[Paleopsych] NYT: Penny-Wise, Not Pound-Foolish
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Fri May 20 19:03:35 UTC 2005
Penny-Wise, Not Pound-Foolish
By STEPHANIE SAUL
DURHAM, N.C. - In late 2003, Susan Blech sold her office products
business, left her home in Long Beach, N.Y., and came here with a plan
to spend her life savings losing weight.
So far, her plan has worked. Ms. Blech, 39, has dropped about $70,000
and 220 pounds in Durham. She subsists on an 800-calorie diet
prescribed by the Rice Diet Program, one of three major weight-loss
and nutrition centers here in the city that sometimes calls itself the
Diet Capital of the World.
When her weight falls another 50 pounds, to 200, Ms. Blech plans to
spend her remaining money for surgery to remove dangling skin from her
midsection and fill out her sagging breasts. She has already picked
her plastic surgeon - one right here in Durham at the Duke University
If she is broke by then, Ms. Blech said, "It's going on the credit
Ms. Blech's losses are this town's gains. Durham, a former
tobacco-trading and cigarette-manufacturing city of 204,000, has
evolved into a Lourdes for the obese. Each year, about 4,000 people
like Ms. Blech arrive here, hoping to change their lives.
And Durham's status, whether as a magnet or national model, seems
likely to grow, as the country increasingly focuses on obesity as a
potential epidemic. The obese now make up an estimated one-third of
the adult population. They are the people most likely to have
diabetes, heart disease and other conditions that account for more
than $100 billion of the United States' $1.8 trillion annual medical
Durham's diet experts say the people who come to their centers tend to
lose more weight, more consistently than people who diet on their own
- because of the motivation that brings them to town in the first
place and the network of doctors, medical staff and fellow dieters.
But as with any diet, anywhere, keeping the weight off long term
depends on a person's willingness to forever alter eating and exercise
"I don't dare go home," said one dieter, Corinne Keene of Naples, Fla.
Ms. Keene, 73, moved to Durham last Dec. 10 after hitting 252 pounds,
a medical emergency on her 4-foot-9-inch frame. She has lost more than
50 pounds, but fears she will not keep dieting after leaving the
supportive cocoon of the Rice Diet Program.
Durham has been known for weight loss ever since the Rice Diet was
founded here in the 1930's. Local residents can reel off a list of
corpulent celebrities over the years who have left some of themselves
There was the Kentucky Fried Chicken founder, Col. Harland Sanders,
who, in his trademark white suit, huffed and puffed on a local walking
trail back in the 1970's while on the Rice Diet - which has evolved
over the years but still largely involves a strict regimen of grains
The comedian Buddy Hackett, also a Ricer, was known for gags like
ordering pizza for fellow dieters when he visited in the 1970's and
James Coco, the roly-poly comedic actor who starred on Broadway in
"Last of the Red Hot Lovers," dieted at the Structure House, then
published a book in 1984 promoting the diet's effects - three years
before he died of a heart attack at age 56.
The celebrities still come, if more guarded these days about their
privacy. But in the last few years, as weight loss has moved beyond
vanity to a matter of national medical urgency, more and more everyday
people have started spending their time and money on the Durham cure.
"I see a shift in people recognizing that this is something they have
to deal with," said Dr. Gerard Musante, a psychologist who founded
Structure House in 1977.
While shedding pounds at Durham diet houses - the Rice Diet Program,
the Duke Diet and Fitness Center and Structure House - dieters pump
more than $51 million a year into the local economy, according to the
city's Convention and Visitors Bureau. The money includes not only the
fees at the diet centers, but also the money dieters spend around town
on everything from new sneakers to cosmetic surgery. "The last time we
did a study, the diet and fitness impact was almost equal to the
conventions and meetings held in Durham in a one-year period," said
Shelly Green, chief operating officer for the convention bureau. "It's
Often, the dieters arrive plagued by the medical complications of
severe obesity, and require visits to eye doctors, endocrinologists
and surgeons. They rent apartments, set up temporary offices and
sometimes come to live here permanently. As their weight drops, they
buy several sets of new clothes. As their diabetes improves, they need
to be fitted for new glasses. All of the spending adds to Durham's
The dieters are easy to spot, tackling a walking path along the
three-foot-high stone wall that encircles Duke University's east
campus; or milling about the Southpoint Mall, where shopping takes the
place of eating; or attending games at the minor league Durham Bulls'
baseball stadium. Some have been spotted cheating on their diets at
Francesca's Dessert Cafe.
A few dieters like Durham so much, they stay. One is Franklin
Wittenberg, a former electronics importer-exporter, who came from
Connecticut for a diet in 1981, disgusted with himself. Nearly 25
years later, Mr. Wittenberg could be called either a success or a
failure of Durham's diet houses.
