The Weight

He dealt with his size the best he could, by preserving friendships, helping out a few people and finding the most flattering clothes he could -- plenty of baggy pants and loose-fitting polo shirts. He was generally too big to sit in a booth in a restaurant without feeling painfully pinched. It was easier not to go anywhere, if possible. When he arrived home from his job as a sales manager for a company that franchises home inspection systems, his weight -- and its toll on his heart, lungs and the rest of his body -- left him exhausted. There were nights when he could not bring himself to rise from the couch. It was all he could do to recline there, watching TV, sating himself with, say, a bag of Doritos or a large pizza.

Hollis grew up in Booneville, Miss., in the state's northeast corner, where his paternal grandparents raised hogs and cattle, among other things. His father owned a plumbing business, and his mother worked in a shirt factory. Nobody in the family became rich, but meat and other food were plentiful. Neither Hollis nor his younger sister, Myra, went off to school before their petite mother, Jelena, fed them sausage, eggs, biscuits and gravy. "Fat and good ol' lard was a way of life," Hollis remembers. "You'd go to the store and buy tubs of lard -- one- or two-gallon size . . . And I grew up with my mother's foods -- lots of fats, lots of sugar -- like a lot of people in this state. She did the best with what she knew, and she cooked what had been taught to her. I knew I was putting it on. I felt obese by the time I was a fourth grader or so, and then you never stop feeling that way. Always on guard."

His father died when he was 12, and thereafter the central event of his life was a Sunday afternoon dinner each week at the home of his paternal grandfather. A widower who, as Hollis recalls, "kind of lived to please us with food," his grandfather involved the women of the family in the preparation of feasts that became standard fare in Hollis's childhood -- platters of fried chicken, fried pork chops, pot roast, mashed potatoes and gravy, plus green beans and lima beans cooked in bacon fat, oil and sugar. A typical summer weekday at his grandfather's would likely include pork chops, steak, bologna sandwiches with mayonnaise, and more mashed potatoes and gravy made with the fat juices from sausages cooked at breakfast. "We ate until we were miserable," he says. "That's what you called it here: eating till you were miserable. Ate until you hurt. You thought that was a good thing. It was pleasure, satisfaction, a full stomach."

He weighed 275 in high school, climbing toward 300. Before graduating from the University of Mississippi in Oxford, he had worked at a Kentucky Fried Chicken franchise for four years, the last two as a manager -- taking almost all his meals there, six days a week, and gaining more than 50 pounds. "Maybe I kind of gave up for a while," he says. "You focus on trying to spare yourself embarrassment. It becomes the most important task in your life."

But, as hard as he tried, some indignities couldn't be avoided. "The most humiliating experience always has been going on a plane and struggling to get in a seat belt," he says. "After a while, I knew I couldn't do it anymore. One day a flight attendant brought me what they call an extender -- a seat extender -- and after that, anytime I got on a flight, the first thing I did was get that extender. I'd get it and think, 'One less possibly humiliating thing to worry about.' You're so grateful. But the possibility of the next embarrassment is never far from your mind."

Pasty-looking, feeling a troubling numbness in his left arm, suffering at once from sleep apnea, high blood pressure and soaring blood sugar levels that had left him diabetic, he went to the doctor in the fall of 2002. "I told him that he couldn't continue to eat and drink as he did and expect to stay alive, that the strain on his heart couldn't handle it," recalls Tom Glasgow, Hollis's physician. "If he was going to live, he was going to have to change. It really was a life-or-death issue for him."

Talk of death got Hollis's attention like nothing else ever had. His sister Myra, with whom he had bought a house, encouraged him to attend a gym run by the local Baptist Memorial Hospital and to accept a radical change in his diet, to turn over the preparation of all meals to her, then strictly adhere to whatever she fixed for the next six months. For 90 days, Hollis's breakfasts consisted of nothing but oatmeal with a dab of sweetener. Fried foods were history. He had small low-cal sandwiches for lunch. For dinner, Myra served baked chicken, baked pork chops, baked salmon or baked tilapia. "I did everything she told me I had to do, and she never let up," he says. "I got tired of the word 'baked' sometimes. But I ate it. I could still hear my doctor's words."

At the gym, he started by walking on a treadmill for 15 minutes. Within months, he had graduated to long walks on the treadmill and then joined his sister in hour-long "spin" classes on a stationary bicycle. Four days a week, he awoke at 4:30 a.m. for a combination of spin and step-aerobic classes, part of a 10-workouts-a-week schedule that has included weight sessions with a personal trainer. "Hollis realized that there were no shortcuts," says Melinda Valliant, who oversees his conditioning at Baptist Memorial. "You have some people who think they'll do it with one kind of change -- like dietary. They hear things on TV, and they think they see shortcuts. Everything is about shortcuts and convenience, right? But you need lifestyle changes, you need dietary changes, you need a devotion to exercise. Nothing radical, just healthy and sensible. It's a message that doesn't go out much, but Hollis got it."

