The moment of truth for Lori Dankert of Perrysburg occurred on New Year's Eve 2001 while watching family videos that depicted her 300-pound self straining to pick up her toddler.
"It just hit me," recalled Dankert, 42. "I was mortified. I couldn't bend over, and when I did my stomach was just hanging. It freaked me out."
For Amherst middle school teacher Nathan Phillips, the moment of truth came while he was dressing for the first day of school in September 2007.
"My size 68 pants were too tight," said Phillips, 48, who then weighed 422 pounds. "I looked in the mirror and just started crying and I could not stop."
Experts call the "moment of truth" a necessary first step in making the changes that will improve a person's quality of life from a weight-management standpoint.
"Every individual who I've talked to has had a different 'a ha' moment," said Dr. Jeanette N. Keith, a gastroenterologist at Buffalo General Hospital. "But what is similar is the inner motivation that allows them to stick with their program. Your friends and family may want it for you, but until you own it, the change just won't happen."
On the second day of 2001, Dankert walked into a Gowanda gym weighing 287 pounds and began a fitness journey that would leave her half that size today.
In the second month of 2007, Phillips walked into Sisters Hospital for bariatric surgery that would reduce his stomach to the size of an egg and ultimately result in a 232-pound loss.
The decisions by Dankert and Phillips to successfully lose the weight that had dogged them much of their lives followed a history of failed attempts, which is not unusual, according to Keith.
"When people are on a diet, after they reach their goal weight oftentimes they'll go back to the way they used to eat," said Keith, whose clinical focus is on the medical management of obese patients. "If you eat the way you used to eat, you'll look the way you used to look."
In Western New York, 26.7 percent of residents are obese and 34.9 percent are overweight, according to a report issued in late 2009 by the BlueCross BlueShield Association. In addition, the weight-related health care issues affecting more than half the adult population in our eight counties translated into $458 million in medical expenses.
(An adult who has a body mass index between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or higher is considered obese. Body mass index is defined as the individual's body weight in kilograms divided by height in meters squared.)
Losing 100 or more pounds through a medical or surgical weight loss program requires you to change the way you eat and the way you live.
"It's that constant discipline, the day-to-day decisions to make different choices than in years past, and in regards to food we make over 200 choices a day," said Keith. "Losing 100 pounds, I suppose, is like running a marathon."
Walking into a fitness club weighing close to 300 pounds was one of the most difficult things Dankert recalled doing. "Here I was this really big girl," she said. "I was intimidated, but I would be at that gym two hours a night."
Ten years later, sitting in the Spring Creek Athletic Club in Springville, Dankert now fits in the fitness scene. She has her eyes on a bodybuilding competition in April, and recalled how it all began.
"My doctor told me to lose weight and gave me a meal plan that was for a diabetic, but I wasn't a diabetic," she said, "so I did a lot of research online. I basically bought every book I could possibly buy and I just read and read. I did it by myself."
While the vast majority of people do need to be seen by a physician or dietitian before embarking on a weight-loss/fitness plan, Keith acknowledged the self-taught dieter.
"Most people are not educated in regard to diet, and they won't spend the time to learn what they need to know," Keith said. "Educating yourself to have a balanced nutrient intake is possible."
After keeping a food journal for weeks, Dankert was astonished at the amount of junk food she ate. Gradually, she began to follow an eating plan she found online, one that allowed 1,800 calories daily.
"I didn't believe how much junk I ate until I started journaling," she said. "It was like 5,000 calories a day. I've got my kids looking at labels now. I don't want them to go where I went."
Slowly she began to lose weight, exercising all the while. She added strength training to her cardio workouts to build muscle to replace the fat she lost.
"Lifting weights was also important because the muscles are filling out my skin," she said. "That was a big difference. The gym scene is addicting."
And a tape measure replaced the elastic waistband as her best friend.
