Tommy Tomlinson has been overweight his entire life. Writing for The Atlantic, he gives an inside look at the struggles he's faced being a 460-pound-man in America—and how he's moving forward.

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What it's like to be 460 pounds

Tomlinson, a journalist who's written for several newspapers and magazines, writes that he's constantly aware of his size. He recalls an instance when he was on a subway in New York City, "praying [that the subway didn't] lurch around a corner or slam to a stop, because [he was] terrified of falling." Tomlinson writes that he was partly worried of the embarrassment he'd feel from falling, and also scared "that [he] might land on somebody" and injure them.

Stairs also present a challenge. After getting off the subway, Tomlinson writes, "I climb the stairs to the street and step to the side to catch my breath. I'm wheezing like a 30-year smoker. My legs wobble from the climb."

Tomlinson describes his body as "a car wreck," riddled with "long, mole-like growths caused by chafing" and "more stretch marks than a mother of five." His stomach hangs below his waist, and his calves and shins are "rust-colored and shiny from a condition called chronic venous insufficiency," which stems from the veins in his legs not being strong enough to move blood back to his heart. "The veins are failing because of the pressure caused by 460 pounds pushing downward with every step I take. My body is crumbling under its own gravity."

Tomlinson writes that sometimes, when he looks at himself in the mirror, he gets "so mad that [he] pound[s his] gut with [his] fists, as if [he] could beat the fat out." Other days, he ends up in "a blue fog that can ruin an hour or a morning or a day."

The cost of obesity

"Fat America comes with a devastating bill. According to government estimates, Americans pay $147 billion a year in medical costs related to obesity," Tomlinson writes. But there's also a non-financial cost.

"Every fat person, and every fat person's family, pays with anger and heartache and pain. For every one of us who can't shed the weight, there are spouses and parents and kids and friends who grieve."

Early death is also a daily concern, Tomlinson writes. "Guys like us don’t make it to 60. Some of us rot away from diabetes or blow out an artery from high blood pressure, but a heart attack is what I worry about most. My doctor likes to say that in a third of the cases of heart disease, the first symptom is death."

Tomlinson writes that his sister, Brenda Williams, died on Christmas Eve 2014 from a Methicillin-resistant Staphylococcus aureus (MRSA) infection that occurred after a sore on her legs caused by swelling leaked fluid and became infected. "The infection was the official cause of Brenda's death, but her weight killed her, sure as poison," Tomlinson writes.

There also was David Poole, a former writer at the Charlotte Observer, where Tomlinson worked. Poole was smaller than Tomlinson, "but he was shorter and rounder," Tomlinson writes. At age 50, Poole died of a heart attack.

While doctors have told Tomlinson his heart currently is fine, he writes, "Every day I wonder if this is the day I might keel over in my office chair or at the bookstore or (God help me) at the wheel of my car," adding, "At 460 pounds, I'm lucky to have made it this far."

The 'rock fight' of losing weight

Throughout his life, Tomlinson has tried just about every diet and weight-loss tool there is. As a child, doctors prescribed him appetite suppressants and what he believes were amphetamines. But no one talked to him "about eating right or exercising," he writes.

It wasn't until years later that diet fads went mainstream, Tomlinson writes. Since then, he writes, "I've done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I've tried the Mediterranean and taken my talents to South Beach. I've shunned processed foods and guzzled enough SlimFast to drown a rhino. I've eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I've been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I've also been told that each one of those things is an essential part of a healthy diet."

Tomlinson explains that it might seem like the solution is to "[e]at less and exercise," but it's much harder than that. He writes, losing weight is a "rock fight."

"The enemies come from all sides: The deluge of marketing telling us to eat worse and eat more. The culture that has turned food into one of the last acceptable vices. Our families and friends, who want us to share in their pleasure. Our own body chemistry, dragging us back to the table out of fear that we'll starve. On top of all that, some of us fight holes in our souls that a boxcar of donuts couldn't fill," Tomlinson writes.

He explains, "I'm almost never hungry in the physical sense. But I'm always craving an emotional high, the kind that comes from making love, or being in the crowd for great live music, or watching the sun come up over the ocean. And I'm always wanting something to counter the low, when I'm anxious about work or arguing with family or depressed for reasons I can't understand."

Why lost weight is hard to keep off

Even if people manage to lose weight, it can be extremely difficult to keep the weight off, Tomlinson writes, because any diet can work in the short-term, but unless people stick with the diet their entire lives, they won't be successful long-term.

People's bodies work against them when they diet, too, Tomlinson writes. "Nutritional studies have shown that hunger-suppressing hormones in our bodies dwindle when we lose weight. Other hormones—the ones that warn us we need to eat—tend to rise. Our bodies beg us to gorge at the first sign of deprivation."

Metabolisms also slow when people start losing a lot of weight, as one NIH study found when it looked at contestants from the weight-loss reality show "The Biggest Loser." The researchers found that the contestants who had lost weight quickly saw their metabolisms slow until they started gaining weight again.

Tomlinson's plan to lose weight

Despite the difficulties, Tomlinson is trying to lose weight. While he knows there are "radical options" available, like boot camps and weight-loss surgery, he prefers to lose weight in a simple, steady, sustainable way.

"I'll count how many calories I eat and how many I burn," he writes. "If I end up on the right side of the line at the end of the day, that's a win. I'll be like an air mattress with a slow leak, fooling my body into thinking I'm not on a diet at all."

It's been four years since starting on his weight loss journey, and Tomlinson writes that losing weight and keeping it off "feels sustainable" for the first time in his life. He's also brought his cholesterol and blood pressure down to normal levels, and stopped getting headaches from poor sleep.

Tomlinson writes that, while he still has more weight to lose, he's looking forward to being slimmer, and healthier. He has a stack of clothes that don't fit that he wants to wear. He wants to be able to climb the ladder to the attic in his house that's only rated at 250 pounds. He wants to put his late father's old boat in the water—a boat he's been afraid to use because he thought he might tip it over.

Tomlinson writes, "I know that the first step of 12-step programs is admitting that you're powerless over your addiction. But I don't feel powerless yet" (Tomlinson, The Atlantic, 1/9).