Mark has been overweight since childhood, but now, at 30, he is tipping the scales at nearly 600 pounds.
With an injured knee, he finds it difficult to stand. He has had to take a leave of absence from his job as a quality assurance technician at Abbott Laboratories in Salt Lake City and mostly sits day after day hooked up to oxygen.
Although Mark's situation is extreme and potentially dire, it underscores the country's growing weight epidemic. Americans are the fattest they've ever been, with 60 percent of adults considered overweight or obese. Experts blame a culture of sedentary lifestyles, processed and fast foods and years of apathy.
In Utah, 55 percent of adults are overweight or obese. The obesity rates have increased from 10.7 percent in 1989 to 19 percent in 2002, according to the Utah Department of Health.
"Every day in Utah, 65 people cross the line from overweight to obese," said LaDene Larsen, director of the health department's bureau of health promotion.
The days of describing overweight people as fat and jolly are history. Obesity, defined as 100 or more pounds over a healthy weight, is the second preventable leading cause of death in the United States, behind smoking, and is a major risk factor for diabetes, heart disease and stroke.
Lifelong struggle: Mark has struggled with his weight - and slurs like fat and lazy - all his life. He believes he inherited a slow metabolism; other family members are overweight, and his dad hit 1,100 pounds at his heaviest.
His parents fed him vegetables, fruits and meats and limited his candy and soda intake as a child because he was husky as early as age 5. As an adult, Mark has tried the low-carbohydrate Atkins diet and prescription diet pills but says nothing has worked.
Now he is caught in a quandary. Before undergoing the knee surgery doctors say will allow him to return to a more normal life, he needs to lose weight. But moving enough to shed the necessary pounds is a problem, because the bad knee buckles underneath him.
"I want to go back to work," Mark said. "I had a doctor who told me I would die in two years and that was four years ago. But I really don't know what will happen to me if I don't get help."
Mark's doctor, Warren Stack in West Valley City, says Mark needs gastric bypass surgery. But his insurance company won't cover the procedure, which costs about $17,000 to $25,000.
"It's critical to have his knee fracture repaired, but the surgeon won't do the surgery until his weight is down," Stack said. "He can't lose the weight because he is immobilized. It's kind of a vicious cycle. His insurance company ought to keep in mind if they get him productive again they will gain another taxpayer. He's a hard-working guy, well-liked at his work and wants to get back to work."
In the past, Mark's dilemma was viewed as a personal, rather than a medical, problem. But attitudes are starting to change. Medicare recently redefined obesity as an illness, a move expected to pave the way for Medicare eventually to cover gastric bypass surgery. Private insurers may feel pressured to follow Medicare's lead.
In the meantime, help is elusive for Mark. And he's certainly not alone in his battle.
Half of Utahns heavy: Utah's rate of overweight and obese residents is below the national average, officials believe, because they get more regular physical activity. In fact, only two states - Montana and Alaska - reported higher levels of physical activity in 2003.
Even so, that leaves more than half of Utah's population heavier than it should be.
"As a society, we've reduced our amount of physical activity while food is more readily available," Larsen said.
While lifestyle plays a large role in the epidemic, research indicates genetics also contribute.
Ted Adams and Steven Hunt began studying the genetics of obesity in 1988 at the University of Utah Cardiovascular Genetics Department of Internal Medicine. They tracked 7,000 people from 400 Utah families with at least two family members who were 75 pounds or more overweight.
"We've done a lot of genotyping of these people," Hunt said. "We found that very few families had only one person who is obese. Ninety percent of the families we've studied have one or more of the genes that contribute to obesity."
Genes influence appetite and metabolism. Adams and Hunt theorize that our genes remained the same as our lifestyles became increasingly inactive. When food was scarce and we had to hunt and forage, our genes conserved energy.
Now food is plentiful and the population is less mobile, but our bodies continue to store the energy that we aren't expending, leading to weight gain.
And some people's bodies cling to the fuel more strongly than others.
"Two people could eat the same thing, and one would burn the food much faster," Adams explained. "Some people can eat whatever they want and not gain weight. Others eat a restricted diet and remain obese."
Adams likens obesity to smoking. While people in some families can puff away their entire lives without getting lung cancer, others die from the disease, he said.
Adams and Hunt say more work is needed to pinpoint genes that predispose people to obesity. Once that is done, pharmaceutical companies could design drugs to alter the genes' activity, much in the same way researchers created drugs to lower cholesterol.
No magic: For now there is no magic pill - and there may never be.
The fen-phen debacle showed the dangers of relying on pills to lose weight. The drugs were pulled from the market in the late 1990s due to concern that they caused leaky heart valves, stranding many people who had thrived on the medication and then gained back even more weight than they lost.
Exercise, diet - and surgery in drastic cases - are the best tools, experts say.
Lezlee Jones, 44, of Bountiful says she is an example of how to lose weight the old-fashioned way - by altering her diet and amping up her physical activity.
The mother of three slimmed down from 171 pounds and a size 14 to 115 pounds and a size 2 in 1999. She has kept the pounds off ever since.
How did she do it?
By eating six small meals a day and working out six days a week, she maintains. Each day, she typically eats three small cooked meals, mainly lean meats and vegetables, and drinks three protein shakes. She alternates three days of weight training for 45 minutes with three days of cardiovascular training for 20 minutes - usually speed walking up the hills in her neighborhood. She takes the seventh day off.
"If you're a busy person, eating six times a day is no small task," she said. "I was hesitant to do that at first because I thought I would gain weight. But the more frequently I ate, the more quickly I lost."
The reason is that eating small portions of healthy food throughout the day boosts some people's metabolism, said Shawn Talbott, associate clinical professor in the Division of Nutrition at the University of Utah.
"It's something that athletes have been doing for a long time, and it also works well for people who want to lose weight," he said. "If you're eating several times throughout the day, you generally don't get very hungry between meals, so you don't overeat. It's a very effective way of regulating caloric intake. And, metabolically speaking, your body handles smaller doses of calories better than large doses."
Jones said she was motivated to stick to her new eating and exercising patterns in part by a $100,000 prize sponsored by Body for Life, which she won in 2000 for transforming her physique in 12 weeks.
"The biggest mistake people make is they starve themselves and then they overeat," Jones said. "Changing your body takes planning. It's not always convenient, but it's doable."
Prevention also is key, said Larsen of the health department.
"We need to address the cultural and environmental factors that promote obesity," Larsen said. "We need support at schools, worksites and communities or this huge problem will get worse."
THE STATE OF WEIGHT
* There was a time, not so long ago, when a little extra weight made people look comfortable, even prosperous. Not anymore. People from all walks of life are looking in the mirror and wondering if that extra weight has or will become obesity, and if so, what to do? Diet? Exercise? Drugs? Herbal supplements? Surgery? Or some combination?
* Today, The Tribune begins an occasional series focusing on Utahns who have fought, and in some cases won, the battle with obesity. We'll look at what obesity actually is, its probable causes and remedies, how Utahns think about food, how we can become fit, and what businesses, government and researchers are doing - or aren't doing - to help us out.
* Then on Tuesday, The Tribune's Health & Science section will examine stomach reduction surgery for the morbidly obese.