long," he said, "I was worried."

Ginger and garlic instead of butter and breading? A pretty good trade-off for health and life.