A man who weighs 53 stone (336kg) has been moved to hospital to undergo specialist medical treatment.
A specially-built ambulance designed for obese patients was used to transport 48-year-old Paul Mason from his home in Ipswich.
It is understood he has been taken to St Richard's Hospital in Chichester, West Sussex, more than 140 miles away, for gastric bypass surgery.
Mr Mason weighed 70 stone (444kg) at his heaviest.
Removed by forklift
A spokesman for East of England Ambulance Service said: "While our ambulances can deal with the majority of the population we serve, we sometimes need to call on partner services which provide vehicles to move patients who exceed 25 to 30 stone.
"St John Ambulance is one of the companies which we work in partnership with for this specialist service.
"We respond to calls for help irrespective of an individual's physical circumstances and will adopt the most appropriate means of transport for that patient's needs."
A St John Ambulance Service spokesman said: "St John Ambulance regularly works with NHS Suffolk and likewise is committed to ensuring patient confidentiality and providing the highest level of clinical patient care.
"In Suffolk, St John Ambulance operates a commercial transport service in support of the NHS specialising in bariatric ambulance transport."
When he needed hospital treatment in 2002, Mr Mason had to be taken from his home by forklift through a window which had been removed.