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Big people struggle in a world where they literally don't fit in.

"You can't get on an airplane without a seat belt extender," said Mark Gosson of Medford, who weighed 361 pounds before he had bariatric surgery last fall.

"You don't fit in a restaurant booth," he said. "You learn which restaurants you can go to.

"There's no place to buy clothes. I couldn't just go to Wal-Mart and buy something."

Many big people are maligned for a condition that's often beyond their control.

"People just look at you differently" when you're big, says Brenda Hiles, 31, of Medford, who weighs about 600 pounds.

"They make remarks about how you look," said Hiles, whose mother, Cindy McMurphy, is also morbidly obese. "If they lived like I live they couldn't go through the humiliation I do. They couldn't handle it."

"I couldn't walk down the street without somebody yelling something at me," said Gosson, who works as a customer service trainer for Lithia Motors. "I pretty much became a recluse."

Hiles' 32-year-old sister, Christina Paez (who also weighs about 600 pounds), said children of obese parents get verbal abuse, too.

"When I go to my daughter's school to have lunch, they make fun of her because of me," she said. "My daughter comes home and says 'Mommy, am I fat?'"

"They hear it on a daily basis," Hiles said. "They come home crying."

People assume all extremely overweight people lack self control, but the causes of extreme obesity can't be easily categorized, said Beth Darnall, a licensed clinical social worker who counsels obese patients at Oregon Health & Science University.

"There's no way to look at someone to know what the cause (of their excess weight) is," she said. "We don't know a person's history. To make assumptions about why they are the way they are is completely unfair."

For some people, the extra weight is the consequence of a medical condition. For others it may be the result of a chronic disability that prevents them from engaging in physical activity. Others made poor lifestyle choices that led to their weight gain, or have an eating disorder that causes them to binge.

Emotional factors may also play a role in morbid obesity in some people. Darnall said morbidly obese people have a higher incidence of physical or sexual abuse than the general population, "but that doesn't mean that everyone had some sexual trauma."

The only common denominator among people with severe weight problems is that "they're extremely distressed by their weight and how it's affecting their lives," Darnall said. "They're very concerned about their health and generally unhappy about their appearance."