It is clear to me you must lose weight, quite a bit of weight, over 100 pounds.
Even at 42 your weight is life threatening, heart attack clearly on the list of risks due to your weight. Even the Echo can't be run... how much evidence of the problem do you need? Didn't you doctor ever mention the weight issue, and give you some risk statistics? I don't have the statistics, but bet you can find them on the web searching "risk factors for extreme overweight".
Sorry if you think I am "bold".. but my reason to take the time to reply is both the fact you haven't gotten any yet, and second, I think I have identified the key problem you, and only you, can solve.
Good luck. I could stand to lose 10 pounds myself. I am about 235, but am a bit over 6' 5".