This is the cost of it, David Baskin figures. He sits, not moving, in a broken-down motorized shopping cart in a Wal-Mart in Oxford, Miss., waiting for store employees to bring him one that works. He sits with his green oxygen tank alongside him in the cart and translucent tubes running into his nose. He is ambulatory, but not fit to walk more than a few steps. Can't walk 50 feet without panting so hard that he thinks he'll keel over. It scares him. At 52, he is an ill man who views his plight as a consequence in no small part of all his good eating over the years.
"Hush yer mouth," he says to a companion.
It is what the man known as Deke sometimes says in happier moments, particularly at a dinner table when somebody has just complimented him on a tasty meal he's fixed, tasty in no small part because the food is laden with fat -- Boston butt roasts and slabs of pork ribs and green beans cooked in ham fat. Damn, those beans are good, man, he reminds guests in his fast-talking way, just to make sure they don't miss out. Hush yer mouth means, among other things, that no praise is necessary; that the food is so superb that compliments are gratuitous; that it should just be eaten.
He once owned and managed a renowned barbecue joint in Oxford. But his ill health means he can't work full time any longer, and he closed the restaurant earlier this year so he could try to get well. He doesn't pity himself. Instead he regales guests with stories about his best days: "I had the best barbecue place around, and I still got the best sauces and dry seasoning. I'm barbecue in Oxford and the whole South. The others think they can do Deke, but only Deke can do Deke. Haaaaaaaa."
With the speed of his patter and that smart-alecky, rollicking laugh, he is a force of nature, blessed with a charisma that made him a man around town when he wrote a book about his recipes -- Deke's BBQ: Hush Yer Mouth -- and had a plate of ribs for whoever needed one. Now he limits himself to catering barbecue parties, selling his sauces and watching his favorite soap opera, "The Young and the Restless," each morning. He tells himself that he needs to get into better shape, lay off the munchies and drop some pounds. "But it's a hard thing, man," he tells people. Hard when the TV is always telling you about some great new fried chicken deal down the street or a cheeseburger to rival the Double Whopper -- hard when you've gone through your whole life tasting what Deke calls the "tasty taste" and not knowing or wanting any other taste but the tasty taste. It's a hush-yer-mouth world, he thinks. People just want the food, and don't want to be nagged about it. "It's powerful, it's like a narcotic, man," he says. "It's gotta be a tasty narcotic to get a man like this. Look at this."
This means all of this -- that oxygen tank, those tubes, but especially his girth. At 5 feet 9 and 296 pounds, Deke Baskin is "morbidly obese," a term reserved by health agencies for the most overweight adults, as defined by a subject's "body mass index" -- a term meant to indicate body fat, and a figure derived by using a formula that essentially divides weight by height. Deke Baskin's BMI is 43.7, on a scale where 25 to 29.9 is simply overweight for adults, 30 is obese and 40 morbidly obese. In what the Centers for Disease Control and Prevention characterizes as an epidemic, obesity has risen in all areas of the country over the past decade, but nowhere else is the problem as great as it is in Mississippi, where slightly more than one in four people are obese, according to CDC statistics.
Deke has had diabetes for 10 years, largely a consequence of his weight. He suffers from lupus and gout. He has a heart problem that landed him in the hospital a few months ago, when, he recalls, his doctors suggested to him that he couldn't expect to live many years longer unless he shed weight.
He has lost a few pounds since. Still he grants himself what he calls an occasional "cheat day" to indulge. "Maybe once a week or every 10 days; I'd go crazy if I didn't get some of my food," he admits. Just the same, he is trying to eat wisely, including staying away from fried foods, and earlier today sought to set an example for his overweight daughter, Marie Pomerlee, at a local restaurant. He eschewed his customary order of several slices of high-caloric, high-fat fried catfish in favor of a single broiled piece of catfish.
But, having eaten properly so far all day, he now feels a familiar pang. Comfortable at last in a functioning motorized cart, Deke cruises down Wal-Mart's aisles, staring up at food for the taking, limitless food. "Look at all this," he says, audibly humming, pointing at packages, marveling at their size.
Ahead of him, his wife, Stella, is picking up items for a big weekend dinner, with an emphasis on healthy items -- lettuce, tomatoes, carrots, bell peppers, cabbage and red cabbage. In the meat department, Deke passes a container with several packages labeled "Pork Shoulder Boston Butt Roast." He points and grins. "That's what we're having tomorrow. Delicious."
