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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.
She's knows what's at stake. "If I don't do something now, I may only have five more years to live," she says. "I have to do this or I'm going to die."
Dr. Wharton recommended that Ms. Sliwa seek gastric bypass surgery - a drastic procedure he advises for about 5 per cent of his patients. The procedure would reduce her stomach to the size of a lemon, dulling her cravings and ability to gorge without feeling sick. Side effects can be serious, but it's the only proven, long-term treatment for morbidly obese patients, Dr. Wharton says.
To get the surgery, she would have to go on a liquid diet for up to several months. The medically supervised program, called Optifast, would shave off pounds and make surgery easier and safer.
If she lost 10 per cent of her weight, or about 50 pounds, she would be physically ready for surgery, Dr. Wharton said. But she also had to be mentally prepared. Bingeing post-surgery could bring serious complications, he warned.
"We're not operating on the person's emotions," Dr. Wharton said later. "So if [patients] still continue to binge eat or [engage in] other destructive types of behaviours, then we're now dealing with a real lethal weapon."
The American surgeon struts across the stage like a preacher.
Tall and slim with a blond crew cut, Steven Hendrick physically embodies what he promises from his scalpel. About 40 per cent of the patients who flock to his Detroit clinic for gastric bypass surgery are Canadian. In 2007, about 900 Ontarians had the procedure in the United States (the $28,000 operation is paid for by the Ontario government), compared with only 300 in Ontario hospitals (where it costs $16,000) because of bed shortages. (A recent $3.7-million infusion from Ontario should shorten the domestic waiting list).