Fat Fortune for Diet Town, Usa

At first, the Structure House clinic looks like any boutique spa. The landscaped grounds host a swimming pool and a gym. Tinkling piped music seeps into the rooms of an elegant mansion house at its heart.

But one thing stands out: the size of the guests. People coming here are not on holiday. They are coming to lose weight - lots of weight.

They have picked the right town. Durham has become the weight-loss capital of America, hailed in one newspaper article as a 'Lourdes for the obese'.

As Americans' waistlines have expanded remorselessly, so have the treatments aimed at fighting the flab - and nowhere has benefited as much as Durham. The former down-at-heel North Carolina tobacco town attracts 4,000 to 8,000 people each year from all over the US to the residential weight-loss clinics that dot the city and its suburbs.

It brings in tens of millions of dollars to a local economy hit hard by the decline in the tobacco industry. 'Durham has become a mecca for weight loss,' said Dr Gerard Musante, founder of Structure House 'Nothing else exists like this. All roads lead to Durham.'

It not a cheap road, though. Structure House charges thousands of dollars for a four-week residential stay. The nearby Duke Diet and Fitness Centre asks up to $7,000 a month. But many Americans are willing to pay, some patients even taking out loans or selling their cars to afford the trip. Structure House alone has so far treated 30,000 people from all 50 American states and 35 foreign countries.

There is no surprise that Durham has been able to recreate itself as Diet Town, USA. America's obesity statistics are shocking. Studies have shown that 60 per cent of adult Americans are overweight and a quarter clinically obese. This weight gain has been fuelled by a fast food industry which has made cheap, mass-produced but unhealthy meals the nation's staple food. As a result, about 300,000 Americans die prematurely each year from causes linked to obesity.

Many who come to Durham believe it is their last chance to save their lives. Certainly that is true for Teresa Khirallah, a 31-year-old schoolteacher from Irving, Texas. She took out a bank loan to fund her stay after a doctor warned that her ballooning size meant she could end up dead or in a wheelchair. A close friend had also begged her at her 30th birthday party to lose weight. At the time, Khirallah weighed 28 stone. 'I could not even shop in plus-size clothing stores any more. I had gotten totally out of control,' she said.

A year and several trips to Durham's Structure House later, Khirallah is a changed woman. She is also much smaller, having lost about 14 stones. Her lifestyle has changed radically, too. She exercises every day, has run a half-marathon and is entered for a full marathon in Dallas in December. She intends to keep coming back to Durham, though, ever mindful that a slip in the Structure House's strict regimen of exercise and nutrition could see her start to put weight back on.

Though America has never been fatter, it has probably never spent so much money on dieting. Statistics show that Americans pay $33 billion a year for weight-loss products and services.

But Musante believes that America's problem with obesity may at last be reaching a peak. He points to the huge interest in dieting as a sign that obesity is finally being seen as a serious health problem which needs to be solved. He cites a growing awareness of health issues which has even seen fast food firms such as McDonald's try to market their food more healthily, scrapping 'supersize' portions and advertising salad options.

There are signs of increasing government involvement too. Last week New York announced plans to track diabetes patients in a similar way to the monitoring of infectious diseases. Diabetes is often linked to obesity and the condition has become commonplace as America has grown fatter. In Arkansas the state government requires local schools to measure their pupils' body mass index and send the reports back to the children's parents.

For Musante the parallel with a gradual shifting of public attitudes against smoking is clear. He expects that, just as smoking has retreated under a hailstorm of lawsuits, legislation and education, so too eventually will obesity.

'It will take a generation or two, but I think now America is looking at this generation and saying enough is enough. We have to tackle this,' he said.

Perhaps that battle is beginning in Durham. Certainly Khirallah has brought a little piece of Durham's knowledge back to her school in Texas. As her class of 20 children watched their teacher shrink, she started a scheme to help her pupils stop eating junk food and lose weight too. It was a success, with the class eventually losing 98lb between them.