[Paleopsych] NYT: Penny-Wise, Not Pound-Foolish

[Premise Checker]

Penny-Wise, Not Pound-Foolish
http://www.nytimes.com/2005/05/19/business/19durham.html

    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
    Medical Center.

    If she is broke by then, Ms. Blech said, "It's going on the credit
    cards."

    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
    bill.

    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
    habits.

    "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
    in Durham.

    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
    and fruit.

    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
    1980's.

    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
    very significant."

    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
    economy.

    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
    benches.

    "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
    poor."

    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."