Mr. Wittenberg, 71, has thick white hair and a chiseled face that is
remarkably thin compared with his girth, which seems to engulf his
office swivel chair. He lost weight several times, but could never
keep it off. Mr. Wittenberg talks about the pain of being obese, but
also seems to revel in his business success.
While on his initial diet here at Duke Diet and staying in a scruffy
Durham motel room, Mr. Wittenberg had an epiphany: dieters like him
should not have to live in such quarters. So Mr. Wittenberg opened one
of the country's first suite motels, a two-story complex with 114
units and a central outdoor pool. It is just across the street from
the Duke center. Since opening Duke Towers in 1983, Mr. Wittenberg
reckons that he has collected $50 million in rent money from dieters.
Many of the overweight come to town in sandals, their feet too swollen
to fit in a closed shoe. Because they must exercise, one of the
dieters' first stops often is a consultation with Walter Cleary. A
74-year-old former Duke football and track coach, Mr. Cleary owns 9th
Street Active Feet. The store's $2 million in annual sales owes much
to equipping dieters with shoes like the Brooks Beast, a sneaker with
extra arch support that comes in super-widths like EEEE and retails
for $110. Shoppers try them sitting on special oversize reinforced
"Invariably, they're going to be overpronated," Mr. Cleary said of the
dieters, using a fancy word for flat-footed. "Their weight has
collapsed their arches."
The other thing he has noticed, he said, is that "none of them are
The diet programs are not covered by insurance. A few of the morbidly
obese spend their last dimes to come here. Others have enough money to
return each year for annual tuneups, and those people seem to be the
most successful, Mr. Wittenberg said.
Durham's roots as a diet capital trace to Dr. Walter Kempner, a kidney
specialist who fled Nazi Germany and joined Duke's medical faculty. As
he was experimenting with diets to control blood pressure and promote
kidney function, he found that an overweight female patient who had
eaten rice and fruit while on an extended vacation returned much
thinner and with her blood pressure under control. The Rice Diet was
born. Dr. Kempner died in 1997, and the for-profit Rice Diet Program,
which separated from Duke in 2001, is now run by a cardiologist, Dr.
Robert A. Rosati. But the program continues to have the same spartan
feel Dr. Kempner favored.
A gravel parking lot adjoins what appears to be a large white
ranch-style house. Inside, the Rice Diet House has all the decorative
appeal of a slightly upscale Veterans of Foreign Wars hall, with
Formica tables and leather sofas. The dieters start arriving at 7:30
a.m. for weigh-ins, thinly brewed decaf to avoid caffeine, and
breakfast - about a cup of oatmeal with raisins and honey, plus a bowl
of fruit. Later, they will hear lectures, go for walks, participate in
group discussions or practice yoga. In the first phase of the program,
the dieters eat only grains and fruit, a regimen that adds up to 800
calories a day or slightly more.
Lunch and dinner each consist of small portions of rice, couscous or
kasha and two fruits. Vegetables, beans and pasta are added in the
second phase, when fish is also served once a week.
Jeff Melchor, 43, arrived at the Rice Diet Program last Nov. 23 in an
old Lincoln Town Car he bought for the cross-country drive from San
Francisco. At 548 pounds, it was the only vehicle he could fit in. A
friend drove him.
As Mr. Melchor tells it, the alternative was death. His body was
covered in Ace bandages to hide sores that seemed to be related to his
diabetes. He was injecting himself with insulin eight times a day.
Five months later, Mr. Melchor has lost 150 pounds and tossed out his
insulin. He no longer needs it. His sores have healed. His shoe size
has shrunk, and he has purchased several pairs at 9th Street Active
Feet. As his diabetes has abated, he has required three different
pairs of eyeglasses, purchased at Specs Eye Care, also on 9th Street.
A team of Duke-affiliated plastic surgeons has become accustomed to
operating on people who have lost huge amounts of weight. One surgeon,
Dr. Michael Zenn, said he received about 50 referrals a year, from
dieters and from patients who had undergone gastric bypass surgery.
"They have skin hanging from their arms, they have skin hanging from
their bellies," Dr. Zenn said. "They have breasts that are empty
bags." Fixing these problems can cost around $25,000, depending on
severity, Dr. Zenn said.
Ms. Blech, who arrived here Nov. 24, 2003, carries an album with
photos of herself 12 years ago when she was a bodybuilder weighing
about 165 pounds, then a more recent version, when she weighed closer
to her peak of 468 pounds. She attributes her weight gain to emotional
issues caused by her mother's stroke-induced quadriplegia when Ms.
Blech was a baby.
Ms. Blech said the emotional issues have been more difficult to deal
with than the weight, but she has made strides on those, as well,
while in the Rice Diet's therapy programs.
Ms. Blech's 220-pound weight loss has elevated her to a special
dieters' Century Club plaque at the Rice Diet Program, a distinction
reserved for those who have lost 100 pounds or more and kept it off.
"I knew when I came down here that I was going to be broke when I
left," she said. "It's worth every single penny."
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