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Life on the scale Add to ...

Juliann Sliwa pauses at the edge of the custom-made, extra-wide seat of her battered blue Chevrolet, summoning the energy she needs to get up.

She grips her cane and the top of the car door, then pushes down hard, levering her body upward until she stands on swollen feet, resting for a moment in the clinic parking lot.

Most people would cruise this route in less than a minute, gliding down a cement path before slipping through the glass doors and down the hall to the third door on the right. But Ms. Sliwa bears the weight of more than two large men on her 5-foot-2-inch frame.

It would have been easy to remain in the safety of her St. Catharines, Ont., home today. She drove 50 kilometres to reach this one-storey brick building in an industrial section of Hamilton. OxyContin numbs her screaming joints; Wellbutrin lifts her depression. This 2 p.m. appointment will be today's main event. She'll need a nap when she gets home. But she grinds on.

Finally she reaches the waiting room of the Wharton Medical Clinic's Weight Management Centre and slumps into a chair, grateful it has no armrests. The five-minute trek has left her winded; her breath bursts out in shallow, wheezy gasps.

She submits herself to this punishing walk twice a month, hoping each step will bring her closer to shedding the weight that has dogged her throughout her life. Now it threatens to kill her.

Getting to the clinic is the easy part.

At Ms. Sliwa's first appointment, in July of last year, Sean Wharton, a bariatric specialist and the clinic's director, asked what her goals were.

She was 42 years old and 481 pounds. "I want to tie my shoes," she told him. "I want to cross my legs. I want to dance."

Many of Dr. Wharton's patients have similarly modest goals. Some aspire to see their own photo or to take off their shirt at the beach without shame. Others want to no longer be the "fat mom" at their child's school.

The Wharton clinic may represent their best hope. Some obesity experts say its holistic approach may be a model for how the skyrocketing problem of obesity can be treated.

Here, the goal is to make patients slimmer and healthier - but also better equipped to battle the temptation of the drive-through window.

Patients are monitored, measured, prescribed medication and given diet plans tailored to their weight and metabolic rate. They also meet as often as twice a month with a dietitian and a kinesiologist. A behavioural therapist addresses the emotional triggers driving them to gorge.

The doctor visits are covered by the Ontario Health Insurance Plan, and Dr. Wharton pays the other specialists to keep them on staff. "If I have cancer, I don't pay an oncologist," he argues. "Obesity is a medical condition, therefore patients shouldn't have to pay a dime to come here."

For patients, who arrive weighing up to 600 pounds, the clinic can feel like a life raft tossed to them after a lifetime spent drowning in shame and isolation.

Many patients have stories of hospital equipment that didn't fit, or family doctors who balked at doing a pap smear. Once, Ms. Sliwa had to be weighed in a hospital laundry room.

This dearth of appropriate services in the health-care system stands in stark contrast to Canada's rising obesity rates. One in three Canadian adults are now estimated to be overweight, and almost one in five are clinically obese, according to Statistics Canada. The health-care costs associated with obesity are estimated at $4.3-billion annually, according to a Queen's University study based on 2001 figures.

Even at Dr. Wharton's clinic, Ms. Sliwa is an extreme case.

A healthy person's body mass index (an approximation of body fat), is between 18 and 25. People whose BMI is 45 or more - about 3 per cent of Canadians - are classified as Class 3 obese, and at extreme risk of serious weight-related conditions including diabetes, heart attack, osteoporosis and some cancers.

Ms. Sliwa's BMI, at her first visit, was 86.5.

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