RESTRICTED: What Life Was Like at 500 Lbs.

It was one of the most traumatic nights of her life, yet Susan Blech can actually smile as she thinks back on the evening in 2002 when she got trapped in an elevator and saw the other riders look on as four firefighters heaved her 468-lb. body up to the next floor. “I just went back to that elevator for the first time,” says Blech, who now weighs 238 lbs. “I said to my husband, ‘You see that sign: maximum weight? I’m way under that.’ I can laugh about it now.”

Being able to laugh about her old size is just one way Blech, who lost 241 lbs. during a 30-month stay at the Rice Diet Clinic, has transformed. Since appearing in PEOPLE last year, the Long Island, N.Y., native got married, left a corporate job to counsel obese kids and wrote a book, Confessions of a Carb Queen (Rodale, December), examining how she nearly hit 500 lbs. by age 38. “This is not an angry fat book,” says Blech, 42, who hopes to help others who have eaten themselves into a similar predicament. “The person will say, ‘I don’t eat that much.’ Well, of course you do. It’s just so hard to admit. I’m hoping the book will give people the impetus to admit it to themselves.”

The memoir is filled with difficult admissions. How she would cancel dinner plans with friends to stay home and binge on pizza and Chinese takeout. How she was shooed out of a lingerie shop by a salesclerk who suggested she try a plus-size store; she did, but nothing fit there, either. She even talks about sex at nearly 500 lbs. and how her mind would drift to the sandwiches and cookies she and her then-boyfriend would eat afterward. Sharing those details “is scary,” she admits. “But it was therapeutic.”

She also explores the roots of her emotional hunger: When Blech was a year and a half old, her mother suffered a stroke and became paraplegic. Yet only when doctors told her she was at imminent risk for a stroke herself did Blech take her health seriously. She quit her job and moved to North Carolina to stay near the Rice clinic. To pay for the $70,000 treatment, “I spent my life savings.”

Now back in New York City with her husband, Marty, 40, an accountant, Blech is a counselor at Brooklyn’s Live Light … Live Right program for obese children. “When I talk to a 12-year-old kid who’s 300 lbs. and he says, ‘What am I supposed to do?’ I can be so empathetic. I’ve been there.”

Next for Blech? Though she says she needs 30 lbs. of loose skin to be removed, she’s putting off surgery until after trying for a baby. She’d also like to write a Carb Queen follow-up about “how to keep it off.” Her rule is to eat what she wants—in extreme moderation. “Last year at a party, I ate one chicken wing. In my life, I’d never eaten just one chicken wing! But I wanted it, I enjoyed it and I moved on. Food is just not that important any more. It’s about living my life.”

To see video from their photo shoots, go to PEOPLE.COM/ALUMNI