Big as Life

His stories unfurl one after another, summoning a vivid world to a room with a large bed.

The other theme in them is his former physical prowess. Scores he settled, challenges he won. Some are impossible to check because they happened long ago -- breaking a bully's leg at the Police Athletic League, getting fired from McDonald's for punching a manager who insulted him, getting kicked out of ninth grade for throwing a punch at a gym teacher who, he says, attacked him after losing a wrestling match. He never went back to school.

He learned martial arts and gave classes. His friend Donna Gause, mother of a former roommate, confirms how, in a Wendy's, Keitz threatened the father of her teenage daughter for hassling the girl. Customers scattered, and the man locked himself in the bathroom.

"He sees himself as a bit of a local avenger," says his friend Mike Schilling, 37, an assistant store leader for Royal Farms. "He's what you call righteous. He believes absolutely in what he does, even if not everybody believes it's the right thing to do."

Keitz was a big talker always with big plans. As his wife would say, "He's good at making plans, lousy at follow-through."

To his spellbound friends, it hardly mattered. "My life would be a whole lot more boring if I didn't know him," Schilling says. "He's magnetic, he's entertaining. . . . If you're standing next to him in the bed or something, you don't know if he'll try to give you a giant bear hug or sock you one."

Battle of the Bulge

Over the years, Keitz says, he tried to lose weight. When he was in the fourth grade, his parents took him to a dietitian, who put him on a 2,000-calorie diet. Keitz recalls losing 40 pounds -- then gaining steadily: 200 pounds at 16, 250 at 18, 300 at 26, 500 at 31.

"I've been on grapefruit diets, rice diets, popcorn diets, I took diet pills, liquid diets, Slim-Fast, Weight Watchers," he says. He lost 25 pounds with Weight Watchers, he says, but it didn't stay off.

He wasn't a dieter who agonized over failure. He came to believe his metabolism was different. From his family doctor he didn't get much advice beyond eat less and exercise. After his early twenties, he stopped following any specific diet beyond watching calories.

"I figured, well, if I'm eating good and I'm still like this, it's how I'm to be," Keitz says.

His definition of "eating good" was somewhat expansive. He would argue that a hot dog from 7-Eleven is okay if the day's calorie count has room. He liked his junk food -- ice cream -- yet he was a regular at the Wendy's salad bar. And he insists he wasn't consuming many more calories than the people around him. This is hard to believe, coming from a 625-pound man, but friends back him up, to a point.

"He wouldn't eat any more than I would," says Gause's son, Andy, 30, Keitz's roommate, first in an apartment, then in a Super 8 motel where Andy was night manager and had a free room. They ate a lot of takeout. Keitz would do one-armed push-ups with Andy on his back.

"I never saw him go too much beyond what the rest of us were all eating," says Schilling, part of a group of buddies with whom Keitz used to eat pizza or burgers in an all-night diner until nearly dawn, talking about sports and science fiction.

"I never seen him overindulge -- but he did eat more often," says Keitz's nephew Jeff McLaughlin, 31, a pallet builder for a trucking company. "An hour after dinner, he'd have a bag of chips, some ice cream."

At 26, Keitz got the first dramatic warning that his weight was curtailing his life. On the job at the bowling alley, his knees gave out. Doctors diagnosed severe arthritis. He stopped working regularly and began receiving disability checks.

"It was horrifying," Keitz says. "You try to overcome your fear but sometimes your fear don't let you overcome it."

Keitz's fear was of what he might find if he directly confronted his weight: that this was one fight he couldn't win.

He tried exercises to build strength, but ultimately resigned himself to his fate.

"When the knees go, the back starts acting up and the arms go, you just give up," he says. "You go, 'That's what I'm dealt with.' . . . I tried all the exercises, I tried all that. You can only do what your body wants you to do."

Accepting his size and decreasing mobility, he defied the rest of the world to do likewise: "If they couldn't accept me for me, [expletive] them."

But as his friends watched him get larger, some saw signs of disaster.

"He stopped moving around as much and started gaining weight," says Andy Gause. "I told him, 'You gotta start moving more.' He didn't pay attention."

After Keitz went down, his father died. On the way to the cemetery, the hearse took a detour to pause outside Keitz's second-story apartment. He pulled himself up to the windowsill to look out and say goodbye to his dad.

Tipping the Scales

About two-thirds of American adults are overweight, according to the Centers for Disease Control and Prevention. One-third of American adults are obese, and almost 5 percent are severely obese.

Are you fat?

Researchers use the body mass index to tell: Divide your weight in pounds by your height in inches squared. Multiply the result by 704.5.

An index of less than 18.5 is underweight; 18.5 to 24.9 is normal; 25 to 29.9 is overweight; 30 to 39.9 is obese; 40 or more is severely obese.