The butt roast has 250 calories per serving, with 180 calories from fat, which amounts to 20 grams. It has been one of Deke's staples for three decades of adulthood, after a poor childhood in which he commonly devoured cheap neck bones high in fat and biscuits soaked in a gravy fattier still -- the residue of bacon and ham fat. He cruises down the sugar aisle, where he thinks of the baked beans he wants to serve with the weekend barbecue feast. His cart comes to a sudden halt, and he reaches up to grab a two-pound bag of Domino dark brown sugar. "You cannot possibly put too much brown sugar in baked beans," he says.
The cart resumes moving. "I've been real good today," he says. He passes the cookie and cracker section, and the candy section, where, out of his sight, Marie has picked up a few Hershey bars.
"I've been real good today," he repeats, selling himself on the idea.
He slowly cruises alongside a rack of Frito-Lay snacks, which has been set off from the long shelves and aisles to call greater attention to it. The cart slows to a stop. Stella is walking ahead of him, inspecting shelves. Deke looks up at a bag of Cheetos Crunchy, a cheese-flavored snack of bite-size munchies. It is a regular-size bag, which is to say a big bag, and relatively cheap, as most snack food is, making it affordable to virtually any consumer -- $2.49 for a bag that is larger than half a pound and yields 10 servings. One serving alone -- which consists of 21 pieces -- has 10 grams of fat in it, and 90 fat calories. Devour half a bag at a sitting, which is not unusual for Deke, and you have consumed 50 grams of fat and 450 fat calories. "Dangerously cheesy," the label boasts.
Deke looks around, slightly lifting himself from the cart. His right hand shoots out, grabs.
"Had to have that," he says softly.
EVEN IF YOU HAD JUST AWAKENED from a 40-year sleep in America and never saw a page of a dietitian's study, never heard a single statistic, you would sense the truth the moment you looked outside and saw a passing throng. You wouldn't need to go to Mississippi for that. Just a glance at Americans anywhere would tell you that something has gone awry, that too many bodies put on substantial weight in those intervening years. There is more of a waddle to our walks. There are more people profusely sweating and breathing hard, while carrying double-fisted sugary drinks from convenience marts. Big Gulpers, indeed.
This crisis sneaked up on us. Three decades of hoopla about the fitness craze in America obscured the reality that health clubs are generally frequented by an elite minority. Two-thirds of Americans are overweight, with about 30 percent obese, according to the CDC. Although the weight problem is greatest in the South, no region or group of people is exempt. While Mississippi's obesity rate is 26 percent, Virginia, Maryland and the District of Columbia, all three at around 20 percent, are plagued by the problem, too. And national health officials believe that many state figures are underreported, suggesting that obesity rates everywhere are higher.
We are a conflicted people in a contradictory land. We are enthralled with the Atkins and South Beach diets, only to be enchanted like children when television offers the latest wizardry, such as a Taco Bell ad in which a taco-munching man is catapulted off his lawn mower and the voice-over promises viewers: "You'll be floored by flavor." We are alternately shamed into sweating and seduced into slurping and munching.
During hours outside prime time, when TV audiences are small, we receive advertising tips from aging celebrities, such as Christie Brinkley and Chuck Norris, on how best to use machines to do crunches and tighten backsides. Encouragement for those with fantasies of a luminous body and life is never in short supply. When Deke Baskin sits down to watch "The Young and the Restless," the weight-loss ads make him fleetingly ponder the possibilities, but then the chain restaurants' images of their latest dishes evoke his lust.
"There is this chain place called Church's Chicken down here that just makes me gotta have their fried chicken," Deke says. "The world's hard, you know, man? Stressful. And then somebody says, 'This food is gonna make you feel good, and it tastes so good, and everybody's tryin' it. Why aren't you tryin' it? Gotta try it.' And you can try it, you know? You can't do that with some things. It costs a lot, too much, to get some things, you know, like a new house, new car, vacations. But you can get food. You can get all the Church's fried chicken you want."
However, he adds, "not many people are gonna work it off."
In fact, national data makes clear that fewer young children are playing sports or even frolicking outside, and fewer adults are strolling to the corner market or anywhere else.
Meanwhile, the demands of jobs and fewer free hours are enticing the weary to skip the preparation of meals in favor of picking up fast-food or dining out at places where big servings are the norm. It is a ritual now to be greeted this way: "What may I get you for starters?" The emphasis on and expansion of appetizers -- and desserts -- mean that the multi-course experience is no longer regarded as a feast worthy of a bacchanal; it's just an ordinary night out. Go to virtually any chain eatery, and it's hard not to marvel at the huge food portions and jumbo soft drinks.
