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Weightloss in Durham, North Carolina

In 1939, when the cardiologist and German émigré Walter Kempner founded his spartan Rice Diet program at Duke University to combat disease, he could not have imagined what would result. Thousands of pilgrims now visit the second-, third-, and fourth-generation fat farms the Rice House spawned, making Durham, North Carolina, America's mecca for the overweight.

Operating from a former schoolhouse, the no-frills Rice program still promotes the spare simplicity of a primarily rice-based diet and an hour a day of walking. But it is Rice's stepchild, Duke University's Diet & Fitness Center, that has developed into the most extensive weight-management facility in the country. Housed in an old YMCA, the DFC offers clients a rigorous reeducation in the psychology and physiology of eating. Across town, and also part of Duke's offerings, the tony Center for Living campus provides high-end dieters with dream-team consultations. And down the road is Structure House, where onetime DFC psychologist Gerard Musante takes a behavioral approach to weight loss. I decided to skip the austere rice-diet regime and find out what makes the new programs the latest in diet technology.

The center for living's three-day health retreats are designed for CEO's and other potentates. The day I visited, staff members were bustling around a real prince and princess, or so they said, who had flown in for the works. That meant a daylong physical, fitness and psychological assessments, personalized exercise programs, and intensive stress-management training. My trainer and masseur, both of whom had M.B.A.'s, talked with me about managing my daily routine, my exercise time, even my difficult family members. Greg, not just a trainer but a human performance specialist (I couldn't help but wonder what that entailed in his off hours), responded to my request for on-the-road exercises with an eight-page treatise. The concept was simple: resistance. With a set of rubber tubes and handles, I'd be able to keep to my program anywhere. After he ran through a routine I could do on my morning dog-walk, Greg showed me the modified versions to be used in a hotel room, while riding in a car, and even while stuck in an elevator.

The Center for Living isn't the only place in town where you can be sure that your bodily needs will be met with an arsenal of intelligence. At her nearby cooking school, faculty wife and Sichuan native Lan Tan offers witty classes on delicious low-fat, low-sodium Chinese cooking. In the grocery stores, local shoppers often gather around field-trip groups to listen to nutritionists compare labels. The salespeople at Durham's most popular sneaker store, 9th St. Active Feet, all have degrees in physiology and sports medicine; after a precision measuring, they select brands that specially correspond to your foot shape and gait, encourage you to test-jog each model on the street, and then customize the shoe with orthotic devices and inserts.

It's no wonder that you run into people like Jan Croft everywhere you go. Croft, a lively retired chemist in her fifties who trekked to the base of Mount Everest after losing 75 pounds at DFC, is one of hundreds of people who have moved to Durham because they cannot imagine maintaining their hard-won health anywhere else.

Durham's bread and butter, however, is not the permanent converts or the jet-set fat cats, but those who return again and again seeking long-term life change. And that's where Duke's Diet and Fitness Center comes in. The area around DFC can be kind of rough; at night, across the train tracks abutting its parking lot, prostitutes congregate, and there is occasional gunfire. But DFC clients are willing to endure the dicey neighborhood, the abysmal service of the motel across the street (the Duke Tower Residential Suites), and the no-frills cafeteria-style meals in a dining hall of painted cinder block. What they get in return is access to extraordinary doctors, nutritionists, and trainers, who convey low-hype, high-fact information as if they were talking with a colleague. The program's one-month cycle of classes covers everything from "How to Eat Just One Raisin" to "Making Peace with Exercise."

I decided to check in for two weeks. One evening, while contemplating whether the duke tower = diet power signs along the walkway reflected a deeper truth, I spied a an enormous Domino's pizza being delivered to the room of an equally enormous woman from Tucson. It was of course she who tended to dominate class discussions with her knowledge of the precise calorie differentials among the various foods we were served.

Over meals whose portions ranged from "kiddie" to laughable, I was getting a second education. My fellow inmates made up for that empty feeling by trading food lore in an Esperanto of lust, as if they were prisoners hatching escape plans. When I mentioned I was from Pennsylvania, a corporate pilot recounted impromptu flights to his Xanadu, an Allentown hot dog stand named Iacco's–down to the perfect ratio of condiments. A major-league pitcher trying to slim down before spring training contributed a Joycean monologue on the juiciness of the Wrigley Field frank. The next night, a housewife who had ballooned after her husband's death revealed her secret vice: rolling scoops of butter pecan ice cream in crushed pork rinds to produce the consummate sweet-yet-salty midnight snack. After I confessed to a compulsive tendency to gobble multiple packs of Twizzlers in airports, a 450-pound millionaire developer recalled his nine-hour binge in every fast food drive-through he came across on his way down.

Like many I met, the developer was a Durham regular. I could see why. Among my people–all of us locked in the same cycle of hope and despair–I could feel myself putting down roots. My motel neighbor, a 34-year-old comedy writer, had tried DFC two years back; now he was spending three months on the rice diet whose severity had scared me off. DFC's moderate approach was bogus, he said, as he offered me a stein-sized glass of wine. He knew he'd be returning to Durham every few years for the rest of his life. Then he announced his plans to celebrate the loss of his next 20 pounds: a four-day eat-a-thon in New Orleans, organized around personal cooking lessons with a famous chef.

At my third–and last–stop in Durham, the life-change intervention reached an entirely new level. The grounds of Structure House are exquisitely manicured, its apartments spacious and comfortable, the tasty meals served by waiters. Here nothing is left to chance. I was instructed to weigh in daily in front of a computer screen that asks, "Were you structured yesterday?" I was given the option of hitting yes or no. Orwellian dining-hall plaques exhort: "You have come to Structure House because you have a serious problem. Dr. Musante wants to help you deal with that problem."

As part of a program orientation session, Musante explains to new clients how incorrect their thinking is. According to him, there are two kinds of eating–structured and unstructured. Apparently, people tend to engage in unstructured eating for three reasons: habit, boredom, and stress. The predominantly female, Canyon Ranch crowd of "incorrect thinkers" had, for the most part, embraced the program's cultish ethos and took umbrage at the merest whiff of irony. Two days into my weeklong stay, a waiter accidentally served me an extra potato with cheese, creating a huge, 700-calorie lunch that was clearly a mistake. I joked, "Mine, all mine!" and the entire table fell silent.

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