On recent "My 600-lb Life" episodes, Chay's story presented an unusual reason for wanting gastric bypass. The obese Chay says he's a man living in a woman's body and wants gender reassignment surgery. However Transgender Chay needed bariatric surgery before he could have a sex change and needed to first lose weight before he could have surgery, period. But when he failed to hit weight loss goals, he blamed his family for not accepting his LGBT lifestyle. Chay's slippery slope thinking, excuse-making, displacement and blame of others highlight why recovery from morbid obesity is so important and so difficult.

Chay overeats due to"coming out" fears

Chay's family was super supportive of weight loss, but not so much of his being transgender. He didn't really say how they'd been unsupportive except that his aunt had posted a talk against transgender on social media. He doesn't mention any harassment or bullying. But he feels hurt and comfort eats. Could his claims of being unsupported really be simple excuses to overeat? Is it easier to shift blame than to accept that responsibility for weight loss?

Is sex change the reason or roadblock to weight loss?

"My 600-lb Life" Dr. Younan Nowzaradan didn't pooh-pooh Chay's transgender, but he did warn the young man that having two major surgeries--bariatric and gender reassignment--could be dangerous.

Just one would be deadly if he couldn't get down from nearly 600 pounds. But the transgendered young man didn't want to talk weight loss as much as sexual identification. He says he's having weight loss surgery to have the sex change but if he had trouble doing the homework for gastric bypass, how badly does he want the other?

Lack of acceptance or tired of caregiving?

Regardless of LGBT orsexual orientation,morbid obesityrequires lots of care--transportation, bathing, cleaning, feeding, cooking, etc. Then there's the cost of all these surgeries? So Chay is obese and transgender--who's going to pay for baratric, gender reassignment, etc?

It could be that Chay's aunt and uncle were tired of supporting him period. They were less enabling and more directly honest than many of the family members on "My 600-lb Life." Their nephew can be grateful for that. Enabling will keep him obese while empowering is what will get him closer to full gender transition.

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