By Carol Harbers

Recently, the Duke Center for Metabolic and Weight Loss Surgery surveyed applicants to their weight loss surgery program about their past attempts to lose weight.

They learned that by dieting, these 1,600 people had lost a total of 248,475 pounds. And then they gained it back. And lots more. Over 325,750 pounds, in fact.

“As anyone who has dieted has probably discovered, the problem is not losing weight,” says Duke bariatric surgeon Dana Portenier, MD, “but keeping it off.”

For some people with severe obesity, weight loss surgery is a life-changing experience that improves their health as well as their self-esteem.

Depending on the procedure, weight loss surgery can help people lose between 40 and 80 percent of excess weight. People who would consider weight loss surgery would have a body mass index (BMI) of 35 or over.

Someone with a body mass index of more than 40, or with a BMI between 35 and 40 with two significant medical problems related to obesity, would be considered a good candidate for surgery.

But weight loss surgery is only the beginning of the journey. Portenier answers a few questions to help put this tool in perspective:

If I get bariatric surgery, will I still be able to have Thanksgiving dinner with my family?

Absolutely. You’ll be able to enjoy the same holidays with your family that you did before the surgery -- the only thing that will change is your choices.

You’ll be eating more in moderation, and we’ve seen that after the surgery our patients naturally start to gravitate toward more healthy food choices. They report high levels of satisfaction with small quantities of healthy foods -- and they’re able to focus more on time with loved ones than on food.

I’m afraid of having elective surgery. What do you tell patients to make them feel safe?

If your BMI is high enough to make you a candidate for weight loss surgery, then it’s actually more dangerous for you not to have the surgery.

A 2004 study showed that health care costs for morbidly obese patients who diet alone are 45 percent higher than those who have weight loss surgery. Severe obesity affects nearly every organ system in the body, and the long-term health consequences of obesity cannot be overstated.

Hands down, severe obesity is simply more dangerous than weight loss surgery for most patients.

This is major surgery and you should know all the risks involved, but it’s important to note that mortality and complication rates of weight loss surgery -- when performed by experienced bariatric surgeons -- are much less than for comparable surgeries, such as colon surgery, hip replacement, and pancreatic surgery.

So while this surgery should never be taken lightly, the evidence shows that it is safe.

My BMI is 35 but I don’t know if I’m a good candidate -- how can I know it will work for me?

If you tend to gain and lose weight cyclically --  meaning you lose, then gain back, then lose, then gain back -- weight loss surgery could be a very effective tool to help you end that cycle and keep weight off permanently.

At Duke, we work with each of our patients to determine whether weight loss surgery is the right tool for him or her. Patients meet with physicians, psychologists, and nutritionists before surgery to make sure that they are set up for success after the surgery.

What happens after the surgery? How long does it take to recover, and how will I know what I can and can’t eat?

We tell our patients that they’ll need to take three weeks off of work after the surgery.

It may be that you are back in action before that, but we believe that this should be a “selfish” time -- it is a momentous lifestyle change, and we want you to have plenty of time to learn how to integrate your new self into your old life.

As for knowing what to eat, we will be with you every step of the way. We develop a lifetime relationship with our patients. They spend lots of time with our specialists before their surgery to get prepared, and after the surgery we check in with them at regular intervals.

Our behavior and nutrition specialists are dedicated to helping you thrive in your new lifestyle.

Weight loss surgery is an excellent tool, but it is only a tool -- the most important factor in your progress is you. Surgery is only the beginning of the journey.