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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.