If Linda Anthony ever needs a reminder of how important her efforts to avoid diabetes have been, she only needs to look at her computer screen at work.

Ms. Anthony, 52, of West Newton, works for the state Bureau of Disability Determination. One of her jobs is to process applications for disability payments, and sometimes, they're coming from people who have suffered the complications of diabetes.

"When you see the diabetes ones, it keeps you straight," she said.

Six years ago, she was heading for that predicament herself.

Her fasting blood sugar reading was 236 -- more than twice as high as normal. She weighed 240 pounds. She ate "whatever looked good in the fridge, and a lot of it." On vacation, she had to stop to rest while walking from her room to the beach.

Since joining a University of Pittsburgh lifestyle modification study in 2002, though, Ms. Anthony has lost 111 pounds and driven her blood sugar levels into the normal range, all without taking medication.

She walks four miles a day and eats several small meals spaced hours apart, to keep her sugar levels stable.

She could be described as an inspiration.

Unfortunately, she's also an exception.

One reason the United States is experiencing an epidemic of type 2 diabetes is not just because people are eating fatty foods and sitting around too much, but because they are resistant to change.

The international DAWN (Diabetes Attitudes, Wishes and Needs) study in 2001 showed that while type 2 diabetes patients were pretty good at taking their medication and monitoring their blood sugar, fewer than 40 percent of them followed their doctors' advice on diet and exercise.

And it's not a problem that's unique to diabetes, says Alan Deutschman, an author and business consultant.

Earlier this year, Mr. Deutschman wrote a book called "Change or Die." He laid out his premise in the introduction.

"Change or die. What if you were given that choice? For real. ... What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think, feel and act? If you didn't, your time would end soon -- a lot sooner than it had to. Could you change when it really mattered? When it mattered the most?

"Yes, you say? ... You're probably deluding yourself."

As Mr. Deutschman goes on to point out, all sorts of people, from heart disease patients to ex-convicts to employees, are unable to change, even when their lives, or the existence of their companies, depend on it.

He then explores examples in each of these areas -- the Dean Ornish heart health program, the Delancey Street community for convicted criminals in San Francisco and a Toyota takeover of an American automobile plant in California -- that have overcome this natural resistance to change.

From these case studies, Mr. Deutschman derived three principles that are vital for making long-lasting behavioral changes, and each of them, as it turns out, have been important in Linda Anthony's transformation.

He describes the principles alliteratively as relate, repeat and reframe. To stick to a new lifestyle, he said, people need to relate to a strong support group; repeat good habits that overcome bad ones; and reframe their attitude toward life.

When Linda Anthony joined Pitt's Look AHEAD (Action for Health in Diabetes) program five years ago, she said, support from her husband and son and from fellow participants became vital.

"When I started in the study, my husband and son were kind of neutral, because they looked at it as another diet, and I had failed a lot of diets before." Once she had lost 50 pounds, she said, "My husband said, 'I think you're adding 10 years to your life,' and the next thing you know, they were my No. 1 cheerleaders."

The Look AHEAD group she was in started by meeting together once a week, and even though they now meet just once a month, the mutual encouragement has been crucial.

"We not only got to tell our stories," she said, "but if somebody had a bad week we'd say, 'OK, you had a bad week and you can pick it up and go on from there.' "

Elizabeth Venditti, a Pitt psychiatry professor involved in diabetes prevention work, said that just as there is truth in the old adage that people get into trouble when they hang around with the wrong crowd, "the opposite is also true."

"If you want to be really successful, you've got to find people who are willing to go on walks with you and get together around things other than a large meal."

"Overwhelmingly," added Mr. Deutschman in an interview, "the most powerful influence on how we think, feel and act are the people we live near or work with. Peer pressure -- we all experienced that in junior high school, but through the rest of our lives, it remains a powerful force."

Ms. Anthony said that for her, the expectations of the study leaders were an important ingredient in her success. "When I was in school, if you gave me an assignment, I did it." she said. "I have to be accountable to somebody to finish an assignment."

Mr. Deutschman's "repeat" axiom is an acknowledgment that any kind of behavioral change requires sticking with a whole set of new habits.

"One of the reasons you just can't tell people to have a different lifestyle is because it involves dozens of small practices and habits and beliefs," he said. "It's kind of like learning a foreign language or a musical instrument, where there are all these little practices that you have to do again and again and again until they become instantiated in the circuitry of your brain."

And when people are starting down that path, he added, "it's important for them to have some kind of quick, clear, visible success ... to kind of prove to them that this works and they can do it."

Karen Harouse-Bell, a diabetes educator at Latrobe Hospital's Excela Health Diabetes Center, put it this way: "We usually start out with small goals, because if you start out with big goals, you have big failures."

"There's no way anyone can comply with something 100 percent of the time," she said. "A lot of times I tell my patients to follow the 80-20 rule -- if you can comply with something 80 percent of the time, you're doing OK."

Linda Anthony fit that pattern, too.

In the first two weeks of the study, she brought her blood sugar down by 100 points, through dieting and keeping a journal of everything she ate.

But the exercise came much more slowly.

After she had begun walking on a trail along the Youghiogheny River near her home, Ms. Anthony went to an exercise session at the Monroeville ExpoMart featuring TV star Richard Simmons and New Castle's Leslie Sansone, and was inspired to buy one of Ms. Sansone's walking videotapes for indoor use.

"The first time I did it I couldn't get half a mile, and I was exhausted, so I sat and watched the rest of it," she said. But eventually she could make it to the one-mile mark on the tape, and that gave her the confidence to keep pushing.

Today, Ms. Anthony walks a mile before work, another mile during a break at work, and then eats lunch at her desk and walks two miles during her lunch hour.

Pat Harper, a research nutritionist in Pitt's Department of Medicine who works with Ms. Anthony, said her story shows that "it's just a matter of deciding you're going to do it and setting up your environment for success."

And if Linda Anthony's remarkable regimen seems intimidating, Ms. Harper added, "it's good to remember that you don't have to be a Linda Anthony. Even modest activity pays off. We start people off with 10 minutes of exercise a day."

Pitt's Dr. Venditti said that in today's work and social environment, people in effect have to learn to swim upstream.

"I'm not sure we have an epidemic of resistance going on. I think what we have actually is an environment that is somewhat toxic and sets people up to consume more calories and be more inactive than they should be.

"The average desk worker could truly go through every day taking no more than 4,000 steps (instead of the 10,000 experts recommend), and the kind of work you do around the house requires less effort than in the past, so you have to make these conscious decisions to go against the tide."

Mr. Deutschman's final axiom -- reframing -- calls for adopting a new attitude to life.

Ms. Anthony understands that, heart and soul.

"I feel so good now. I wish I could have felt this good in my 30s. I could have done so much more with my son."

Just like Linda Anthony, Mr. Deutschman said, "at some point, you have to rewrite your autobiography."

He noted at the end of his book that heart program founder Dean Ornish "discovered that heart patients weren't motivated by the idea that they could live to 86 if they changed, even if they were already 85.

"They're motivated by knowing that they can enjoy and improve their lives right now."