At 5 feet 10 and 625 pounds, Keitz has an index of 89.9.

Many scientists, doctors and health insurance executives are coming around to the conviction that obesity is a disease. Even the IRS has ruled that obesity is a disease, allowing some deductions for treatment.

If so, it is a disease with personal responsibility attached. Advocates for obese people say health care is replete with analogous conditions -- gum disease brought on by poor dental hygiene; skin cancer following too much tanning -- yet obesity is unique in how much blame fat people get. "Once you take off this moral interpretation, it is a dysfunction of the body and an abnormal physiological state," says Morgan Downey, executive director of the American Obesity Association in Washington.

Researchers are still teasing out all the factors involved, including genetics, metabolism, hormones and social influences.

Keitz has never been diagnosed with any obvious condition that would cause his obesity. Researchers say it is difficult to identify specific causes in a given individual, but they are gaining an understanding of the mechanics at work.

"There are very powerful brain signals dedicated to keeping you alive," says internist Arthur Frank, medical director of the George Washington University Weight Management Program. "The balance is sometimes distorted in individuals. They get very strong eating signals and not very well-coordinated stop signals. . . . You've got to be respectful of the complexity with dealing with it."

Once a person starts overeating, research suggests, his body chemistry may change to make shedding pounds extremely difficult, says Louis J. Aronne, professor at Weill Medical College of Cornell University and president of the North American Association for the Study of Obesity, based in Silver Spring.

The pounds add up. Aronne, who has never met Keitz, does a quick calculation.

Since Keitz was 18 and 250 pounds, he has gained 375 pounds, or 1,312,500 calories. That's 62,500 calories per year, or 171 per day.

Just 171 calories a day?

That's roughly equivalent to going to McDonald's and ordering a double cheeseburger (460 calories) instead of a cheeseburger (310). Or a quarter pounder (420) instead of a hamburger (260). Or large fries (520) instead of medium fries (350). Or a large Coke (32 ounces, 310 calories) instead of a small Coke (16 ounces, 150 calories).

Before you know it, you are supersized.

Off to Wilmington

The bed is Keitz's office, living room, kitchen, flying carpet. His world.

Four days after the chicken dinner, on May 23, it is taken away.

The county constable and the lawyer for the landlords show up before noon. Keitz, his wife and sister are being evicted. The battered three-bedroom rowhouse in Dundalk is Keitz's boyhood home, but after his father died, it was bought by a niece of Keitz's and her husband. Keitz signed a lease for $325 in rent.

"The landlord didn't want to renew the lease," says the lawyer, Alfred Brennan Jr., in a brief sidewalk interview. "They sent the letter giving the proper notice to get out. . . . It's nice that they're family, but still."

Brennan says the couple want to fix up the property, which they can't do while Keitz is ensconced there. The lawyer did not respond to later requests for more information, and the landlords did not respond to a letter sent to Brennan's office.

A judge signed the eviction order two weeks earlier. The Baltimore County Department of Social Services provided a housing voucher to cover part of the rent in another apartment. But neither a social worker nor the Keitzes could find another place that the family could afford and that could accommodate a 625-pound man.

The Keitzes never believed this moment would come. They are not packed. They have no place to go.

Keitz is raging unprintably on his bed. He works the phone in desperation. He calls a documentary maker in Delaware who recently interviewed him on obesity. The documentarian, Joe Piner, finds an apartment in Wilmington. He says the landlord says it's suitable.

Social Services comes up with $1,200 for a special ambulance to move Keitz, plus $1,025 for two men to help take the family's belongings to storage. Keitz's bed is a rental, so he cannot keep it.

Six strong men from East Coast Ambulance arrive; the company has invested in a special ambulance for obese people because it is a growing market. Some don purple rubber gloves for the job.

An aquarium sling is unnecessary this time; the crew has a yellow rubber tarp. Gina can't bear to look as John says, "Let's do it," and they count "one-two-three!" and hoist him into the ambulance.

In Wilmington, the media circus is waiting, tipped off by Piner, who appealed to the public for help. Cameras poke into the ambulance. A crowd surrounds it. Children jump up to peer in the rear window: "Where's the fat man?"

But the apartment isn't ready. It is locked. It has no electricity. There's no bed. Piner is flummoxed, and Keitz is worried. The purple-gloved ambulance crew is livid: They have a fat man in their custody and no place to put him.

One asks a television cameraman for the address of the nearest hospital.

Gina and Jessie -- left behind in Dundalk to finish packing -- don't make it to St. Francis Hospital until the next morning. Catching a ride, they arrive at the emergency room with soda, cereal, cans of Chef Boyardee, $41 in bills and $83 in quarters.

