DURHAM, N.C. -- Thousands of dieters come here every year from around the world with one goal in mind - turning their flabby figures into svelte, healthy bodies.
This city, once home to the tobacco industry, has taken on a healthier image by transforming itself into the diet capital of the world, with three major weight-loss clinics that attract up to 4,000 people annually who spend more than $51 million during their stay.
The Rice Diet Program, the Duke Diet & Fitness Center and Structure House don't resemble the posh resorts where the wealthy go to drop a few pounds while getting pampered with body wraps and facials.
These are hard-core, medically supervised weight-loss programs requiring participants to check in every morning and follow strict diets.
As Americans have grown more overweight in the last two decades - with more than 60 million obese people - the weight-loss industry has worked to keep up with the demand.
But nowhere has the $40 billion a year weight-reduction industry thrived as much as in Durham, where diverse programs offer something for just about every serious dieter. With a price tag of $3,000 to $8,000 a month, plus housing, the programs, which are not covered by health insurance, are generally for people with 50, 100 and 300 pounds or more to lose and whose life hangs in the balance.
"We are here because of a calling. We are very sick people who see this as our last chance," said Joe Celi, 55, who has lost 30 pounds in five weeks.
Celi, a schoolteacher from High Point, N.C., came to the Rice clinic in 2001 and lost 70 pounds, but by the time he returned this June he had gained it back and more. To finance his second trip, Celi charged $3,000 on credit cards, took out a $4,000 loan and accepted a $1,000 gift from his daughter.
Desperate to make a new start, the clients will do almost anything to get here, including borrowing from friends, racking up credit-card debt, double-mortgaging their home and in some cases moving to Durham. But they seem to have no regrets. In most cases, during a one- to three-month stay, they quickly lose the pounds, though the success is not always permanent.
"My biggest concern was the cost," said Fran Antrim, a 59-year-old tour guide from Peoria, N.C., who spent $4,800 for a month at the Rice program plus $34 a night for a hotel. "But my boyfriend said, `You spent $6,000 for a new hot tub and didn't think a thing about it, and you won't do this for your health?'
In four weeks, Antrim said, she lost 31 pounds and was on her way to her goal of losing 150 pounds. She also said her diabetes and high blood pressure were under control, and she no longer had to take five pills a day. The Rice Diet, founded by Duke University's Dr. Walter Kempner in 1939, gained fame in the 1940s and 1950s. Celebrities such as Shelley Winters, James Coco, Dom DeLuise and Frances Bavier - Aunt Bee from The Andy Griffith Show - headed to Durham for the low-fat, salt-free, rice and fruit diet that supporters say not only resulted in quick weight loss but also controlled diabetes and high blood pressure.
In recent years, privacy laws have protected the identities of celebrities who flock to Durham to lose weight, but the who's who list includes everyone from Hollywood stars to professional football players to sumo wrestlers. The Rice Diet Program, housed in a converted restaurant that looks like a white frame house, is no longer affiliated with Duke University.
"People come here out of desperation. They have tried everything else, and it didn't work," said Dr. Robert Rosati, a former Duke University cardiologist and protege of the late Kempner who runs the Rice Diet Program with his wife, Kitty, a registered dietitian.
"People make a commitment when they come here. They are leaving their families and their jobs and moving to a strange town to live in a hotel. Maybe we are picking out the most committed people, and they do well here," he said.
Duke University started the Duke Diet & Fitness Center, which focuses on low-fat eating, nutrition and exercise, in 1969. The independent Structure House, a residential center that emphasizes finding out why its patients overeat, opened in 1977.
"We believe that obesity is a chronic disease. And for many people it is not just about weight, it's about chronic fatigue, chronic pain and low self-esteem," said Dr. Howard Eisenson, director for the Duke Diet & Fitness Center, which is housed in a former YMCA building. "We offer an environmental approach where people can experience a healthy lifestyle long enough to see what it is like."
Patients share stories of miraculous recoveries from everything including swollen ankles that put them in a wheelchair to heart disease that had left them incapacitated.
"When I came, I weighed 412," said Amy Woodall, 33, a dispatch coordinator for Wal-Mart in Palestine, Texas, who used her income tax refund to help pay for eight weeks at the Rice clinic. Her parents paid the rest.
"I have lost 48 pounds," Woodall said. "I feel like I am in a different body already."
Dahleen Glanton writes for the Chicago Tribune.