In death, as in life, one size doesn't fit all

"We need to quit hiding it and thinking, 'Oh, well, they're just larger than life,'" says Keith Davis, slightly out of breath. "If I hear that one more time, I think I'm going to scream."

Davis is puffing a little because as we're speaking, he's loading one of the specialized caskets he manufactures onto a truck to begin its journey from his town of Lynn, Ind., to another state and, eventually, a funeral home.

But Davis' caskets are different from those most Americans are placed in after they die. The one he's wheeling onto the truck is 37 inches wide; the average casket width is about 26 inches. Davis and his company, Goliath Caskets, make some of the largest caskets in the country for some of the largest Americans, who are simply too big to fit into the ones most people use.

The New Year usually brings with it resolutions to tackle weight gain. Gym memberships spike in January as more people vow to get fit and drop pounds.

Responses to the obesity epidemic often deal with the issues facing those living with the disease: how to combat it, medicate it or prevent future generations from suffering from it.

Companies everywhere are adapting products and services to accommodate the widening of girths and the steady climb in the numbers on scales. Movie-theater seats are wider. Car seats are broader; some even have rearview cameras for drivers too big to turn around when they drive in reverse. Revolving doors are roomier. Amtrak is adjusting its dining-car seats. Hospitals have surgery tables that can support heavier patients.

Yet one of the most overlooked aspects of obesity is what happens after we die.

Caskets and the many other aspects of a funeral that come into focus after death are often the last things people think of, says Davis.

"Stuff you would never, never think about suddenly become gigantic obstacles," he says. "Who would ever have thought you'd have to have two grave sites or have a backhoe come in and lower the casket into the grave?"

Bob Arrington has been in and around funeral services since he was 7 years old, growing up in Milan, Tenn. 

"My elementary school was across the road from the funeral home my neighbor worked at," he recalls. "I used to go across the road and wait for my neighbor to drive me home at the end of the day."

By the time he was 9, he was helping out — opening the front door, handing out flowers, spending the long summer months there. Now 57, he heads a funeral directors' association in Jackson, Tenn., and is the treasurer of the National Funeral Directors Association.

He says he began to see changes in the size of caskets about seven years ago.

"You go to a casket convention, you used to have one or two choices. Now they have a whole line of choices because it's becoming more requested," he says. "It's a noticeable trend."

"They're making more room on the inside," he says of average-width caskets, which can range from 26 to 30 inches. "The casket manufacturers are realizing that this is an issue, and they're starting to make changes."

Most of the standard caskets have room to accommodate people who are slightly wider or heavier than average. They're usually filled with extra padding to fit most people.

When someone is simply too big for that accommodation, specially made oversize caskets come in.

The larger caskets are "among the fastest growing of the different categories of products," says Teresa Gyulafia of Batesville Casket Co., one of the largest manufacturers of caskets in the country.

And, she says, the demand varies by geography too.

"There are parts of the U.S. — states that have higher-than-average demand for oversize products," she says.

The spread of obesity across the country and now across the world has reached epidemic proportions. The Centers for Disease Control and Prevention reports that in the U.S., approximately 1 in 3 adults is obese, as well as 1 in 6 children. It is a major cause of death, a consequence of heart disease, cancer and diabetes.

The World Health Organization reports that obesity, "once considered a problem only in high-income countries," is now increasingly an issue in low- and middle-income countries, particularly in Africa and Central and South America.

Causes for the rise in obesity range from a change in lifestyle for many in developed countries — from labor intensive to largely sedentary — to the availability and higher cost of fresh, natural food compared with easily accessible, cheaper fast and processed food.

The statistics in this country have raised so much concern that First Lady Michelle Obama has taken the helm of a White House initiative to spotlight obesity and, as she says on the Let's Move campaign's website, "change the way a generation of kids think about food and nutrition." 

If anyone can do a snap survey of the fluctuating fortunes of overweight Americans, it's Keith Davis. From the casket-manufacturing business he inherited from his father, he has a pretty good sense of how widespread the obesity problem is and how young those who die of obesity-related complications can be.

"We have a generation of people now, especially the younger ones in their 30s, who are going to die before their parents because of obesity," he says. "As I travel around and deliver these caskets, the average age of these people is 40, 45 years old. And many of them are younger than that.

"I've delivered to people who are 25 years old, and it's not because they died on a football field. They were just so big, their hearts gave out or their kidneys gave out," he says. "We're eating ourselves into an early grave, one shovelful at a time."

Many families of obese people don't come to grips with their loved ones' size until they're faced with the somber task of saying farewell, says Davis. It's often when the details of preparing for the funeral become clear that people are surprised by obesity's ripple effect on the way they expect to say goodbye — ways most people take for granted.

"In many cases, the family doesn't recognize them as large. Sometimes it's a real shock to the families when a director has to explain why it's unique," he says. "If they're able to explain how the memorial will be a little bit different, they’re prepared for the differences, and so no one's embarrassed."

There's a list of problems, Davis says, and he begins counting them off.

"Family plots where whole families are buried together — that's real common around here. If you have one member of the family that's very large, they'll require more than one," he says. "They may not be able to be buried under the oak tree next to Grandma and Grandpa."

There's transportation: "You may not be able to use a hearse because the casket won't fit. We've used everything from wagons to flatbed trucks to fire trucks," he says.

Older funeral homes may not have doors wide enough to accommodate a 52-inch casket. Or such a large casket may not be able to go down the aisle of a chapel for the viewing.

When the casket is too heavy for pallbearers to lift, a backhoe is sometimes used to lower the casket into the grave. Sometimes vaults aren’t available.

Special services mean more costs too. The caskets themselves cost $3,000 to  $5,000; the standard size is $2,000 to $3,000.

Davis, 64, says he won’t be retiring anytime soon. He's too busy, and there's simply too much work.

"That's the saddest part of the whole thing," he says. "It's a serious crisis." As someone whose business it is to cater to large people after they die, Davis wants to send a message to those who are still alive: Get help.

"Realize you are large. Understand this — it's not a sin, it's not an evil thing," he says, urging people with weight issues to seek professional help. "Make a commitment with someone, so you have to show up and be accountable."

The reality of not doing that is something he sees every day.

"They're losing their lives over this," he says.