When John sees his wife, tears come to his eyes. She hugs him. He apologizes to her. Their life together wasn't supposed to be like this.

Big Love

They met via a telephone dating service.

John, divorced after a two-year marriage, placed a voice-mail ad looking for a friend, nothing more. He went to church and prayed for the right woman to come his way. When he checked his responses, there was Gina's voice.

She lived in Ellicott City, he in Dundalk. Neither one drove, so they courted by phone. In one of their first conversations, they played favorite songs for each other. Gina put on "Kiss You All Over." John started laughing. He had the same song cued up.

They started talking Aug. 12, 1997. He proposed marriage over the phone Sept. 3 -- before they met in person. She said yes. A few days later, he surprised her in the parking lot of the Subway in Catonsville where she worked.

"I gave him a hug and I didn't want to let go," Gina says. "Hugging him was like hugging a big old teddy bear. It felt very safe."

Once they met, Gina feared John would change his mind about marriage. "I'm just the girl next door," she says. "I was never most-likely-to-anything or one of those stunning beauty queens."

John felt no doubt about his feelings for Gina -- he believed she had been sent by God. Nor did he feel any self-consciousness about his size: He had been frank over the phone.

"I weighed what -- about five?" he asks.

"Yup," says Gina. "We both knew neither one of us was built small."

"What's the sense of judging people by looks?" says John.

They married in December and moved into the Super 8. Andy Gause, their night manager friend, slept during the day in the free room, and John and Gina slept during the night. After Gause lost the job, they began paying $31.50 a night, then found the Essex apartment.

The night they moved in, John, tired from walking up the stairs, began making their first dinner in the new place: macaroni and Velveeta. That's when he went down.

They weren't alarmed. By then, John sometimes walked with a cane, and some days he had trouble getting up out of bed.

"He didn't seem too worried at that, and if he doesn't worry, I don't worry," Gina says. "He doesn't like to admit he needs help."

"Typical fat man: I can do it on my own," John says. "Once you get past the hump to where you see you literally need help, it's too late."

But one month became 12, and one year became seven. The Keitzes' life rearranged itself to make room for a big man in a bed.

Mini-crises monopolized their energy. Deaths in the family. The move to Dundalk. Unpaid bills. Hospitalizations. The family feud over the house.

"It never was a kick in the stomach or a light bulb, that this could last a while," says Gina. "It was just running from job to job and trying to take care of life."

Gina worked all day at Waldenbooks, then clocked in at a Wendy's until 1 a.m. When she got home, John would have dinner waiting -- eggs, chipped beef and gravy -- made while he lay on their mattress on the floor.

For the first time, John began asking for help. He received stints of in-home physical therapy designed to get him up. He says the sessions always ended after the therapists concluded he had "plateaued," a judgment he disputes.

"He was doing as much as he thought he could do to modify his lifestyle," says his doctor for the past year, Jennifer Hayashi, with the Johns Hopkins Elder House Call program. Keitz says he did not ask Hayashi to arrange more physical therapy because he was too busy fighting eviction.

He also played video games and watched television -- he liked wrestling and cooking shows.

The longer he stayed in bed, the more likely it became he would never get up again. Building strength is difficult when you can barely move -- daunting when getting to a therapy center requires an ambulance that costs hundreds per trip.

"Most people don't have a bed-bound spouse until they're in their fifties or sixties," Gina says. "I was not quite 32 when he went down. . . . Taking care of him, it's like my life has come to a standstill. Everything revolves around him."

John knows. He can barely find the words to thank her. When the pharmacy delivers his medications, he has it also bring Beanie Babies or teddy bears, favorites of Gina. During her shift at Wendy's, he had a pizza delivered to her with pepperoni slices arranged in a heart and olives spelling "I Love You."

John would talk about what he would do when he got on his feet again, but gradually people began to take his condition for granted. He became another neighborhood character. Children passing by the open door would call out, "Hi, Mr. John." They might stop in to play chess or learn martial arts pressure points. John would baby-sit for neighbors.

"I just accepted him being in bed," says Donna Gause. "I didn't want to get used to it, but I got used to it."

"After a time, his being stuck in there became as natural as the sun rising," says Schilling.

Physical Promise

The hospital in Wilmington manages to find something that eluded Keitz, his doctors and social workers for years: a nursing home that specializes in heavy people. Medicare and Medicaid pay roughly $313 a day for this type care.

On May 24, the ambulance arrives at Genesis Knollwood Manor in Millersville, northwest of Annapolis, after the kitchen has closed. Keitz sends Gina out for a Burger King Whopper, large fries, Diet Coke and a salad from 7-Eleven.

His occupational therapist is Kathy Brown and his physical therapist is Barbara Lowndes. Keitz immediately strikes up a jocular, almost flirtatious rapport. This is the big personality he has learned to project from his bed.

