Longtime Durham residents easily spot the people who’ve come to lose weight. They see them huffing along the gravel trail encircling Duke University’s East Campus, marked by their girth, their tentlike T-shirts and their new sneakers. They watch them squeezing through the aisles at Southpoint and Northgate malls. They notice them wedging into seats at Durham Bulls’ games.
These are the clients of the city’s three nationally known weight-loss clinics — Rice Diet Program LLC, Structure House Inc. and Duke University’s Diet and Fitness Center. You might assume that the number of dieters in Durham is multiplying — driven by America’s rampaging obesity — and that they’re more visible around town.
Instead, the programs are not rushing to expand their campuses, launch satellite operations, plunge into franchising or try anything that would cause an MBA’s adrenaline to spike. They’re not in a hurry to capitalize on opportunity. For the time being, they’re satisfied with what they are. Unlike their clients, they’re happy with their size.
Even at the status quo, the business of losing weight is lucrative for the programs and for Durham. None of the clinics would reveal revenue, but dieters contribute about $30 million annually to the city’s economy –- paying the lofty fees that the programs charge, renting hotel rooms for weeks or months and buying everything from baseball tickets to the occasional illicit pizza. Slimmed-down alumni have appeared in Vogue and The New York Times and on Oprah and Good Morning America.
Public interest in weight loss is soaring. As anyone who has seen the funnel-cake line at the State Fair knows, America is fattening up. We’ve become a nation devoted to life, liberty and the pursuit of the all-you-can-eat buffet. According to the Centers for Disease Control, two out of three of us are overweight. Nearly a third are obese. In 2004, the agency declared obesity the No. 1 threat to the nation’s health because of its link to diabetes, hypertension and a host of other ailments.
Those extra pounds could translate into larger profits for Durham’s programs. The city draws about 3,000 dieters a year, from around the country and the world. It could attract many more. But presented with the chance to gorge on more of the $40 billion — at least — that Americans spend annually on dieting and weight loss, Durham’s programs prefer to nibble.
The Rice Diet Program’s boss says expansion would hurt his ability to serve his patients. “Once you get past about 70 to 80 people at a time — and we’ve been up to about 110 –- it’s hard to give everybody the personal attention that you’d like,” says Robert Rosati, a cardiologist who, with his wife, Kitty, owns and runs the program.
At Structure House, psychologist-owner Gerard Musante says he’ll expand “when the conditions present themselves.” He points out that he has added programs for diabetics and for folks who’ve had stomach-stapling surgery, even if he isn’t planning new buildings or a facility elsewhere.
Duke’s Diet and Fitness Center offers weights for the weighty. Waistlines start wasting away.
The Diet and Fitness Center — DFC for short — could grow more easily. Its building has plenty of room, and it has the backing of a big parent in Duke. But university bureaucracies aren’t known for nimbly responding to financial opportunity, unless it involves sports facilities or sweat shirts.
The father of this weight-loss wonderland was Walter Kempner, a German doctor and researcher who joined Duke’s faculty in 1934. He was seeking a treatment for hypertension when he came upon his now-famous diet. His daily regimen of rice, fruit and vegetables was less than 1,000 calories. Originally, he wasn’t trying to limit calories, just cut salt and fat.
The diet drove down blood pressure — and weight. His program led to the rise of the other two and the city’s growth into a weight-loss Mecca. Kempner’s flinty charisma contributed as much as his menu. “He had a commanding presence, and a lot of people did it because he told them to do it,” Rosati says. “It wasn’t, ‘What do you mean?’ He said, ‘Do it,’ and they did it.”
Kempner didn’t have much use for psychotherapy or hand-holding. In a lawsuit filed near the end of his life — he died in 1997 at 94 — a former patient claimed that he spanked her and a few others when they strayed from his regimen. In a deposition, Kempner admitted he had — but only because they had asked him to.
He operated with an autonomy Duke today reserves only for its men’s basketball coach. Though affiliated with the university throughout his career, Kempner’s program operated from several bungalows near downtown. Clients went there for meals, going onto campus just for medical appointments and walks. “They’d have breakfast, lunch and dinner at the Rice House, and it would close in the interim,” Rosati says. “Kempner would tell them to take a walk in the morning and a nap in the afternoon.”
