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Admittedly, Martz of Columbia City likes to eat. He loves pizza. Tenderloin sandwiches. And, like most people, he says, "too much of what you would call junk food."

At 6 feet tall and well over 200 pounds, Martz says being heavier than many people never bothered him that much. In fact, he says he felt his best when he weighed "about 280." And, in a state that consistently ranks among the heaviest 10 in the nation, Martz wasn't that different from many of those around him.

At work as a hospital maintenance man, he says, he would get winded. "It got harder to climb ladders," he says. "The pain in my knees was always there, and I figured a lot of it was the weight."

He couldn't play the way he wanted to with his grandkids. And he was facing - "dreading," he says - his second round of knee surgery because the cushioning in his knee joints was pretty much gone.

Many of us could stand to lose a few pounds. A lot of us are just plain fat. And, like Martz, we're starting to realize that something has got to be done.

In 2003, according to federal health statistics based on a measurement known as the body mass index or BMI, 26 percent of adult Hoosiers qualified as obese.

Last year, Indiana dropped to eighth place in the nation for obesity, with 25.5 percent of adults qualifying. The proportion of overweight residents increased to 36.5 percent.

What the numbers mean is this: Nearly two of three adults in Indiana are overweight or obese. Those people are your co-workers, your neighbors, your friends at church, your relatives.

And all of those overweight and obese people either have, or are raising their risk of, developing or dying from major health problems. Problems such as diabetes, where the link to obesity is strong and has been documented for decades. Cardiovascular problems that contribute to heart attacks and strokes. High blood pressure. Gallstones. Joint problems from one kind of arthritis. Breathing troubles, including asthma and sleep apnea.

Even many kinds of cancer - of the liver, the pancreas, the prostate, kidney, esophagus, colon and rectum, of the reproductive tract and breast in women and stomach in men - have been linked to being overweight.

"Many Americans have not acknowledged the contribution of obesity to chronic disease in general, and cancer in particular," says Eugenia E. Calle, lead author of the American Cancer Society study that examined the links.

"For example, many women are very concerned about breast cancer, but few understand that obesity doubles their risk of getting, and dying from, the disease."

Indiana is only now getting a handle on how many kids are facing obesity because the state hasn't systematically collected or analyzed information on height and weight in youngsters.

Still, based on surveys that asked high school freshmen their height and weight, the state health department believes 11.5 percent of high-schoolers have achieved overweight status and 14 percent more are at risk for becoming overweight.

Experts say that being overweight puts kids at earlier risk for developing adult diseases, including Type II diabetes, high blood pressure and high cholesterol. Last March, a study suggested obesity might shorten the lives of today's children by two to five years.

It was the first to suggest that Americans' expected lifespan might be getting shorter for the first time since the government began keeping track of the data in 1900.

The health problems associated with obesity are beginning to take a toll on society's pocketbook. Studies show that individuals' medical costs go up in tandem with their weight: More doctors' visits, more hospitalizations, more drugs, more disability payments, higher insurance rates. The costs are borne not only by individuals, but also by employers and taxpayers.

Nationally, the expenses total $70 billion to $100 billion annually, depending on what is counted. In Indiana, the cost of obesity-related medical treatments was placed at $1.64 billion billion in 2003 - 17th among states and the District of Columbia.

At 5 a.m., when most of the city is still asleep, he is starting the early shift at Parkview Hospital's Health and Fitness Center on East State Boulevard, where many people start fighting back against fat.

After Thurber arrives, people in workout gear or carrying gym bags start trickling in to ride exercise bikes, walk or run on treadmills, use stair climbers or elliptical trainers or just walk laps around the main fitness floor.

Some people are so limited in their ability to move that Thurber has them start their exercise program by just moving their arms and legs while sitting in a chair.

When he starts other overweight people on a walking program, he gives them a pedometer to wear so they can see whether they get the recommended 10,000 steps each day.

"People are shocked when they find out how inactive they are, he says. "I've trained office workers who only take 5,000 steps a day. I've trained people who were doing only 3,000 steps."

As a behavioral therapist with Lutheran Hospital's Weight Management Center, she has been helping people overcome compulsive eating and weight problems for 15 years.

"Compulsive eaters often come in saying they can't stop eating and don't know why they eat that way," she says. "Or, people say they've lost hundreds of pounds over the years and they can't understand why they can't maintain the loss. They ask, ‘What's wrong with me?' "

Usually, she says, her overweight and obese clients are depressed. Often, they're also angry - at themselves, or at others for stereotyping them and treating them badly. Their self-confidence has been sapped, and some feel hopeless. "They have started to think things will never change," Oscher says.

What many of her patients don't understand, Oscher says, is something that medical science is just learning. Becoming fat may seem like a simple matter of eating too much and exercising too little. But it's not really that simple.