Loretta Douglas, director of nursing, steps into the room.

"Your staff is so great," Keitz says.

"The worst is yet to come," Douglas teases.

"When I'm on my feet, you and I are going dancing," he says. "I'm taking you all dancing!"

The doctor at the nursing home says he may be a candidate for gastric bypass surgery, where the stomach is reduced. Previous doctors had told him he was too heavy for it. The thought makes Keitz nervous. He'll mull it over. For now he's on a low-carb diet to get his diabetes under control. Douglas says that soon they'll discuss a more restrictive diet to lose weight.

Brown and Lowndes have him doing arm and leg exercises every day, and they say he is progressing better than expected.

"You're going to make us look good," Brown says.

Keitz's face lights up when the women arrive for a morning workout. The fear is still with him -- "I may never walk again," the big man frets one day -- but for the first time he imagines he has capable allies.

After a week, the goal becomes more ambitious: The therapists want Keitz to sit up. The last time he sat up was nearly three years ago.

To psych himself up, he selects a thumping dance tune, puts on headphones and turns up the volume.

He does the old one-two-three! and heaves himself crossways on the bed. This takes several minutes, with long pauses. He is panting, sweating. He tells the women he's dizzy.

He is still on his front. One-two-three! and he rolls to his back. His great belly rises like an angry red mountain. It maintains its flattened face-down shape: Fluid has pooled in the tissue, making it rigid but impressionable to the touch, like wet cement.

Brown props up the belly with both arms so it doesn't topple Keitz over.

Lowndes must rotate his left leg so the knee will be turned up, ready for a sitting position. This leg has atrophied because it has been immobile as he's lain for years tilted left to make room for his stomach.

Keitz grunts and strains and hauls himself to a sitting position, his legs dangling over the side of the bed.

He looks stunned. His eyes are wide and bugging out. He is seeing the world upright!

"Hi," he says in a small voice.

Then: "I'm going down."

He flops back.

"That was a huge accomplishment!" Brown declares.

Technically, it wasn't a complete sit. The women were holding him upright. And his right buttock was slightly elevated from the bed. His body is lopsided from so many years on his front side.

But the day after that, he does a complete sit. Another day he sits for two minutes.

The milestones make John proud and Gina teary-eyed.

The coming days bring more fitful progress. Some days Keitz can't attempt a sit, because he keeps pulling back muscles that haven't been used in years.

"I want it to be known I'm not giving up," Keitz says, after a difficult day.

"You're such a hard worker, it's really good," Brown says.

Brown predicts it will take a couple of months for Keitz to be able to scoot into a wheelchair.

The progress gives Keitz the first concrete hope in years that leaving his bed is a possibility.

Still, Brown cautions, "Walking is a year down the road."

Plans for a Victory Dinner

Keitz passes his 39th birthday in Knollwood.

Gina's card says: "We are not in the best of circumstances, but at least we are together. I love you!"

Jessie draws a $20 bill and writes "Ha-Ha. God loves you."

Gina and Jessie remain homeless, sleeping on couches of friends or family, while Keitz and a social worker continue to call landlords in search of an apartment.

He is leaning against surgery. He'd have to undergo a drastic version of the procedure and would face severe diet restrictions afterward. "Them telling me I can't have fried fish or fried chicken is telling me they can't have my stomach," he says.

He says he'll focus on physical therapy.

He dreams the dream again, the one where he is cooking in the kitchen and refusing anyone's help.

He recites the menu in detail.

"Let's see, I made a shrimp salad, steamed shrimp, grilled shrimp, shrimp dip, shrimp scampi . . . crab cakes, crab puffs, crab dip, crab soup . . . barbecued chicken, baked chicken, fried chicken, chicken soup . . ."

Gina looks at him and says, "It sounds like you made too damn much food."

" . . . chicken salad, egg salad, potato salad, macaroni salad . . . roast beef, barbecued beef, beef and gravy . . . pork roast, spare ribs . . . brownies, chocolate cake, spice cake, cupcakes. . . . plus I had two full kegs of beer."

John thinks the banquet was a fundraiser, because there was a large fish tank filled with cash.

He thinks it must be a fundraiser for a nonprofit he hopes to start, to provide services for obese people. Beds for the evicted, therapy for the bed-bound, a restaurant with healthy recipes.

It's a project for when he gets on his feet.

In the dream, says John, "a number of people were saying, 'It's good to see you up on your feet.'

"And I was saying, 'Get the hell out of the kitchen before I kick you out!' "

Staff researcher Bobbye Pratt contributed to this report.

A gallery of photographs by The Post's Carol Guzy can be viewed http://www.washingtonpost.com/photo.