Durham was a perfect hideout for desperate dieters. Midway between Florida and New York, its distance from Washington, Wall Street and Hollywood let celebrities slip in without being bothered. And if Fat City was Dullsville, so much the better. The high life was what had landed these folks in Durham in the first place. Harland Sanders, the fried-chicken king, came. So did actor Lorne Greene, U.S. Supreme Court Justice Stanley Reed and Hee Haw star Roy Clark. Crooner Frank Sinatra sent his mom. Comedian Buddy Hackett was a repeat customer.
Rosati joined the Rice Diet staff in 1983. Kempner was cocksure and militant; Rosati is amiable and low-key, wearing his learning as lightly as an old cotton T-shirt. While running Duke’s cardiac-rehabilitation program, he became convinced that diet, more than anything else, even bypass surgery, lengthened heart patients’ lives. He started working with Kempner part time, visiting to check blood pressures and weights and discuss clients’ health. Within a few years, he shifted to full-time employment in anticipation of Kempner’s retirement.
Robert and Kitty Rosati rule the Rice Diet with simplicity: To lose, eat just what we say.
Kempner stopped working in 1992, shortly after the program moved to its current site on a mostly residential street in north Durham. It’s a low-slung, white clapboard structure that looks something like a barbecue joint — minus the inevitable smiling pig. Nestled in a stand of old oaks, it has a gravel parking lot and a motley cluster of newspaper racks. Next door, the medical offices occupy a small turn-of-the-20th-century schoolhouse.
“This doesn’t take bells and whistles,” Rosati says. “If you build a swimming pool, it costs money, and you’ll have to pass that on to the patients.” His prices are lower than the competition’s. For a new client, a month of the Rice Diet costs $4,800, while one at the DFC is $6,995; neither includes housing. A month at Structure House, which furnishes well-appointed rooms for its clients, can cost as much as $9,150. Of course, the two pricier programs include low-calorie menus that are more varied than the Rice Diet’s.
Its no-frills approach seems rooted in Rosati’s personality. “Kempner always used to say, ‘It’s what happens here, not how the place looks, that matters.” Rosati is opposed to making the program more like a spa. “The problem with a spa is that you go there and you’re out of the world. When you come here, you have to drive past Bojangles’, and you have to drive where you go to exercise. It’s like real life. I don’t see any reason to make it more complicated.” Over the years, he has added classes on nutrition, meditation and yoga. But he has about 20 employees, compared with about 40 at the DFC and 45 at Structure House, even though each program treats 1,000 people a year. Rosati tries to keep it simple.
In 2002, Duke approached him about severing his link to the school. Long expecting Kempner’s retirement, Duke had started the precursor to the DFC in the ’70s. The university also was running a third diet-and-exercise program, now called the Center for Living, for heart patients. “Part of Duke’s problem was that, when people called up, the idea of saying they had three programs bothered them,” Rosati says.
Outwardly, little changed after the Rosatis took ownership of the program. Robert continued monitoring patients’ ailments and vital signs. Kitty, who had arrived about a decade earlier as the Rice Diet’s first nutritionist, oversaw patients’ education, importing principles from Alcoholics Anonymous and teaching them how to hew to the diet after going home. On average, men arrive at Rice House weighing 280 pounds and lose 30 in their first month. Women, typically 210 when they come, average losing 19 in a month. Psychochatter flows as freely at Rice House as the water with a twist of lemon, about the only beverage clients are allowed. Talk with Kitty, and clients aren’t gluttons; they’re addicts.
She has published two diet books and is more eager to expand than her husband. Still, like him, she’s unwilling to license the name and says they’ve never met the right partner with whom to launch, say, a West Coast branch. But she’s open to other possibilities. “We just got an offer to open a program in Turkey,” she says. “This guy and his brother came from Turkey and did the program, and he had incredible results. He’s hot to do something, and he owns a fancy hotel there. But I haven’t been able to interest Rosati.”
If the Rice Diet resembles a 12-step program in a roadside restaurant, the Diet and Fitness Center still looks much like the YMCA it formerly was. It’s filled with badge-wearing staffers scurrying here and there and customers who come and go freely. Patients weigh in daily at Rice House, weekly at the DFC. The Rice Diet is regimented — you eat what they tell you — but the DFC is relaxed. If you want a small piece of steak, fine. Caffeinated drinks? They’re fine, too, if sugarless.