Even so, Americans' collective affluence means that we eat for less than we once did, actually. You don't become an obese nation unless food is a relative bargain. Meals consume about 10 percent of the average American family's income, about half of what food cost (adjusted for inflation) in the 1950s, according to public and private researchers. At the Wal-Mart where Deke Baskin shops, customers regularly come across a sign reading, "100 Piece Fried Chicken -- 25 Breasts, 25 thighs, 25 legs, 25 wings -- $54.83."
Limitless food and sedentary lives coupled to produce obesity's explosion. From 1960 to 2000, according to the National Institutes of Health, the percentage of obese American adults under age 75 more than doubled, jumping about 8 percent in the 1990s alone. About 15 percent of children from 6-year-olds through teens are overweight, up from 5 percent two decades ago, while the risk that such children will become overweight adults is a dispiriting 80 percent.
In March, the Journal of the American Medical Association reported that poor diet and inactivity will likely surpass tobacco as the leading cause of preventable death by mid-decade. Diabetes has risen about 50 percent in 20 years to afflict 4.2 percent of the population, according to the CDC, and researchers see ties between excess fat and high blood sugar levels. Surges in weight have led to heightened risk for stroke, heart disease, hypertension, several cancers, infertility and osteoarthritis.
Not surprisingly, the poor are most vulnerable, particularly impoverished African Americans, according to studies conducted by the Center on Hunger and Poverty. But there are limits to how closely class or race can be associated with obesity. Poverty and plenty each invite risks. William Dietz, the CDC's leading authority on the subject, says that, while a report from the National Center for Health Statistics shows that African American women have the highest rate of obesity at about 50 percent, another highly susceptible group is white men. A larger percentage of white males than African American males are classified as "overweight," but a lesser percentage of white men are categorized as "obese."
Unquestionably, experts agree, the role of food in a regional or ethnic culture plays a major role in obesity's reach.
Deke Baskin knows the subject like the barbecue master knows his sauces. And his candor echoes the assessments of academicians studying diet and American culture. "Down here, in the South, we grew up around cheap and fat food and, if you were lucky, sometimes barbecue," he says. "Didn't matter if you were black or white. We grew up around a lot of that stuff if we had money, and we grew up around a lot of that stuff if we didn't. And it went places with you -- to friend's homes, to churches. You know, it was soul food, besides everything else. And it didn't matter if we were gonna get our hands on some money someday. We weren't gonna give up the food -- not when it tastes that good and there was that much of it."
The consequence of that ravenous appetite ripples across Mississippi, where the diabetes rate is more than double the national average, at 9 percent, according to a state study. "If you want to know about obesity, you got to eat the food in Mississippi," Deke says. "It's powerful stuff. And it's gonna be no easier to get the young off it than the old, because good is good. It's hush-yer-mouth stuff. Throw in our fast-food places, and you got a problem."
DEKE WORRIES ABOUT HIS 35-YEAR-OLD DAUGHTER, Marie Pomerlee, who stands 5 feet 5 but weighs more than 300 pounds. She teaches pre-kindergarten at Bramlett Elementary School in Oxford. On a warm May afternoon, after her students have gone home for the day, she slowly escorts a visitor about 150 feet down a hallway to her classroom, softly panting halfway there, out of breath by the time she reaches her desk. She fans herself with index cards.
Her parents split up when she was a little girl. She didn't grow up with Deke, but Marie is, in every way, her father's daughter. She has his entertainer's charm. Has the same robust laugh that makes a listener feel he's in on an intimate joke. Has the same rat-a-tat-tat speech pattern, the words coming so fast a listener has to lean forward to catch them. She does not hang her head or dodge truths; she realizes she has a problem. "I just feel stuck by my urge for it," she says. "It's the most powerful thing there is, food is. I want to lose weight, and I start, but something always comes along, and then I want these foods -- hamburgers, fried catfish. The tasty taste. So I go along with it. I get depressed about it sometimes, I pray about it sometimes, but there's no way to get away from it here, so I go back to eating and work things out for myself and move on. I know how to do it. I know how to live, how to get things for myself so I look presentable. Like this."
