In early 2003, after years of yo-yo dieting with zero success, Marilyn Garcia -- a 5 foot, 3 inch mother of three -- weighed 260 pounds. She had trouble getting around the grocery store without the help of a motorized cart.

Garcia, then 41, decided it was time to do something that would change how she looks, as well as how she eats for the rest of her life -- she had bariatric surgery.

Surgery Explained | All About Obesity | Other Surgeries

"My choice to have surgery wasn't about getting thin for the sake of looking good. It was about getting my life back," she says. In October 2003, Dr. Paul Wizman performed a laparoscopic gastric bypass on Garcia.

Bariatric surgery is the medical term for the surgical treatment of morbid obesity. It's a drastic option for those for whom diet changes and exercise have not worked. While the perception may be that gastric bypass is a quick fix, there's nothing quick or easy about the procedure and the lifestyle changes it requires.

What Surgery Does

In gastric bypass, the stomach is reduced to a small pouch using surgical staples. The smaller stomach is then connected to the small intestine so that food bypasses the old stomach.

Other kinds of surgeries use a band to reduce the size of the stomach.

Wizman, the medical director of bariatric surgery at Northwest Medical Center in South Florida, calls the procedure the "gold standard of weight loss surgery -- the most effective treatment of morbid obesity currently available."

The National Institute of Health has set strict guidelines to determine a patient's eligibility for bariatric surgery. Once a person meets those requirements, she must undergo both physical and psychological screenings.

Shrinking Before Your Eyes

"You have to be prepared for what's going to happen in your head when you start shrinking right before your very eyes," Garcia says. "There's a tremendous high, but there's also a lot of fear -- especially about all the explaining you'll have to do to people who think if you had just eaten less and exercised more, you would not have gotten fat."

The first few weeks after the surgery were a nightmare, Garcia says.

"I was in the hospital emergency room on several occasions. I was throwing up several times a day, and the smell of certain foods would make me gag. If you had asked me six months after surgery if it had been worth it, I would have said, 'No,'" she says.

Surgery Can Cause Complications, Death

There's been much debate over the mortality rates and the factors that affect it, but in general, 1 of 200 patients will die as a result of bariatric surgery. Many will suffer complications that require additional surgery.

Garcia was one of the lucky ones. A year after surgery, she weighed 140 pounds and could eat just about everything she could before the surgery, with the exception of large quantities of sweets and milk-based products. The crucial difference was that her new stomach limited her to smaller portions.

When she eats something she shouldn't, she experiences what's commonly known as dumping. The symptoms include rapid heartbeat, nausea, tremors and a faint feeling, sometimes followed by diarrhea.

Slowly Starting To Eat Again

Before a person can return to a regular eating pattern, they must follow strict guidelines for the first few months after surgery.

"The first couple of weeks I was eating the equivalent of a tablespoon of food that had passed through the food processor so many times it was almost liquid," Garcia says. "Solid food was slowly introduced beginning in about the fourth week. But then it was only a forkful or two. The most important thing was to eat protein."

About four months after surgery, Garcia was off most of those restrictions, with a few caveats.

"I had to learn how to eat all over again," she says. "I had to eat slowly, sometimes as slow as 30 minutes to eat three or four bites of chicken. And I had to pay attention. If I watched TV or got distracted, I would eat too much or too fast for my new stomach to handle."

Supplements Needed

Three years later, not much has changed.

"I still have to work at it," she says. "I know that if I miss too many workouts, the weight will begin to creep back. I also have to take a daily dose of vitamins and get a B-12 shot once a month."

This is part of the fallout of bariatric surgery. Bypassing part of the intestine results in fewer calories being absorbed. It also prevents the absorption of nutrients and vitamins. To prevent long-term problems, gastric bypass patients must take supplements regularly.

Doctors say there is no way to predict how a person's body will respond after surgery. And while they can offer guidelines, it is up to the individuals to learn what their body can tolerate.

"I was told I would never be able to eat sweets again," Garcia says. "But I find I can eat a small piece of cake without problems. But a woman I know who had the surgery around the time I had mine can't even look at a cookie without getting nauseous."

Can Extreme Diet Alone Work?

Skeptics wonder if surgery would have been necessary had the gastric bypass patient followed the diet and exercise regime they follow post surgery all along.

"I was addicted to food," Garcia says. "In many ways, I still am. But because I have a smaller stomach, there are limits to the quantity of food I can eat."

"Studies have demonstrated that once the problem of morbid obesity has been reached, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief," says Dr. Robert Marema. "One percent or less of morbidly obese individuals is able to lose even moderate weight and keep the weight off for even a year. In contrast, the commonly performed weight-loss surgeries result in maintenance of average excess body weight loss of 40 percent to 60 percent at five years."

Marema, who is the medical director of bariatric services at Holy Cross Hospital in South Florida, has the unique distinction of being both a bariatric surgeon and patient.

"People don't know what it's like to be morbidly obese," Garcia says. "Imagine strapping a 100-pound weight on your back and jumping on a treadmill. That's what exercise is like for an obese person."

Because no operation can solve emotional dependence on food and compulsive overeating, patients also have to learn to deal with the emotions that led them to self-medicate with food in the first place.

Surgery Means New Lifestyle

Bariatric surgery is not a cure. In reality, it's just the beginning of a new lifestyle -- a lifestyle that offers no guarantees and demands commitment to behavioral changes and medical supervision. For many, the struggles continue even after the surgery.

"Gastric bypass is a tool that allowed me to drop weight so I could begin exercising and living healthy," Garcia says. "For me, it was the right decision." Other Links:

Are You A Candidate?

Risks And Benefits Of Surgery

Nutritional Counseling

Diet Changes After Surgery