"The tape measure would tell me," she explained. "I could be losing inches but not be losing weight because I was changing my body completely. I could have gained two pounds, but it was in muscle."
It took Dankert 18 months -- from January 2001 to June 2002 -- to lose 100 pounds. Her most valuable tip? Morning cardio. And when she lost 80 pounds, she rewarded herself with a tattoo that circles what has become a well-toned bicep.
"[My husband] never thought I would do it," she said. "I did and then I hit a big wall. I really wanted to get to 180, and that's when I went on a bodybuilding diet."
Dankert believed the most marked change is her skyrocketing energy level, not to mention a confidence that led this former court clerk to run against and unseat an incumbent town judge.
"Nothing stops me," she said. "One of the main reasons I did this was I couldn't run. I couldn't chase my kids. Now they can't keep up with me, and they're teenagers."
There are many moments in Phillips' life that he would like to forget: like the time he couldn't fit into the roller coaster seat at Darien Lake, and the laughter he heard as he was forced to leave; or the looks on the faces of fellow air passengers when they realized Phillips was heading for the seat next to theirs.
"When I look at the 'before' pictures now, I never saw myself as that big," he said. "It's almost surreal that I let myself get that way. Why didn't anyone ever tell me I was that big? They said it was because I was so active."
His affable nature and dynamic personality made Phillips a student favorite, but what he really wanted was to be a role model. He coached volleyball and softball all the while eating way too much food, a habit that started in childhood. Secret eating became a way of life for Phillips, who regularly stopped at the drive-through on his way home for dinner.
"At age 40, everything started hitting," he said. "I had severe sleep apnea, and I was taking medication for diabetes, cholesterol, blood pressure. And then I lost my baby brother to a heart attack. At 44, everything got worse with shooting pains and tightness in my chest."
In February 2007, Phillips was operated on by Dr. Joseph Caruana of Synergy Bariatrics. After two days in the hospital, he returned home and learned how to eat with his drastically reduced stomach.
Gradually, Phillips introduced healthy food into his diet, learning to chew it and taste each mouthful. Eating food, he would realize, must be a conscious decision. He learned to like vegetables and avoid sugar (in bariatric patients, sugar triggers the dumping syndrome, or the inability to properly metabolize sugar, which results in sweating, diarrhea and pain). Chicken breasts have become a staple, as well as the multivitamin he takes four times daily.
"Basically, the surgery is designed so you won't absorb a certain percent of your calories to facilitate weight loss," explained Keith. "The majority of the stomach is bypassed, but it's still physically present.
"The stomach pouch at the time of surgery goes from a small- to medium-size football to the size of an egg," she continued. "Over a year or so, it will increase to the size of a tennis ball.
"There's a period of time when you actively lose weight, and when your body adapts you become weight stable," Keith said. "You have to pay attention to nutrient intake. The key is to fill up with protein and vegetables."
In one year, Phillips lost 100 pounds. The second year he lost another 80 pounds. Noticeably absent from his daily routine are the medications he once took. They have been replaced by 50 stomach crunches a day. Three times weekly Phillips heads to the gym for a round of cardio. He loves to spin, but has yet to pick up a weight.
"The one thing that upsets me still is when people find out I had gastric bypass, and they say it's the coward's way out," he said. "They say it's not natural, and the people saying it are the ones who never had an issue with weight."
Keith pointed to a misperception with bypass, one of many tools effective in facilitating weight loss.
"Unfortunately some people have used it as a means of escape, but it is not easy," said Keith. "There are many behavioral changes required."
"To me gastric bypass was a last resort," he said. "Don't let people make you think it's the cowardly way. It's what you need to do for yourself. It's what you need to do to live."
Occupation: Town Judge
Weight start: 287
Size start: 24-26 pants
Weight now: 144
Size now: 7 junior
Occupation: Amherst middle school teacher
Weight start: 422
Size start: 68w pants/7x shirt (size 28)
Weight now: 190
Size now: 34w/medium shirt