She fingers her skirt. It is long and gray and on the elegant side, with a little mesh. "Big, huh?" she casually says. She is a size "24-plus," as she puts it. Her blouse is black and hangs loosely, in a kind of muumuu. She has plans to wear a resplendent pink blouse and pants tomorrow, when she'll lunch with her father and other family members at a favorite Oxford restaurant. "The world sells to the overweight more all the time," she says, "because there're more and more people in the same situation. Maybe it'd be different if I couldn't find clothes, but I can."
Another thing Marie can find easily enough is snacks. She has a little blue Wal-Mart sack in her bedroom closet that she keeps stocked with candy. Hershey almond bars. Peanut M&M's. Mr. Goodbars. Reese's cups. Snickers bars. She developed a taste for sweets early, because sweets were cheap, she says. She weighed 170 pounds before she got out of high school.
When she looks out the back of her house, she can see the Kroger store, no more than a minute away, and she knows the store is loaded with goodies. On evenings when her husband, Gerry, heads there to shop and asks if he can bring her home a treat, she typically answers, "Yeah, get me two of those," those meaning candy bars, whatever he sees; he knows what she likes and how to fill that small sack.
Gerry dotes on her. He is a mechanic and part-time minister who is lean, fit and has loved his wife through all her expansions, during which she has put on about 100 pounds, she imagines. "He doesn't pressure me about anything, and he always tries to make me happy," Marie explains, shrugging. "Gets me presents. He got me a treadmill. No pressure with it. Just got it if I wanted to use it."
She hasn't used the treadmill much. She lost 30 pounds once in high school, around the same time doctors diagnosed her high blood pressure. And, a couple of years ago, she lost a little by walking in a local park for three months. But her knees hurt so much that she became discouraged, and the weight came back with a vengeance after she stopped.
The demands of her four children -- 2-year-old triplets and a 9-year-old son, Kenny -- generally leave her exhausted and sometimes stressed by the end of a workday that begins at about 7 a.m., when she arrives at school to prepare for her class. "Sometimes I think, 'I should go . . . and buy something really healthy for my babies, and fix it,' " she says. "But you would need to park, and somehow get all the kids in the store, and keep them together and keep them from screaming, and you're tired and breathing hard and getting more tired. I know I shouldn't say it, but it's easier sometimes to just give them a broken-off bit of Butterfingers. Or some cakes, chips, a lollypop, a cheap fruit juice."
Sometimes she'll look out her back window, past the Kroger store, and realize that McDonald's, Burger King and Taco Bell are right there on the horizon, only two minutes away. "And McDonald's is a lot easier than anything," she says. "You get it, you're done. And it's tasty; it's got that tasty taste. You have stress in life, and food is the one thing they can't take from you."
She has spasms of guilt about her diet. One night, she and Gerry were sitting in one of her favorite restaurants in town, the Huddle House, and she was trying to be so good, vowing to start anew on a diet. She told Gerry that she was going to order only a salad, maybe with some chicken in it. She heard her own words as they left her mouth, heard her tone, which sounded grudging and mournful.
I need your encouragement, she said to her husband.
She already felt herself weakening, looking over the menu again, scanning its fried section.
What do you want, baby? Gerry asked her.
I think I should have the salad.
What do you really want, baby?
And she thought to herself, He knows what I want.
What do you want, baby?
I want the country-fried chicken. And I want the fried okra, mashed potatoes with brown gravy, and field peas.
Then that's what we're going to get you, baby.
And, if she wanted, they'd go somewhere afterward to get a dessert, maybe a tasty cobbler -- blueberry, apple or peach -- whatever she wanted, with vanilla ice cream on top.
She vacillates between gratitude for Gerry's deference and irritation that he won't protect her from her urges. But he knows the truth. He realizes that when she wants something, she's going to get it somehow. She figures he's just trying to make her life easier.
Recently, Deke has told her what a doctor essentially told him: that he had to lose a lot of weight or his heart was going to fail him again; that either the pounds had to go or he would die sooner rather than later. She tells Gerry that she's afraid the fat is going to cover her own heart someday and kill her.
Gerry says he'll do whatever she wants him to do. And she knows that -- which is the problem.
When one of the school's bus drivers tells her about a great new big fried chicken sandwich at Burger King that's to die for, she responds excitedly that she'll be down there that week to try it. "When he said tasty, that was good to hear," she says. "And I liked hearing it was big. That means it will fill me up."
Marie isn't Deke's only concern. He also worries about the pull of all that fast food and candy on his grandchildren as well. Recently, Kenny celebrated his ninth birthday at Deke's house, on an evening when Deke and Stella asked their grandson what kind of dinner he wanted and who should make it. Deke was in fine form, regaling his grandson with reminders of his barbecue prowess, finally posing a loaded question: "Kenny, who should cook? Should Grandma do it, or are you going to let Papa fix you a fantastic dinner? What do you want?"
