Staff Photo by Matt Fields-Johnson Jaime Kendall of Dalton, Ga., had laparoscopic gastric banding surgery (Lap-Band) in April 2006 and has since lost 250 pounds with the help of a proper diet and exercise.

At 24 years old, Jaime Kendall never knew what it was like to ride a roller coaster.

At 5 feet 4 inches and weighing 400 pounds, the Dalton, Ga., resident was too large for the seats. She couldn't watch movies, fly on a plane or fit into traditional school desks because of her size.

"I just never felt full. I ate and ate and kept gaining weight," said Miss Kendall, now 27. "My weight just consumed me. It was all I could think about."

Miss Kendall quit college because she didn't want to leave home for class. She fell into a deep depression, and her family worried she might harm herself if she didn't lose weight.

"One time, when I was driving down the road, I just prayed to God that he would steer me into some trees," she said.

Then she heard about the Lap-Band bariatric surgery, which installs a silicone band around the top of her stomach. The process helps slow food digestion and makes patients feel full, and the band can be tightened or removed altogether as patients age.

In the three years since her surgery -- and after trying dozens of diets with limited or no results in the years before the procedure -- Miss Kendall has shed 250 pounds, and she has continued to lose weight through increased exercise and improved diet.

"Some people say, 'Oh, you're having surgery. That's the easy way out,'" said Dr. Jaime Ponce, medical director of bariatric surgery at Chattanooga's Gastric Band Institute. "But it's really just a tool for the patient. They still have to exercise and eat right."

Dr. Ponce, Miss Kendall's surgeon, has performed 2,500 other bariatric surgeries over the last 10 years. He figures he'll perform about 300 this year.

Roughly 200,000 Americans each year will have similar surgeries in a bid to lose weight, according to the Gainesville, Fla.-based American Society for Metabolic and Bariatric Surgery. From 8 million to 12 million Americans are candidates for the surgery, Dr. Ponce said, because they are classified as morbidly obese, which is considered 100 pounds over the recommended weight for a person's height.

Depending on the type of surgery, patients can expect to lose between 40 percent and 80 percent of their excess weight, doctors say. To qualify for the surgery, however, they must have a body mass index higher than 40 or be roughly 100 pounds overweight, according to National Institutes of Health guidelines.

Some thinner patients may qualify if they have a BMI higher than 35 and have weight-related medical conditions, the guidelines say.

LIFE AND DEATH CHOICE

At 35, Sonya Standridge, of Ducktown, Tenn., had already suffered one heart attack. She was diabetic, had high blood pressure, high cholesterol and took a mix of nine expensive medications a day. All of her health problems were related to her weight, which at one point hit 346 pounds, she said.

"Diets were not working," Ms. Standridge said. "My child had just turned 5 years old, and I knew I needed to do something so I could be there to provide for him."

Ms. Standridge chose the Realize Band, a newer version of the same Lap-Band surgery Miss Kendall had. Since 2007, Ms. Standridge has lost 131 pounds. Today, standing 5 feet 4 inches, she weighs a much healthier 215 pounds.

She's not the only person in her family to have the surgery. Counting in-laws, six members of her family have had bariatric surgery, she said, including her brother, Stoney, who lost 140 pounds after having Lap-Band surgery.

"As soon as I had it done, I started losing weight," Mr. Standridge said. "Before, my knees and back were killing me. Now, that's all better. My cholesterol and blood pressure have improved."

Ms. Standridge, likewise, saw all her health complications fall away. She's no longer taking medications and her cardiologist has released her from his care, she said.

COST BARRIER

The largest obstacle to getting bariatric surgery is cost, surgeons said. Depending on the type of surgery performed, the cost is between $14,000 and $20,000 in the Chattanooga area. Only about 30 percent to 40 percent of insurance covers the surgeries.

Miss Kendall, so distraught over her physical condition, pleaded with her family for the money. Ms. Standridge, a registered nurse, said her insurance would not pay, so she saved half the money for her surgery and borrowed the rest from a bank.

"We're trying to convince in the insurance companies that they really need to cover this," Dr. Ponce said. "Studies show they will save money."

Dr. Rutledge said the average diabetes patient costs about $8,000 a year in medications, so the costs of the surgery could be recouped within a few years.

Patients who drop the weight with bariatric surgery see a more dramatic reduction in obesity-related illnesses compared to people who lost their weight through improved diet and increased physical activity, studies suggest.

All the patients and the two surgeons interviewed for this story referred to the surgeries as a "tool" to assist in weight loss. And Dr. Ponce admits that it's still possible to gain weight after a bariatric procedure.

"About 75 percent of patients will maintain some or all of their weight loss," he said. "About 20 or 25 percent of the patients will regain the weight because they stop using the tool."

Mr. Standridge, who admits he was a big eater before his surgery, said now he can eat very little at one sitting. For instance, one day last week, he could eat only one taco for lunch, and that meal would tide him over until dinner.

Dr. Rutledge said patients can defeat the surgery by eating high-calorie foods in small portions over a long period.

"If you sit down and eat a whole bag of potato chips while watching a football game, you did yourself no favors by getting the surgery," he said.

A 1995 study distributed by the American Society for Metabolic and Bariatric showed that a group of 600 bariatric patients monitored over 14 years, on average, maintained a mean weight loss of 49.2 percent of excess body weight.

CONSTANT WORK

Chattanooga financial planner Warren Dropkin said his gastric bypass surgery helped jump-start his weight loss, but he said weight is a constant struggle.

"I had to learn to eat to live, not live to eat," said Mr. Dropkin, 51, who went from 372 pounds in 2007 to 220 today. "The surgery is a tool. It helps you learn to eat what you need, not everything that's put in front of you."

Mr. Dropkin, like the other patients, admits that his weight fluctuates. At his lowest point after the surgery, he weighed 196 pounds. At 6 feet tall, he was the thinnest he has been in his adult life.

But overall, the surgery "was a life-saver probably," Mr. Dropkin said. "It motivated me to get into an exercise program and I still work out three to four days a week."

Mr. Dropkin's only regret is that he didn't get the surgery earlier in life.

Miss Kendall is thankful her weight loss came when it did.

"I've been to Six Flags, I go to White Water, I love to go to the movies with my friends now," she said. "I used to hide, but now I enjoy going out. Before, I was hiding and avoiding and I don't do that anymore."