These four clubs have earned their stripes in the fight to overcome obesity.

We pick up doughnuts at the drivethru on the way to work, order in pizza in the office so we don't have to walk to the deli, and pick up Chinese on the way home. At the movies, we snack on jumbo popcorn and gigantic boxes of licorice while we stare motionless at the screen for two hours. It's never been so easy to eat so much - or to exercise so little.

It's no wonder that so many Americans are fighting a losing battle of the bulge: According to a July 21 news story on CNN.com, 97 million American adults, or 55 percent, are considered overweight or obese. But fitness facilities have the power to turn things around with weight-management programs that teach members how to live thin in a fat world. As a bonus, such programs can serve as profit centers or member-retention tools for clubs.

Read on to learn how four facilities help their members manage their weight in an increasingly fitness-unfriendly environment.

Tilton Athletic Club: Making Connections
Credibility. If you don't have it, even the best weight-management program in the world won't fly. And when it comes to health issues such as weight management, what has more credibility than a hospital?

That was the thought which motivated Sam Young, owner of Tilton Athletic Club and president of the Tilton Shore Fitness Network in Egg Harbor, N.J., when he approached a local hospital in 1992 with the concept of a hospital-affiliated weight-management program. "They were very receptive," Young recalls. "We divided the responsibilities of the program: We did exercise, and they did nutrition education." At first, the hospital and the club split costs and revenue, but the hospital eventually did away with the wellness program that complemented Tilton's program, so now the hospital just charges the club a set fee for the services of its nutritionists.

In the Tilton program, members keep food logs and meet as a group with a nutritionist every week to learn how to decipher menus, read food labels and more. Because the program focuses on counting fat calories, every week one member brings a low-fat treat for everyone to enjoy.

For the exercise portion of the program, members receive a personal exercise program devised by the lead trainer, a Tilton fitness professional with a degree in exercise physiology or exercise science. Members meet with a personal trainer once per week for an individual session. The program works around the members' fitness levels, their likes and dislikes, and their medical restrictions - but always incorporates weight training.

"Recent data shows overwhelming evidence that strength training is at least as effective, and often more effective, than cardiovascular training for effective weight loss," Young says.

Young guarantees members that the 12-week program will work - that they will achieve the reasonable goals which they establish with the trainer at the beginning of the program. "In eight years, I have never had a graduate call me on the guarantee," he says.

Young recalls one inspiring success story: Bob, a 40-year-old deconditioned man, who always felt tired and wanted to be more active with his children. In 1994, he took Tilton's 12-week program and made lifestyle changes that he has maintained to this day. In the past six years, Bob has lost 30 pounds and 30 percent of his body fat, lowered his blood pressure and cholesterol into the normal range, and significantly increased his overall strength. He's now a full-time member of the club, and coaches and participates in his children's sports teams.

"That is why this program is so effective: It shows the clients how to live a healthy lifestyle that is maintainable - vs. other programs that offer fast results through methods that are impossible to maintain," Young says.

How does Young turn Tilton Ath-letic Club's weight-management program into a profit center? It's easy.

"You just have to generate more revenue than you spend in expenses," he chuckles. Young knows how much he can charge before encountering resistance from members, and he knows his break-even point. But what he always keeps in mind is that the program helps Tilton make members for life. "Eighty percent become members and stay members for a long time," Young says. "They're walking billboards for the club."

Westerville Athletic Club: Teaming Up With a Weight-loss Winner
Why reinvent the wheel when there are plenty of effective weight-management programs already out there? That's the prevailing attitude at Westerville Athletic Club, located in Westerville, Ohio, where the local Weight Watchers chapter meets every Wednesday.

In 1995, the general manager of Westerville Athletic Club began looking into established weight-loss programs to bring to the club's members. She was impressed with Weight Watchers' attitude that no food is forbidden. Rather than limiting, say, cookies or french fries, the program assigns points to different types of foods, and allows members to use only a certain number of points per day. The instructors also teach members how to create life-long healthy habits.

The general manager spoke with a Weight Watchers representative and learned that the organization normally rents space to hold its meetings. Westerville Athletic Club and the rep struck a deal - free space at the club in exchange for the right to use the Weight Watchers name in advertising and promotions.

Weight Watchers' initial fee is waived for Westerville Athletic Club members, though nonmembers can also participate in the sessions. Jim Matuska, the current general manager, looks at the Weight Watchers program as a retention tool and a service for members - not as a profit center. "We're not interested in creating a separate profit center," he says. "Getting members into a successful program is the biggest motivation for us." In addition, since Weight Watchers stresses exercise as part of a successful weight-loss program, participants are encouraged to join and work out at the club.