"Burger King," the child answered.
The moment served as confirmation for Deke that there already have been too many Burger King nights in Kenny's life, and in Marie's. It was one more reason, he thought, to change his own behavior, to show her a way to get off the path.
One Friday, Deke and Marie were eating lunch at a restaurant. He nibbled at his broiled catfish, avoiding anything fried, trying to set the right example, talking about his weight-loss goals. "See what I got here," he said to Marie. "Doing it right today."
Oblivious to the message, Marie was eating fried catfish and hush puppies.
"You gotta step up to the plate and be a man, Gerry," Deke told his son-in-law later. "You gotta get her off that stuff. It's no good for her. You gotta stop it."
"C'mon, man, you know your daughter," Gerry said. "You two are just like each other. She wants something, and that's the way it is."
Deke fell momentarily silent. He knows Gerry is right. "It gets hard, and then it gets too hard for some people," Deke says. "It's all a hard thing."
HARD BUT NOT IMPOSSIBLE, Hollis Green keeps telling himself. Just two years ago, at more than 400 pounds and in the shadow of 40, Green considered the real possibility that he might be morbidly obese for the rest of his life and, therefore, he told himself, undesirable to the opposite sex, a bachelor for his remaining days.
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.
ANY CRISIS NEEDS A LOCAL CRUSADER, and, in the Oxford schools, Amy Murphy plays that role. At 30, she has been the director of child nutrition for two years, recently attracting attention for helping to land Oxford Elementary School a $40,000 grant from the CDC for a fruit and vegetable pilot program being administered by the Department of Agriculture. The program's hope is that escalating obesity rates in the state might be slowed, even reversed, if kids like Derrick Dennis can be sold on the idea that eating fruits in lieu of high-caloric, fatty foods is a smart thing.
"Five a day the Oxford way," Murphy says.
It's one of her favorite lines now. Five servings of fruits or vegetables a day for each student. Teachers now regularly talk to the youngest children about what to eat and how often. In a first-grade class at Bramlett Elementary, Vondelle Fairbanks drilled her students on nutrition factoids, instructing them to tell their mothers and fathers about the benefits of melons, kiwis and avocadoes. "What are you going to tell your parents?" she asked.
"Oh, my mother won't listen to that," said one child.
Murphy has tried to improve the quality of school meals by adding fruits, vegetables and low-fat meats to the menu. She supplements standard school meals that have items from all food groups, known as "trays," with tastier, more popular, generally fattier "extras," allowing kids to buy the extras only if they first purchase a tray. One day the extra is a personal Red Baron pepperoni pizza. Many kids purchase the tray merely to get a chance to devour the pizza, concluding their meal by trashing most of the tray's contents.
Murphy is undaunted, convinced that culture will yield in time to enlightenment, but only if the kids are exposed repeatedly to foods relatively new to many of them. "We're going to have to do whatever it takes," she says. "If it's not changed, obesity means there's going to be a diminished return on education -- more kids getting sick, diabetes, heart problems when they get older . . . Culture has something to do with it, but we've always had these foods in Mississippi. People didn't have this problem a long time ago. Why, suddenly, are obesity rates so high? Something happened."
What has happened, believes New York University nutrition professor Marion Nestle (no relation to the chocolate maker), is that the voice of the food industry, particularly the sector selling chips and colas, long ago became overwhelmingly loud and persuasive. "The budgets between the good-food messages and the food industry's messages don't compare," she says, referring to studies that indicate explosive growth in food advertising to children in particular. "Kids get hit with 10,000 ads every year on TV -- ads for everything they don't need: sugared cereals, the potato chips, tortilla chips, candy, the cheeseburgers, every kind of fast food you can think of, the colas. The food industry spends more than $30 billion a year on promotion; the [federal] government spends no more than a few million on good-food messages."
Nestle's is a moderate voice, in many respects. She applauds McDonald's for incorporating salads into its menu and is pleased to see Ruby Tuesday listing the fat content of its dishes. But these efforts pale against the aggregate impact and power of the food industry, Nestle says.
And government benefits make many high-fat, high-caloric products cheaper still. Many crops -- whose uses range from entrees to junk-food sweeteners -- benefit from federal subsidies that make the goods that much more affordable for consumers and, in turn, encourage more consumption. "What subsidies do is simply lower the cost of the ingredients that go into processed foods, making it possible both for people to buy them in large quantities and for companies to sell cheap and maintain large profits," Nestle says. "The problem derives from there."
