It's late afternoon in Spring, Tex., and as usual, Patricia Oramas is rushing. She's just driven a carpool for one daughter, the other has basketball practice in an hour, and dinner is at that delicate stage of timing between never and maybe.

Even if the arroz con pollo makes it onto the back burner, the first chance the family will have to eat it will be almost 9 P.M. Nonetheless, Patricia Oramas has invested thousands in learning how to break the fast-food, eat-on-the-run routine that has contributed to her daughters' longtime weight problems--and she's determined to serve a healthful dinner at home tonight.

Across the country, in Concord, Mass., Susan Zellmann-Rohrer is also rushing--in her case, to make a quick sandwich before picking the kids up from school for horseback riding. Like the Oramas family, Zellmann-Rohrer has struggled with chronic weight problems, and she, too, believes she has found an antidote. Two years ago Zellmann-Rohrer lost 50 pounds, partly through a regimen of strength training and other exercise.

There are many roads to weight loss, but one truth remains constant: If dollars were pounds, most Americans would be thin. Last year, according to industry analyst Marketdata Enterprises, 45 million dieters dropped $30 billion--an average of $667 each--on strategies that included commercial programs, meal replacements, health-club memberships and diet drugs. So anxious were they to lose weight that they paid most expenses out of pocket; insurers seldom cover diet products and plans.

Yet obesity in this country exacts an even heavier price, accounting for more than $52 billion in direct health care expenses each year for conditions such as heart disease, type 2 diabetes and hypertension that are related to excess weight. Someone with type 2 diabetes, for example, could spend $1,000 per year to manage the disease.

About 60 million American men and women are overweight, and nearly one in three adults is considered obese. And with one in four elementary school kids overweight, the future doesn't bode much better. Says Nadine Pazder, a spokeswoman for the American Dietetic Association: "Statistics say that if you're overweight as a child, you will be overweight as an adult."

STRATEGIES THAT SPELL SUCCESS

Still, the outlook isn't all bad: Recent studies have shown that even a small weight loss--as little as ten pounds for a 200-pound person--can substantially reduce the risk of obesity-related diseases. "There is some evidence that if you can be realistic, in the long run you will be more likely to keep weight off," says Barbara Moore of Shape Up America!, a group that advocates healthful weight loss.

It's no secret that losing weight means, as Pazder says, "eating a little bit less and exercising a little bit more." Some people can accomplish that on their own. But many need help forming a plan that turns dieting today into healthful living tomorrow. Experts such as Kelly Brownell of Yale University, author of the self-help book The LEARN Program for Weight Control (American Health Publishing Co.), suggest that success requires three components: a balanced diet based on guidelines like the food pyramid, a sensible exercise program that helps you weave activity into your daily life, and a behavior-modification program--"that is, the way you think about yourself, your eating, your body," says Brownell.

Such a whole-person approach doesn't have to cost an arm and a leg. Though the Oramas family is making a sizable investment--and counts it worth the cost--Zellmann-Rohrer found her solution at virtually no cost.

TAKING THE TEAM APPROACH

For Lisa Oramas, 15, and her sister, Stacy, 13, achieving a healthy weight is an uphill climb. Their dad, Henry, comes from a family that tends to be heavy. They live in an area dotted with Tex-Mex restaurants serving copious amounts of low-cost, high-fat food. Life is busy: After Girl Scouts, church activities, music lessons and playing with brother Michael, 3, there is little time to focus on nutrition and exercise.

But last year, Lisa entered high school, and her mother, Patricia, decided to tackle the problem head-on. "I thought, If we don't get control of it now, we'll never get control of it," Patricia recalls. She signed the family up for a program called Committed to Kids, in which a dietitian, a registered nurse, an exercise physiologist and a behavioral therapist meet weekly with children and their parents.

A recent two-hour session, at the Doctor's Weight Control Center near their home, progressed from weight checks, sit-ups and stress management to discussions of how to cut the fat in that arroz con pollo and how to manage dietary danger zones such as, in Lisa's words, "my grandparents' house!"

"Of all the things we've tried, this is the only thing we've been committed to," says Patricia, whose previous outlays for herself and the kids have included a stationary bike, a health-club membership, even a personal trainer for Lisa and a group of friends. "They really weren't losing weight because we weren't monitoring their diet while they were exercising," she says. Oramas figures the family spent $2,000 on various stalled efforts.

This time, eight months into a yearlong program, the girls have had results that are good but not dramatic. Stacy has lost 20 pounds off her 5-foot 1-inch frame; Lisa, who is a few inches taller, has shed ten pounds and brought her cholesterol level down from a borderline-dangerous 201 to 180. Perhaps more crucial from a teenager's perspective, Lisa has lost enough inches to cruise the juniors department "and have something fit," Patricia says.

But for the thrill of shopping at Old Navy instead of Lane Bryant, Patricia and Henry pay a steep price. So far, they've forked out $200 a month per girl, or $3,200 over an eight-month period--none of which has been covered by insurance. That's typical, says Dr. Larry Richardson, who heads the clinic. "Insurers penalize people for being overweight by charging higher rates, but they won't cover treatment," he says. HMOs, however, are increasingly coming up with their own programs: About 60% of those surveyed by the American Association of Health Plans, a trade group, said they offered a nutritional counseling program for $25 or less; 35% offered an exercise program for $25 or less.

PURSUING THE ACTIVE LIFE

Susan Zellmann-Rohrer, a digital photographer, is the beneficiary of one such program. Several years ago, her insurer, Harvard Community Health Plan, paid almost all the cost for her to attend an eight-week weight-management course at the Lahey Clinic in nearby Burlington (her share was $40). As with the Oramases' program, sessions focused on behavior as well as diet and encouraged physical activity. She learned how to check impulse eating, cut fat to 30 grams a day, keep a food log and blend exercise into her daily routine.

Over several months, Zellmann-Rohrer lost 35% of her body weight, but her biggest challenge lay ahead. "My approach has always been, if it's new, I get very enthusiastic about it. The question was, how do you maintain it?"

Neighbor Miriam Nelson proposed a solution. A nutritional researcher at Tufts University, Nelson had been studying the effects of strength training on metabolism and invited Zellmann-Rohrer to learn the techniques. The results of her research, published in Strong Women Stay Slim (co-authored by Nelson and Sarah Wernick; Bantam Books), showed that increasing your muscle mass helps burn calories and boosts energy for other activities. The upshot: It's easier to lose weight and keep it off.

As a research participant, Zellmann-Rohrer learned free what she might have paid a personal trainer $75 to $100 an hour to teach her. Now she incorporates weightlifting into a daily regimen with other relatively inexpensive activities. The whole family, including Isabel, 9, and Michael, 11, took skating lessons last year and outfitted themselves with in-line skates. Zellmann-Rohrer runs her two African lion hounds, Zulu and Amini, hard every day in the hills behind her house. For her, such wholehearted involvement is half the battle in staying motivated. "Once I do something," she says, "I do it 110%."

Shopping for a plan that helps you lose

Any diet can work to get the weight off," says Anne Fletcher, who surveyed successful weight maintainers for her best-selling book, Thin for Life (Houghton Mifflin). "The question is, can you live eating that way for the rest of your life?"

Of the so-called masters Fletcher interviewed, about half used formal programs for initial weight loss, and the others used or adapted strategies on their own. Says Fletcher: "The message I got from successful dieters loud and clear was, you have to find what's right for you." Sources of help include: