Evie Vicchrilli wanted to lose 72 pounds, but she meant to lose fat, not a major organ.

After 18 months of dieting, she lost 69 pounds - and her gallbladder.In a glass jar kept in her home, nine tiny gallstones - each smaller than a pepper corn - tell the story of another diet gone awry.

Shortly before completing her diet program, Vicchrilli began experiencing sharp chest pains. The first time, her doctor diagnosed it as indigestion. Other attacks followed. Seven months after losing her weight, Vichrilli's doctor removed her gallbladder.

Since the surgery, Vichrilli has regained 25 of the lost pounds. "There were problems involved with my surgery that left me immobile. I stopped going to the spa. I stopped walking," she said.

Her story isn't unique.Thousands of Utahns annually pour hundreds of dollars each into the pursuit of a thin body and the "happily ever after" life they believe goes with it. To be skinny is to be successful, the reasoning goes.

Yet one local physician says the failure rate of each diet program is high. People shed weight only to regain it a year or so later.

"I am fatalistic about diets. They all work temporarily, but in the long run they all seem to fail," said Dr. Spencer B. Jones, an internist who's counseled many obese patients. "There really is no golden answer or all people would be thin and some doctor would be collecting a Nobel Prize."

Americans know fat isn't pretty. But few seem to understand that skinny can be dangerous.

Jones said obesity, left unchecked over time, fosters early and more severe arthritis of the weight-bearing joints - feet, knees and hips. Obese people are vulnerable to high blood pressure, diabetes and heart disease.

But Vicchrilli - and others like her - discovered that skinny can hurt, too. Other Utahns have lost their gallbladders shortly after losing weight.

Obesity causes an increased risk of gallstones, similar to the risk posed by any rapid weight-loss program, said Dr. Bruce Benowitz, medical director for Optifast programs at LDS and Cottonwood Hospitals. Benowitz is an endocrinologist and an associate clinical professor at the University of Utah Medical School.

Gallstones are made of cholesterol. As people lose weight, the fat from their fat cells gets mobilized and funneled through the liver. The fat then gets secreted through the bile ducts and stored.

With any kind of weight loss, more cholesterol is delivered to the bladder. "Yes, there is an increased risk, some, of forming gallstones if you're on one of these diets," Dr. Benowitz said.

Nationally, consumers who suffer medical complications from rapid weight loss are striking back. Company officials confirm that at least 179 people are suing Nutri/System nationwide, charging that they had to have their gallbladders removed while on the company's diet. None of the suits involve Utahns.

But company officials argue that obesity, not weight loss, causes gallbladder trouble. Their diet plan, they say, is designed to provide a "healthy and safe weight loss of from 1 1/2 to two pounds a week."

"There is no merit to those lawsuits and no connection to the Nutri/-System plan," said Thym Smith, vice president for the company.

Jones maintains people can lose up to 2 pounds per week through a "common sense diet" that comes without a hefty price tag. He advocates a balanced, low-calorie diet, a regular exercise program and outside support. "I think attending some support group is very beneficial to making a commitment to continuing the diet."

Tim G. Butler, a rehabilitation counselor at LDS Hospital, agrees. Too often programs don't evaluate a person's psychological reasons for being overweight. "We need to get more sophisticated in how we evaluate patients for treatment and the kinds of interventions we have to offer."

Butler said commercial diet programs have to stop treating all people alike.

"Commercial diets aren't necessarily bad, but their approach to clients is `jump right in. Let's get the weight off,' " he said. "They set up unrealistic expectations for people. There's not a quick and dirty way to turn the corner."

Statistics show that most habitual dieters do lose weight on commercial programs. At least, initially. However, officials with programs surveyed by the Deseret News - Diet Center, Nutri/System and Jenny Craig - said they made no effort to measure dropout rates in their programs or their clients' success in keeping weight off.

"It's very hard to measure that," Nutri/System's Smith said. "I don't think anybody in the industry measures that."

There are statistics on weight gain.

Butler said the typical American is 30 pounds heavier at age 55 than at age 25. In 30 years, they pick up 30 pounds of extra fat weight and lose 15 pounds of muscle mass. For most people, it takes two to four years of continuous work to lose 50 pounds or more.

Psychiatrist Joe C. Culbertson believes 15 percent of people wanting to shed pounds need psychotherapy, along with a weight-loss program.

"There are a few people who have therapy issues that get in the way of their losing weight with any diet program," said Dr. Culbertson, medical chief of the adult unit at Western Institute of Neuropsychiatry. He said such people hang onto weight:

- As a way of distancing themselves from people much like a workaholic doctor uses his work to avoid family intimacy.

- To avoid sexuality - something they fear.

- As an excuse for not being perfect.

But 85 percent of those who are overweight don't have psychological reasons for their extra baggage. They just have a hard time with diets.

Part of that is the individual's fault. "It's tough to lose weight and maintain that weight loss," Culbertson said. "It's not that diets don't work; it's that they don't work for everyone."

Why do diets fail? Culbertson says:

- They don't take into account individual differences.

- They don't teach long-term lifestyle changes.

- Many programs don't stress long-term commitment.

"It's easy to lose weight over the short-term but hard to keep it off," the psychiatrist said.

Vicchrilli is a good case in point. But despite the surgery and weight gain, she doesn't consider her diet a failure.

"If I had it to do over again, I'm sure I would," Vicchrilli said. "I was very happy with the program. It made a lot of difference in my life. I was so heavy I couldn't even turn in the car seat to look behind me when I backed my car out of the driveway.

"It's a good program. I enjoyed the food. They took very good care of me. But then these other things come along with it."


(additional information)

Choosing a commercial diet program

Salt Lake psychiatrist Dr. Joe C. Culbertson recommends programs that:

- Are serious and stress long-term maintenance

- Emphasize exercise

- Include individual differences - take into account that people have different lifestyles and eating patterns

- Teache facts about food; don't just give a list of food to eat

- Are medically supervised if participants have medical problems or want to lose more than 50 pounds

- Require attendance at group sessions



Are you overweight?

Weight* (without shoes)

Height Cosmetically Midly Moderately Markedly Morbidly

5'0" 120-143 143-167 167-208 208-238 238+

5'1" 123-146 146-171 171-214 214-244 244+

5'2" 126-150 150-175 175-219 219-250 250+

5'3" 129-154 154-179 179-224 224-256 256+

5'4" 132-157 157-183 183-229 229-262 262+

5'5" 135-161 161-188 188-235 235-268 268+

5'6" 138-164 164-192 192-240 240-274 274+

5'7" 141-168 168-196 196-245 245-280 280+

5'8" 144-172 172-200 200-250 250-286 286+

5'9" 147-175 175-204 204-256 256-292 292+

5'10" 150-179 179-209 209-261 261-298 298+

*Weight estimates for women only

Source: Glamour magazine from information provided by Metlife. S M M M M M M M M M M M M M M M M M M M M p p p p q 5'0" 120-143 143-167 167-208 208-238 238+