Things hit the "big crescendo" for Marci Williams in December 2005.

Williams, 47, of Greensboro, N.C., had been obese for some time, weighing as much as 332 pounds at just 5-foot-3.

That month she went to her family doctor for a routine physical. The physical changed her life.

"That day, I left her office with a couple of medications for high blood pressure," Williams said. "The following day, I got a call that I needed to go to her office to get a referral to a diabetes educator, who would teach me how to inject insulin." Her fasting blood-sugar level indicated that she had developed diabetes.

Within a couple of weeks, Williams learned that her cholesterol was also off the charts.

"It was outrageous," she said. "The doctor's office called to let me know I needed to be on two different cholesterol-lowering medications as soon as possible."

Williams had metabolic syndrome, a major risk factor for heart disease. The diabetes, cholesterol and blood pressure were combining to wear out her heart prematurely. And her body already was showing signs of damage.

"My resting pulse was in the 120-something range," she recalled. "That's a racing pulse for most people, and that was my resting pulse."

Her doctor referred her to a cardiologist, who performed some tests and laid it out plainly for Williams.

"I just knew the minute he walked in this wasn't going to be a very good appointment," she said. "He said, 'You know, you are not going to live to see 50 if you don't lose this weight.' He made it very clear to me that all these things that were happening to me were symptoms of obesity, rather than stand-alone illnesses. His advice to me was (that) we can treat all of these symptoms, but the only way to cure this is to lose the weight."

First things first. Williams underwent angioplasty in January 2006 to open up her arteries and relieve her racing pulse. The procedure went well, and she had no significant or permanent damage to her arteries.