And it works. Take Beverly, who joined Westerville Athletic Club and the Weight Watchers program in 1995. She lost 25 pounds on the program and went from couch potato to fitness devotee. Beverly now works on Westerville Athletic Club's membership staff and is the club's Spinning coordinator. "She still maintains Weight Watchers' philosophy of eating normal foods, counting points and reading labels," says Matuska.

Final Results Fitness: Changing for Good
Don't be afraid to change - that's the idea behind the successful weight-management program at Final Results Fitness in Gilbertsville, Pa.

In 1986, the program was based on Dr. Ellington Darden's 10-week Nautilus diet program, one of the first to incorporate weight training and reduced calorie intake. "We started out by the book, but he had a rigid diet program," says John Wood, president of Final Results Fitness. "It's not particularly user-friendly; it has a `hold your nose and eat it' attitude toward food." So Wood and two registered dietitians of his acquaintance came up with a more flexible plan where members select the foods they like from a list of choices. The staff then prints a diet for the member with the foods he or she chose.

Besides loosening up the diet restrictions, Wood reduced the program from 10 to six weeks, which is easier to manage and makes the price more attractive. He also incorporated glycemic index values into the menu. "The glycemic index is a comparative rating system for carbohydrates based on their effect on blood sugar levels," Wood explains. "The faster and higher a particular food increases blood sugar levels, the higher the glycemic index rating." Using glycemic index tables, Final Results has chosen foods with low glycemic index levels for the program.

In addition to proper nutrition, the club's program emphasizes super-slow weight training for participants, where an interactive fitness system monitors the members' lift and drop speed. "Because super-slow exercise has standardized guidelines, it keeps participants focused on a safe, efficient, effective protocol," Wood ex-plains. "Super slow was originally designed for research on patients with osteoporosis so almost anyone can do it. Super slow is much more than simply lifting slowly. It provides a complete protocol and framework from which instructors and participants can intelligently monitor progress and modify workout variables as they progress. It makes record-keeping infinitely more accurate. It leaves nothing to question, nothing to chance. All of these factors make it ideal for the non-exerciser."

Combining these nutrition and exercise components, the weight-management program works like this: The member undergoes an evaluation and receives a personalized diet plan. The following few visits consist of one-on-one sessions with a trainer; the member engages in cardio and weight training three hours per week. Whenever the member visits the club, a staff person weighs him or her and identifies any potential roadblocks. At the end of the program, the member undergoes a post-evaluation and receives a maintenance sheet.

Wood can relate many success stories from his program, but the one that stands out the most is the story of a woman in her 70s who had been diabetic her entire life. She lost 75 pounds on Final Results Fitness's program and decreased the amount of insulin she needed by a full three-quarters - proving that for people and fitness facilities, success comes to those who change.

Wolff Health and Fitness: Teaching Basic Skills
Super-size fries, king-size candy bars, jumbo buckets of fried chicken, 62-ounce cups of sugary soda - the ubiquity of giant portions of inexpensive and tasty treats makes it no surprise that our country is facing an obesity crisis. Just telling people to avoid the bad stuff isn't enough - weight-management programs need to teach members basic skills so they have the tools they need to be healthy in a junk-food environment, says Richard Wolff, owner of Wolff Health and Fitness in Elgin, Ill.

According to Wolff, many weight-management programs fall short because they fail to recognize three truths: that weight management requires a long-term effort, not a quick fix; that most people lack basic weight-management skills; and that there's a cultural influence on our food choices that needs to be overcome if a weight-management program is to succeed. Not enough structure is another problem. "We played around with a program that was less structured, and people didn't do as well," says Wolff. "If you say, `Just eat a little less,' it's too abstract. Now they get clear, measurable guidelines."

Wolff Health and Fitness offers a 13-week Healthy Solutions program originally developed by Health Management Resources in Boston. In the 10 years since its inception, 13,000 members have benefited from this weight-management program.

New members get three personal training sessions to show them how to exercise - a basic skill that many fitness newcomers don't have. They also keep a food log (as does the staff, who are sticklers on role modeling). The club offers phone support to keep members motivated during the week. Members burn 2,000 calories each week through physical activity, and are encouraged to use portion-controlled foods such as snacks or meal replacements, which they can buy at the club. Because it's no piece of cake to make life-long changes in eating and exercise habits, Wolff Health and Fitness also offers a 12-week maintenance class. "We emphasize that we're training people on skills," says Wolff. "In this day and age, it is a skill to manage your weight."