So what is required? “If you’re not going to classes and meals, they’ll ask you what’s up,” spokeswoman Becky Oskin says. “But there are no requirements per se. The main idea is to get in a lot of exercise.” Duke tries to make that easier — or as easy as it can be for those whose heart rates soar when they stroll across a parking lot. Unlike the Rice Diet, which urges clients to walk but has no gym, the DFC has a big one and a heated pool.
Musante, Structure House’s founder, helped start the DFC in the ’70s. While there, he came to believe that people’s weak wills prevented weight loss more than their tireless stomachs. Those who come to Structure House, he says, “know what to do, but they’re not doing it.” Anna Stout, the psychologist who leads his research and clinical staffs, elaborates: “The focus of this program is more understanding psychological issues that lead to the abuse of food, and we talk a lot more about understanding our clients’ relationship to food.” Each day, dieters enter their weight in the program’s computer and answer three questions: Were you structured in your eating? Did you exercise? Did you keep your eating diary?
This is the cushiest of the programs. On a quiet side road not far from a large shopping-and-office center, its 21-acre campus fronts a building that looks like a midline business hotel -– a Homewood Suites or a Marriott Courtyard. Rocking chairs line the deep porch. The manicured lawn is accented with tidy flower beds. Pillowed couches fill the lobby. The similarity to a hotel isn’t accidental. Unlike the other programs, Structure House provides lodging. The nearly 80 one- and two-bedroom apartments are equipped with recliners because some customers are so heavy they can’t sleep flat on their backs. Like much of the furniture, the recliners are specially made for large people.
Musante says the decision to build apartments arose from a combination of his background — psychologists often are experienced in residential treatment and are more comfortable with the idea than physicians, he points out — and plain prudence. “One of the problems I saw [with the DFC] was that people were spending a lot of energy trying to find a place to live. Hotel rooms were cramped and expensive, and this is a very involved program. It just made sense to put it all under one roof. I wanted it to be comfortable and homelike.”
He comes across as more of an entrepreneur than his buddy Rosati. Friendly competitors, they occasionally have lunch or dinner together. At Structure House, he leaves little to chance. Musante’s clients never have to leave campus. Everything is here — meals, lodging, gym, pool, medical appointments. And while not rushing to cash in on the surge in obesity, he doesn’t oppose expansion the way Rosati does.
“We’ve been approached throughout the years about a facility in another part of the country, and there could be one in the West. The problem is that all the folks I’ve met over years, I’ve just not found a group of people who I felt comfortable would be able to make it happen. If we could find a group, we’d be supportive.”
Structure House could see more people at its campus and would be happy to, he says. “In addition, only half of our land at this campus is developed. So we definitely have room to grow. I have always approached what we do here in a very organic way. We know how we would expand, so in that sense we have plans, you might say.”
Durham is magnetic for dieters. Structure House’s Gerard Musante counsels a client from London.
In the Structure House lobby is a flier that hints at a secret of its business success — as well as that of Rice House and the DFC — and its shortcoming as a panacea for its clients’ woes. The brochure offers discounts to those who book another visit before they leave.
Staff at all three programs concede that, though plenty of participants stay trim, people tend to gain back some of their weight. About two-thirds of those coming to Structure House are returnees. The other programs also rely on repeat business. “As hard as it is to lose weight, keeping weight off is much more difficult,” Stout says. “We try to dispel the notion that coming back here is a failure.”
That stance is psychologically realistic and economically pragmatic. Encouraging people to return makes sense for their waistlines. It also benefits the programs, turning a one-time sale into an annuity.
Bob Sapnar, an insurance salesman from Hampton, N.J., first tried Structure House four years ago. He weighed 232 pounds and had failed to slim down with Weight Watchers, Jenny Craig and Atkins. In four weeks at Structure House, he lost more than 30 pounds. But the weight keeps returning, and so does he. After a three-week visit this spring, he was down to 191. “I was absolutely committed to get to 180. So I’m planning to come back in October.”
Perhaps that’s part of the reason for the lack of urgency about growth in Durham’s diet programs. It’s reassuring to know that folks who come to lose 30 pounds this year will probably return to lose them again next year.