As she sat atop the remains of the patio chair that crumpled under her weight, Jean Anspaugh realized it was time -- time to leave law school, leave her home in California and head for the "diet capital of the world."
"I had an epiphany," she said. "I thought: That's it, I can't even feel secure in my own house. That's it -- I'm out of here. I sold everything. I sold my house. I sold everything I owned just to go to Durham and lose weight."
Anspaugh is among the thousands who flock every year to Durham, a city of 187,000 that is best known as a fading tobacco capital and home to Duke University. But for those desperate to lose weight, it is a place of pilgrimage, a place so sacred that some who have lost weight at one of the city's three major residential clinics have returned to sleep in a hotel for a night or two -- just to be close to Durham.
"This is indeed a mecca," said Gerard Musante, a clinical psychologist who founded one of the clinics, Structure House. "People have come to us from all over the country. People have come to us from other countries."
Anspaugh, 50, struggled with obesity all her life and at one point tipped the scales at 300 pounds. After dieting, using prescription diet pills and binding herself in restrictive undergarments, she believed Durham was the only answer.
"To me, it was the Emerald City," she said.
Since the mid-1980s, when she came to Durham from Sacramento, she has lost about 100 pounds over two collective years at the Rice Diet Program. Now living in Fairfax, she has kept off about 80 percent of that weight loss.
People whose weight is a major health concern often need to put everything in their life aside so they can accomplish their goals, said Robert Rosati, who has worked at the Rice Diet Program since 1983. So do people who merely want to commit to a major life change.
"The reason, I think, that people who come here are more successful is, when you come here, you have made a huge commitment," Rosati said. "You have to uproot yourself, it costs a lot of money and you have to leave your wife at home."
The Rice center was the first to open in Durham, in 1939. Three decades later, Duke University opened its Duke Diet and Fitness Center, followed in 1977 by Structure House. Each residential clinic offers a distinct program for weight loss, and stresses follow-up support methods so patients can maintain their success after leaving Durham.
Durham has become a weight-loss hub because it is where doctors and researchers first started looking at obesity from a scientific and psychological perspective, Musante said.
"Back when we started, people didn't know really where to go for this problem," Musante said. "And we were the only people working on it, so Durham became that area."
And the residential model is hugely attractive to those who come to Durham. Teresa Khirallah, 31, of Irving, Tex., arrived weighing 355 pounds, scared by a warning from her doctor that in 10 years, she would either be in a wheelchair or dead.
While at the center, Khirallah wore a swimsuit in front of other people and took a self-defense class -- things she would have been far too embarrassed to try outside of Structure House. She lost 22 pounds in her four-week stay and then continued to lose after leaving and now weighs 198 pounds.
"It's almost like your own private life to try out things that you always wanted to do in a safe environment," Khirallah said. "Where you could do these things and not worry. You were able to take risks."
The privacy offered by the clinics, and Durham's relative anonymity among the celebrity and fashion capitals of the world, is also a major selling point. Over the years, such celebrities as James Earl Jones, Harry Wayne Casey of KC and the Sunshine Band, and comedian Buddy Hackett have ducked into Durham to lose weight.
Andre Leon Talley, the 56-year-old editor-at-large at Vogue magazine, came to Durham when he found himself dressing differently to hide a weight gain. The New York City resident lost 28 pounds in seven weeks at Duke and hopes to lose another 28 over the next year.
"It is a wonderful place of well-being," Talley said. "It's a place of positivity. You can reach the goals that you set for yourself."
Spending time at one of the diet centers in Durham isn't cheap. Duke, for example, charges new patients up to $7,245 for a four-week stay. Each year, the diet centers generate an estimated $51 million in spending in Durham. That is the equivalent of the spending generated by the 4,000 meetings and conventions the city hosts each year.
"There's not a whole lot that we do to encourage them to visit," said Shelly Green, an executive of the city's Convention & Visitors Bureau. "They come because of the diet and fitness centers."
Experts caution that losing weight does not require something as radical as spending the time and money it takes to enroll at a residential facility. Small, gradual diet adjustments can also be effective, said Dawn Jackson Blatner, a registered dietitian with the American Dietetic Association.
"The idea of doing something radical to kind of shake it up can really spur people," Blatner said. "Because the idea is that success can spur success . . . but I believe that small changes can make a big difference [too]."
Those who have experienced success in Durham swear by the residential approach. Anspaugh even said she dreams of taking extended stays at each of the city's diet centers.
"I used to know people who came from New York to rent a hotel in Durham just to be in the same city where they lost weight," Anspaugh said. "I used to think they were crazy, but now, I kind of understand. It's something about being there."
Executive Chef Andrew Craven prepares skinless chicken breasts at the Duke Diet and Fitness Program, one of three weight-loss centers in Durham, N.C.