That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn't take drastic action, the dream would become reality.
Cyrus had grown gargantuan. His girth had destroyed his knees, spiked his blood pressure, sapped his breath and landed him in the hospital for several days with severe leg swelling.
Cyrus' older sister, Sheila Tehrani, 37, was just as big, and just as imperiled. Only a pound separated the siblings: Cyrus weighed 578, Sheila 579.
Guarderas hatched a plan. "If you knew Cyrus was going to die," Guarderas recalled asking the healthier Sheila, "would you give anything to get him back?"
"In a heartbeat," Sheila replied.
"Would you give up the house?"
"Of course," Sheila replied.
Well, said Guarderas, "that's what you may have to do."
That conversation late in 2004 launched the Tehranis' last-ditch attempt to shed the weight that was slowly smothering them. Surgery to slash their food intake would cost at least $25,000 each. With no health insurer willing to pay, the only recourse was to refinance the house they had inherited from their father. Sheila still lives in a studio apartment behind the house.
Sheila researched options on the Internet and made an appointment with one of Los Angeles' most experienced bariatric surgeons, Dr. Carson Liu.
Liu wondered if it was too late. Had the siblings become so huge that the surgery was too risky?
Vast numbers of Americans face a similar predicament. They have outgrown the weightiest medical description: morbid obesity. About 725,000 to a million people fit in this "super-obese" category.
But even that term is no longer expansive enough for the Tehranis and a fast-rising number of others. Between 140,000 and 400,000 Americans are believed to weigh more than 400 pounds. Liu dubs them the "super-duper" obese.
With a few hundred extra pounds severely straining every bodily organ, they appear to have one last hope: bariatric surgery.
But that surgery poses such grave risks for huge patients that many surgeons refuse to operate on them.
"They are at the end of their lives," Liu said. "They are being operated on much too late. These are the patients that have bad congestive heart failure — their hearts can't keep up with their bodies, which are falling apart."
By the time the Tehranis consulted Liu in early April 2005, they could walk only a few yards before becoming winded. Their arms puffed out like basketballs. Their distended bellies draped to their knees like sandbags. Restaurants with booths, chairs with armrests, airline flights, even clothes from shops catering to big and tall people — all were out of the question. (Cyrus jokes that labels on his clothes couldn't accommodate all the Xs: he wore 7X shirts over 78-inch-waist pants.)
Stares were as painful as stairs for Sheila.