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Hugh Teddy Black in April 2013, eight months after bariatric surgery. At his heaviest, the Chesapeake lawyer weighed 440 pounds. He had surgery in September of 2012, and now weighs 205 pounds.
There was something defense attorney Hugh Teddy Black used to dread in court - and it didn't involve a judge, a client or a critical piece of evidence.
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He'd use his foot to scoot the fallen object to the nearest desk, where he could firmly grasp the edge, squat down low enough to grab it, and then hoist himself up without losing his breath - or his dignity.
A growing number of people, however, face such everyday challenges. One-third of Americans are considered obese, and the American Medical Association recently brought more attention to obesity by classifying it as a disease.
It's not clear what the impact of a word change will mean, but addressing the weight problem is the proverbial elephant in the room of a country where 20 percent of health expenses are obesity-related.
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Black, having gone from one side of the issue to the other in less than a year by undergoing bariatric surgery last September at Sentara Norfolk General Hospital, has a unique perspective on the AMA's decision.
I can see where someone would say it's a disease when you have a hard time reversing it, he said. It's like an addiction, to a point.
But for him, it was also about the poor decisions leading up his extra-extra-large size. It was a high-stress job with 12-hour days, eating the wrong foods and not making time to exercise. It was being in denial about just how bad the extra weight was for him. It was moving past the point where he could diet his way back out again.
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He doesn't know whether it's a disease, but he does know this: In a politically correct world, where you're not supposed to discriminate on the basis of skin color, ethnicity, sexual preference or disability, people seem to feel free not only to judge the obese, but to lambaste them.
You need only check out a few finger-wagging blogs to see that. Laden with phrases like personal responsibility, government meddling and push away from the table, the opinions aren't exactly sensitive.
He was not, as some bloggers would have you believe, sitting around eating bonbons in front of the TV. In fact, the long and sometimes stressful hours at work contributed to his problem.
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This day in July he's wearing a seersucker suit that's clearly too big for him. His tailor says he's taken Black's suits in as much as he can without making him look like the guy whose big brother stayed home so he could go to the dance.
Black doesn't care. Right now he's feeling victorious over an enemy that began elbowing its way slowly and insidiously into his life when he went to Old Dominion University, then to law school in Ohio.
When I started practicing law, that's when the weight came hard and fast, Black said. Not eating right. Eating late at night. Not exercising like I was supposed to.
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He didn't like to eat out because of the booth issue. He couldn't fit into one; they'd have to wait for a table.
After years in the big and tall sections of clothing stores, he got to a point where he couldn't buy clothes off the rack. They had to be tailor-made.
And he avoided flying because of what he saw in the eyes of people waiting with him in the airport: I hope I don't sit next to that guy.
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It wasn't his own health problems that pushed him to make a change. In 2008, his father had surgery to treat pancreatic cancer.
A friend led Black to Dr. Stephen Wohlgemuth, who has been doing bariatric surgery - in which the stomach size is reduced - since 2000. Wohlgemuth practices at Sentara Comprehensive Weight Loss Solutions, in an office that opened near Sentara Leigh Hospital in April.
There are separate waiting areas for people going through bariatric surgery and those trying to lose weight through diet and exercise. It works out better that way, Wohlgemuth explains, because tension can arise when one group drops weight quickly through surgical means while the other chips away at it slowly.
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When Wohlgemuth witnessed his first gastric bypass surgeries as a medical resident, he didn't care for the procedure. The large, invasive incisions needed to staple off a part of the stomach were prone to infections and complications. He considered the surgery forced behavior modification.
But when a local surgeon started doing them laparoscopically 12 years ago, he joined in. Over time, he did more and more, and bariatric surgeries are now 95 percent of his work. He figures he's done about 1, 500.
There are the folks who say it takes away personal responsibility, encouraging costly, quick-fix measures that ultimately fail and increase government meddling at taxpayers' expense.
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But others hope the designation will lead to better insurance coverage for battling weight. That, in turn, could decrease cases of Type 2 diabetes, high blood pressure, heart disease and cancer in a country where an estimated $190 billion is spent annually on obesity-related health care.
There's a huge segment of people, physicians included, who still view it as a character flaw, Wohlgemuth said. That it's a condition that leads to a disease, and that it's still basically the patient's fault.
Recent studies suggest genetics play a role not just in how much people want to eat, but also in how much of what they eat turns into fat. Also playing a role are sedentary jobs and more working parents, environmental aspects like supersized drinks and a fast-food culture, and psychological triggers like emotional and stress eating. Hormones and body chemicals, too, pose medical mysteries yet to be unraveled.
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It's incredibly complicated, said Wohlgemuth, whose treatment center includes a psychologist, an exercise physiologist and a registered dietitian. We could argue about it for a million years. The bottom line is there's a huge number of people who are obese.
Teddy is a successful guy, a bright guy, Wohlgemuth said. He has control over every part of his life - except for his weight.
For his insurance to cover the surgery, he had to purchase a rider - for himself and the other lawyer in his practice, even though that person wasn't overweight. That cost several hundred dollars a month.
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Black then had to go through a year of doctor-supervised dieting. That in itself convinced him he couldn't lose weight by diet alone. After a year, he had lost 35 pounds and still weighed so much that exercise was nearly impossible.
Guideposts in determining the need for surgery, vital for insurance coverage, have been developed by the National Institutes of Health and focus on a person's body mass index, a weight-to-height ratio.
The surgery, which averages between $41, 000 and $45, 000, is recommended for people with a BMI of 40 or above, and those with a BMI between 35 and 40 with at least one condition such as diabetes, sleep apnea, heart disease or high blood pressure.
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Using BMI for this type of determination has come under fire. Wohlgemuth said some people with a high BMI aren't as prone to diseases; they tend to be pear-shaped and are sometimes referred to as the healthy obese.
Others with a BMI in the low 30s might have a much greater risk of diabetes and heart problems because of fat around the core of the body. They tend to be apple-shaped and are much more costly to the medical system. Insurance coverage of that cohort might give the health system a better bang for its buck.
In the months after his surgery at Sentara Norfolk General, the pounds dropped off. His diabetes and sleep apnea disappeared. His blood pressure fell to a point where he went from two medications to one. He stopped his cholesterol meds.
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He lost enough weight that exercise became easier. He joined a gym and frequently walks from his office to the Chesapeake courthouse. Before, he wouldn't even tackle the flight of steps; he'd take the elevator.
Surgery is a tool, not a cure. People usually do well for a year, Wohlgemuth said. The weight's falling off, they're getting positive feedback. But they start tapering off, then reach a plateau.
Wohlgemuth bristles when people say bariatric surgery is taking the easy way out. Success is not easy, and requires the same willpower - in the long run - as losing the weight more slowly.
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One of the newest physicians at the center is Dr. Caren Beasley, a medical weight-loss doctor who works with people who don't qualify for, don't want or can't afford surgery.
She helps patients figure out what their eating triggers are and whether any medications they're taking are making them hungrier. They look at social aspects like eating differently from the rest of the family or working shift jobs where healthy food is scarce.
Beasley, 41, can relate to her patients' frustrations. In medical
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