Many factors - biological and environmental, physical and emotional, personal, spiritual, cultural and societal - cause people to gain more weight than they need.

Today, food isn't just in the forest or the lake where it has to be hunted down and killed - or out in the ground, where it requires calorie-burning planting, tending, harvesting, preparing and preserving. It's there at every turn - not only in the refrigerator or cupboard, but also the gas station, the ballpark, the mall, the school vending machine, the drugstore, the drive-through down the street.

It comes packaged and prepared and ready to eat at the touch of a microwave button, so we expend hardly any energy to feed ourselves. And it's served in huge quantities that would probably astound our ancestors.

Indeed, says registered dietitian Misti Evans, manager of Lutheran Hospital's Weight Management Center and St. Joseph Hospital's Bariatric Center, if there's one thing she could change to improve Fort Wayne's weight picture, it would be to reduce restaurant portions.

"With more people eating out more and more, they become one of the driving factors in obesity in this area," she says, noting that one serving of pasta at a popular local Italian eatery could actually feed eight people if recommended serving sizes were followed.

It's what dietitians call calorie-dense food. Instead of eating 80 calories in an apple, we eat 400 calories in a slice of apple pie. Instead of a having a piece of broiled or roasted chicken, we coat it in egg and flour and deep-fry it in fat. Instead of no-calorie water when we're thirsty, we drink 140-calorie sodas several times a day.

"So we're getting many more calories than we should," says Julia Just, a registered dietitian at Parkview Hospital. "So much of what we eat around here is ‘typical Midwestern food' - fried meats, fried potatoes, gravy."

It's food left over from the days when typical Midwesterners worked dawn to dusk on the family farm or did manual labor in factories. We like it, she says, but it doesn't suit our more sedentary lifestyles.

Plus, we socialize around food. We use it to bring our families and friends together, to celebrate our successes and milestones, and, too often, to soothe our frustrations, comfort ourselves, ease our stress.

"A lot more doctors, because they are concerned for their patients' health … are referring them to programs to help them. In the old days, they would have just said, ‘Go on a diet,' " Oscher says.

And locally, people have many more programs, and more sophisticated approaches, from which to choose. At Lutheran's Weight Management Center, patients are placed on a medically supervised fast, are started on exercise and can receive behavioral counseling. Parkview Hospital has a Healthy for Life program, which helped 66 people lose weight last year through nutrition and exercise education. St. Joseph's Hospital has started a weight-loss surgery program, where the very obese can have surgery to shrink the size of the stomach.

America on the Move, a non-profit group working nationally to reduce obesity, kicked off a Fort Wayne chapter last month. Its message is to cut calories by 100 a day and increase steps by 2,000 a day to aid losing or maintaining your current weight, director Marsha Worthington says. The group is planning a promotion to enroll thousands of participants in the spring.

The group is also compiling a list of ways to exercise in Fort Wayne. "We want to make it as easy to say, ‘Let's go out and do something active,' as it is now to say, ‘Let's go out and get something to eat,' which is what we do now, myself included," she says.

Last year, when the non-profit group City Walks of New Haven sponsored its Holiday Challenge, urging residents to pledge not to gain more than 5 pounds during the Thanksgiving and Christmas season, 183 people signed up.

When the same group hosted a one-night program in New Haven in September, including a fitness walk and a healthy-food tasting, 300 people came, says Kerri Zurbach, executive director of the group, which is repeating its holiday event with a component for young people beginning Nov. 19 at Glenbrook Square.

Gov. Mitch Daniels, who recently made obesity and inactivity a campaign issue, has started the INShape Indiana program with a new Web site at .gov and a statewide obesity summit on Thursday in Indianapolis. A more comprehensive approach to the issue may make securing federal money for combating or preventing obesity in Indiana easier to obtain.

"Obesity is a complex problem, but that also means that there are many avenues for addressing it," says Michael Earls of the Trust for America's Health of Washington, D.C., a non-profit advocacy group that issued "F as in Fat: How Obesity Policies are Failing in America, 2005." The report found that not a single state is on target to meet a federal health goal for 2010 to have not more than 15 percent of its citizens obese.

"Certainly, at its heart, obesity is a personal responsibility issue," he adds, "but we need to be nurturing an environment where people have healthier food and exercise choices available and can make them more easily."

With the help of Parkview Hospital dietitians Julia Just and Kathy Wehrle, Martz has been concentrating on eating smaller portions more slowly, so he doesn't override his body's signals that he's full. Before, he says, he often ate so much so fast that he was actually uncomfortable after eating.

"It's not a diet. They teach you how to control your eating with smaller amounts and more times every day so you don't get hungry," he says. "I tried diets and they don't work for me. Well, they work for a while, but you either get bored and hungry, and that's the end of the diet."

"It's a struggle sometimes," he says, noting his knees do worse in wet weather. "But I get out the ibuprofen and take a couple and still go for a walk."

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