CHARLESTON, W.Va. -- As part of his job, Dr. John Linton has talked with more than 500 West Virginians who weigh 300-plus pounds. They talk with him because they want to change. They tell him about stairways they can't get up, economy cars they can't drive, escalators, bus doorways, movie seats and restaurant booths they can't fit into.
"Every day, they contend with problems and hazards that don't even occur to most people," he said. They pay a huge price for being heavy.
"I've talked with people who were kicked off airliners because they couldn't buy more than one seat," he said. "And people who got stuck in amusement park rides while people in line yelled things like 'beached whale' and 'wide load' at them in front of their children."
As acting director for Charleston Area Medical Center's behavioral medicine department, Linton interviews people whose weight puts them at extreme medical risk. The more overweight they are, the more likely they are to get diabetes, heart disease, strokes and the more likely they are to die early.
Yet many people Linton interviews tell him they did not clearly understand that they were at risk until their weight became extreme or they had a heart attack or stroke.
Some needed information, he said. "But there's also the fact that, if a lot of the people around you are overweight, it's easy to tell yourself you're still OK."
That is an important clue to the state's soaring chronic disease rate, he said.
"A cardiologist friend said, 'I'll tell you why so many West Virginians are heavy,'" Linton said. "'When they go out the front door to their vehicles to drive to work, they look to the right and look to the left, and all of their neighbors look just like them, so it seems OK.'
"People tell themselves, 'I'm not different from everyone else, so it's nothing to worry about.'"
One in 3 adult West Virginians is obese, according to Centers for Disease Control and Prevention surveys.
Lots of reasons why
People become extremely heavy, at medical risk, for many reasons, Linton said. Some overeat for situational reasons. Those who work a night shift may eat constantly, trying to stay awake. Some medicines make a person feel constantly hungry. Many people eat mainly processed food and don't cook.
"As a breed, we Americans often have no idea what we put in our mouths," he said. "We don't know a lot about nutrition.
"Everyone eats for emotional reasons too, to a certain extent," he said. "Pleasure chemicals like serotonin go up when people eat. People who don't eat hot dogs will eat them at a ball game because they are connected with the pleasure of the game. People who don't eat buttered popcorn will eat a vat as big as their head at the movies.
"We eat more cookies around Christmastime than we eat the rest of the year. It only becomes a problem when you eat that way all year round."
The causes of serious overweight can be roughly divided into three categories, he said: emotional, environmental (surroundings) and genetic. "Sometimes it's all three.
"I always ask people, 'If I saw a picture of your third-grade class, would you be heavier than the other kids?' Half say yes. We don't know yet how big a part genetics may play in that," Linton said.
The others didn't get heavy till they were adults, he said. "Maybe they got hurt at work and couldn't move about easily. Or they got pregnant and gained 50 pounds, then never stopped.
"It's more complicated to treat obesity than it is to treat smoking and alcohol addiction. People don't have to drink or smoke to live, but they do have to eat, and they're constantly tempted by ads for junk food and soda pop."
Many cultures do not encourage overeating, he noted. "One man, a heavy fellow, went to Japan to work with his son for three months. Soon after he arrived, they went to a buffet restaurant. After his first plate, my friend went back for more food. The entire place went quiet. In Japanese buffets, you only go through once. If you go back twice, something is wrong.
"That man lost 30 pounds during his stay in Japan," he said. "It's a lot easier to eat a healthy diet when the environment encourages it."
Conversely, you're more likely to eat an unhealthy diet if the people you love eat that way.
"If you're 10, and Uncle Mike is 20, and he is 5 foot 10 inches and weighs 300 pounds, and he taught you how to fish and hunt and you love him, and when he takes you to a fast-food place to eat, and he has three hamburgers and a Big Gulp and an order of fries, well, that's your role model. Uncle Mike is who you want to be like."
For that reason, he said, many counselors refuse to treat a child for weight loss unless the whole family is involved.
Meal pattern matters
Another insight: About 8 in 10 dangerously heavy people tell Linton they eat no breakfast.
"They say, 'I never eat breakfast,' and they're proud, because they think it helps hold down their weight to skip that meal. But they're doing the exact reverse of what they need to do to lose weight."