What startled Hollis was just how quickly the weight came off. By early last year, aboard a plane with Myra, headed for a vacation in New York, he dared to try what had been the unthinkable only a few months earlier. "I decided to do without the seat extender and just try to buckle the seat belt," he remembers. "It was snug, but it buckled. Pretty easily. It was the happiest moment I'd had in a long time. I just looked at my sister and said, 'Just us two skinny people flying to New York.' "

He has lost 116 pounds since getting the ultimatum from his doctor a year and a half ago. Still, he is unsatisfied. "If you look at my [body mass index], I'm still obese," he says. That frustration sometimes raises red flags for those who care about him. "I don't want him to get discouraged," Valliant says. "Because if you get discouraged, that's when you're most vulnerable to the temptations out there. And there're a lot of temptations."

Hollis couldn't agree more. He mutes his television during commercials so he can't hear the tempting voices. "I don't need hearing about Boston Market or Mrs. Smith's pies, you know?" he says. "I'd love to go down the street and get a Big Mac, but I know I can't, and I don't need some voice getting into my head. The place is heaven, but it's hell, and those salads of theirs wouldn't do a thing for me but get me thinkin' about what else I could have there."

TO LOOK AT DERRICK DENNIS is to wonder if he might be a future Hollis Green. Derrick has a mass body index of more than 50, which, as one pained doctor put it, "is off-the-charts bad." Encouraged by doctors to lose 10 pounds earlier this year, Derrick gained 10 instead. His cholesterol shot up. His blood sugar rose, making him a superb candidate to acquire Type 2 diabetes. Meanwhile, his diet has not changed. He likes, among other things, fried catfish, pepperoni pizza, tater tots with cheese, mashed potatoes with cheese, dessert before entrees, french fries before meat, root beer before milk, any kind of ice cream, large cheeseburgers, and fried "popcorn chicken" from Sonic fast-food restaurant. He often complains of feeling tired. He stands about 4 feet 4 and weighs roughly 193 pounds. He is 8 years old.

He draws pictures of his friends in his writing journal, where he sometimes portrays himself as having a larger head than his playmates do, this perception of his bigness already beginning to solidify. On many days, he is fatigued even before noon.

Generally when his teacher asks, during class discussion about current events, whether anyone wishes to "share" -- this an invitation for any student to tell the class about something he finds interesting -- Derrick resists; for part of sharing involves having to stand, a task that Derrick can manage only with extra time and strain. During recess soccer games, he generally stands immobile in the center of the field while children whirl around him.

Earlier this year, seated in a classroom desk designed for a child who weighs at least 100 pounds less and with legs, tummy and chest half of Derrick's size, his body looked as if it were snared in a vice. He tried to find relief by hooking his feet behind the back legs of the desk. He might have sat that way the entire school year had not his teacher, Maggie Mistilis, discerned his discomfort and had his desk raised, giving his legs and stomach more room.

One Saturday afternoon in spring, he sits in his family's two-bedroom trailer on the edge of Oxford, watching cartoons while his mother is shelling and frying shrimp. After the cartoons end, he'll turn to his video games, he says, and maybe play a little Rally-X. He seldom plays outside. He feels trapped inside sometimes, not an unusual feeling for an increasing number of American kids. The Dennises' neighborhood is rough, says Derrick's mother, Sandra. There are a few drug dealers believed to inhabit the streets, and neighbors have pit bulls and Rottweilers roaming freely. Derrick often stays indoors because Sandra can't be sure it is safe out there.

By the start of summer, Sandra wants to begin taking him on walks, to shed some of his weight and maybe take off a few pounds of her own, adding that size runs in the family. "We kind of like eating the same things," she says one day in a restaurant, as Derrick devours fries and a discus-size cheeseburger, downing it all with a root beer. "And high sugar is on both sides of our family. Derrick's uncle had diabetes, real bad sugar, and had to have a leg amputated. So I got real concerned back around the last doctor's appointment. But somebody in the family then gave Derrick a whole bunch of candy around Easter, and that weight and sugar went way up again."

She winces, her frustration palpable, and quells a yawn, saying it's been a long last few weeks. She works hard, cleaning houses in the morning, so she can be there for Derrick and her 15-year-old stepdaughter when they arrive home after school. Her days can be tough, but she always tries to have a good-size meal waiting. Determined to avoid the fast-food route, she generally prepares meals, her menu inevitably similar to what she ate herself as a child, her favorite foods now Derrrick's.

"I'm just hoping it will be cool soon, so we can walk," Sandra says after Derrick finishes his cheeseburger. "I know he doesn't get much exercise anywhere."

Derrick's teacher, Maggie Mistilis, has become involved, taking him on walks. "We don't have to say too much about it," Mistilis says of approaching Sandra about Derrick. "It's a hard subject, and you want to be kind and sensitive, of course. But Sandra and I are also friends, and she knows that I just want to help Derrick."

And Derrick knows the truth. "I'm heavy," he says.

He soaks a last fry in his ketchup, eats it and then rises, panting during a short walk to the car, where he turns and hugs an adult companion hard around the waist -- he is forever putting his arms around someone for a hug. He then advises his companion to roll up his windows and lock his car. He grins when the man says they can go to lunch again sometime. "Cheeseburgers," Derrick says excitedly.