No crop is subsidized more heavily than corn, a major use of which these days is as a sweetener -- to be found in candy, snacks and colas, where it takes the form of high-fructose corn syrup. "The food companies have gotten a free ride," says Nestle, who contends that generous agricultural subsidies are a direct function of the food industry's political clout. "Until the federal government addresses the subsidy problem, not much will change."
"We don't think [the subsidy question] is the real issue," says Richard Martin of the Grocery Manufacturers of America, a group that opposes any government proposals to curb food-industry advertising to children or to tax high-fat foods. "We don't force people to buy products. We are driven entirely by consumer demand, and people don't want restrictions. What really matters is how many calories people consume. Unless people are able and willing to expend enough energy in relation to calories, they'll gain weight. I don't really like the phrase 'personal responsibility,' but to a large degree it is an individual's responsibility. There are no simple answers."
The ultimate problem, contends Agriculture Undersecretary Eric Bost, is inertia. Bost would like to see local school boards eliminate vending machines in elementary schools (some states, including Mississippi, already bar vending machines in public schools, while others, including Virginia and Maryland, permit them) and include healthier fare in high school machines. He favors the restoration and enhancement of physical education programs in school systems.
In Oxford one May afternoon, high school football coach Eric Robertson looks out on a gym floor filled with kids in jeans and khakis playing a pickup basketball game. It is a gym class, though the students look as if they are dressed for a party. At Oxford High, there is no locker room or shower facility for regular PE; those niceties are reserved for team athletes. With PE not being mandatory there or at any other public high school in Mississippi, and with most students in the school declining to take the class, Robertson and other coaches need to sell the kids on the fun of fitness. This means listening when they generally say they don't want to run or do pushups. The kids, they keep getting bigger all the time, Robertson says.
It is what those involved in the obesity issue all over the state say, from Oxford to the impoverished towns along the Mississippi Delta, where the obesity problem is believed to be most acute. "In any place, but particularly in a poor area, parents often express their love for their children through food," says Kathleen Yadrick, an official with the Delta Nutrition Intervention Research Initiative. " 'Mama fed me a lot': You hear that often. The attitude can be: 'The more I feed you, the more I love you. And you won't get hungry. I might not have the big house on the hill, but I can give you all the food you want, and make it delicious, too.' "
Yadrick sat in a convenience mart in Hollandale, a small Delta town that has lost many of its businesses to outsourcing and whose city budget was too small to afford a fitness path at a local park. But Mayor Robert Buford and residents raised the money anyway, and now a modest one-eighth-mile walking track rings the children's playground. "Don't know how many people are going to use it when it gets real hot," Burford says. "But it's there when they want to. And we know we got a challenge we gotta do something about."
IN THE END, Deke Baskin thinks, maybe it comes down to this. Maybe truth is meant to be a hard, cold-sounding, redemptive thing. Maybe saying no is saying yes. A few hours after he has watched his daughter consume another large plate of fried catfish and hush puppies, a few hours after he has told his son-in-law yet again that he needs to rein in his wife's appetite, Deke sits down with his daughter at his house and says what he has been trying to work up the nerve to say for a while.
"Marie, you need to stop eating so much," he begins.
"I'm gonna try," she says, "but it's hard. I need some of this stuff."
It is what she always has said, more or less.
He thinks a second before letting loose with it: "Marie, I love you. But you need to lose weight for your children. Papa is not going to be here, and you aren't, either, if we don't lose weight and stop eating some of these things."
A shocked Marie says nothing for a long moment. Then she begins to cry. Deke cries, too.
"We have to do this together," Deke says. "Have to get on the treadmill together. Gotta think of your babies."
"You're right, I know you're right," Marie says. "It's just so hard." And they cry some more, before a new ache takes over in her. She can see herself staring out her back window, can see the Kroger store, can see clear through to the horizon, can picture McDonald's and Burger King. Can taste the Hershey almond bar and that new fried chicken sandwich. "It's powerful," she says.
"I know, I know," he whispers, ready to weep some more. He wants to give her solace, wants to fall back on words that provide comfort. And so he says it. He's making barbecue tomorrow. Hush yer mouth.
Michael Leahy is a Magazine staff writer. He will be fielding questions and comments about this article Tuesday at 1 p.m. on www.washingtonpost.com/liveonline.