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On this cold Tuesday night in February, the doctor has travelled to Brampton, Ont., to recruit more patients.
His audience - some of whose bottoms take up two seats - hang on every word. But of the 50 people at the free lecture sponsored by Dr. Wharton's clinic, none are more enthusiastic than Ms. Sliwa.
Seated in the front row, she takes pages of notes and peppers the doctor with questions. She marks one point with a star: "Bariatric surgery is not a cure but a tool to change habits and manage comorbidities."
That tool is within her grasp. For six months she has religiously followed Dr. Wharton's advice. Since December, she has been consuming only Optifast - or "sludge," she jokes. That week at her weigh-in, she was 429.5 pounds - down 52 pounds.
Celebration is in order, and a few days after the lecture, Ms. Sliwa puts on a red blouse and sparkly earrings and drives an hour to Toronto for a Valentine's Day dance hosted by Curvacious, a social club for plus-sized women and their admirers.
"Here, you get unconditional love," Ms. Sliwa says.
At other nightclubs, the women say, they've endured disgusted stares, hissed "moos" and worse.
"Men think just because we're fat, we're easy!" one woman says over dinner.
But here, slender men ogle them from the bar. No one blinks when a woman pulls a cellphone from her cleavage, or kneels to tie a friend's shoelace, saving her the effort.
Bags of heart-shaped chocolates and Tootsie Rolls are passed around while gossip swirls about breakups, babies and who just lost 100 pounds.
For hours, Ms. Sliwa sits at the edge of the dance floor and delights in the spectacle, occasionally with the arm of her boyfriend, Jeff Burke, draped across her shoulders. They've been together since meeting at a Curvacious event two years ago.
He bobs off to dance, leaving Ms. Sliwa behind.
When a Bob Marley tune booms, she moves her head and waves her arms to the rhythm. "When I used to dance, this was my music," she explains.
She hasn't danced in 11 years.
For years, diet and exercise were championed as the twin strategies for weight loss. But as the obesity epidemic spreads, researchers are exploring why someone like Ms. Sliwa becomes obese.
One of those explanations is genetics. "It's very clear that some individuals are much more susceptible to weight gain than others, and some individuals have much greater difficulty losing weight than others," says Ruth McPherson, a molecular biologist and director of the University of Ottawa Heart Institute's lipid lab, where researchers are studying and comparing the genetics of thousands of lean and obese individuals.
A second, often overlooked, component is mental health. Some people turn to food to ease pain or distress - and some doctors say that these triggers can be the biggest challenge.
"Food is a comfort for all of these people, but there's some who really rely on it," says Joseph Berlingieri, an internist and cardiac specialist who runs Pounds for Health, a medically based weight management clinic in Burlington, Ont.
"It's got a different kind of power. It's their refuge. It's their security."
Doctors have begun adding counselling to their weight-management programs.
But there is an acute shortage of psychiatrists, and therapy fees can be prohibitive, Dr. Berlingieri says.
Yo-yo numbers on the scales are often the result. Dr. Berlingieri has been referred patients who lost hundreds of pounds after gastric bypass surgery, only to gain it all back.
"For those kind of people, it's very hard to deal with this [emotionally]. And that would not be the kind of person you send to surgery."
It's an overcast Friday morning in early May, but inside Ms. Sliwa's curtain-drawn living room it's even gloomier. Sunk into a chair, a cluttered table pulled up to her chest, Ms. Sliwa shifts to ease the pressure on her hips. By her elbow is a box stuffed with drugs: painkillers, antidepressants and heart medication.
"See, I told you it would be boring," she tells a visitor.
Most days, her only company is the cast of The Young and the Restless and her two cats, Mordacai and Mr. Mistoffolees. There's also Fran, the woman who stops by five days a week to cook, clean and help her bathe. Without Fran, whose services are covered by disability insurance, Ms. Sliwa would never have clean laundry. She hasn't braved the 18 steps to her basement in 11 years.