When Alexis Khan saw images of herself taken six months ago, before she underwent gastric bypass surgery, she was shocked.
Alexis, 16, weighed 243 pounds, more than two and a half times the 100 pounds recommended for her 4-foot-11-inch-tall body. She had diabetes and sleep apnea and was borderline hypertensive.
Her mother, Gina Khan-Debrum, was acutely aware of the dangers her daughter faced. "Everything was spiraling out of control," she said.
Mother and daughter took a last, drastic effort to avert a future of disastrous health consequences. In October, Alexis underwent gastric bypass at Medical University of South Carolina. The surgery reduced her stomach from the size of a large grapefruit to the size of an egg.
Alexis is now more than 60 pounds lighter. She can shop off-the-rack at her favorite store, Aeropostale, and fits into a size 12.
She walked the Cooper River Bridge Run in 2 hours and 22 minutes. Driving is easier. She got a job working with small children, whom she loves being around because they don't judge, she said.
The procedure was not a magic bullet, however. She has fought for every pound she's lost, at a rate of about 2 pounds a week. She can only eat a few bites of food at a time, about every four hours. Two California sushi rolls are a meal, she said.
To ensure success, she will never be able to eat more than one and a half cups of food in one sitting. So far, she has had no nausea or vomiting, a side effect called "dumping" that occurs when food rapidly enters the small intestine.
Alexis and her mother did not rush headlong into bariatric surgery, but nothing else had worked in Alexis' lifelong struggle.
Three times, she has successfully followed a medically prescribed high-fat, low-carbohydrate diet. At age 14, she slimmed down to her lowest weight, 153 pounds. But whenever the carbohydrates were reintroduced, the weight returned.
While eating basically a starvation diet, Alexis suffered symptoms of malnutrition. Her hair fell out by the handful. With gastric bypass, however, she can eat an array of nutritious food, plus vitamin supplements, leaving her hair shiny and her skin clear.
"She's never been able to eat like a normal child," Khan-Debrum said. "Even before her first birthday, people questioned what I fed her."
In California, doctors enlisted Khan-Debrum and Alexis in a 30-day program for observation, thinking Khan-Debrum had Munchausen by Proxy, a psychological condition in which a caregiver makes a loved one sick to gain attention.
The doctors later apologized. A string of endocrinologists and geneticists have studied Alexis and found no clear cause for her weight issues. Her rounded face and the fat around her neck suggested Cushing's disease, an endocrine disorder cause by high levels of cortisol in the blood, but blood tests lacked evidence.
The weight loss plateaus occasionally, which is hard for Alexis and her mother. "You see her eat these tiny amounts, and the scale doesn't change," Khan-Debrum said.
"I hate the scale," Alexis said.
But eventually, another pound melts away. Alexis walks for about two hours every day. Recently, one morning, she returned from a walk that broke into a run. She told her mother she "felt free."
Her sleep is more restful, too. The weight she retains around her neck still affects her breathing at night, but it's getting better. "I never had a lot of dreams," she said.
She stopped taking her diabetes medication within weeks of the surgery. And her cholesterol and blood pressure have dropped to healthy levels.
Alexis hopes to get down to 110 pounds. But even then, the war will not be over.