"I used to not take breaks because I didn't want to walk to the break room," said Cynthia Lebamoff, a 47-year-old quality assurance technician at Mullinix Packages Inc. in Fort Wayne. At most, the break room was a couple hundred feet from her work space, she said.

Since undergoing bariatric surgery in May, Lebamoff has lost more than 120 pounds, reduced the number of medications she's taking and rediscovered fashion - no longer forced to wear whatever fits.

"My whole life has changed," said Lebamoff, who once weighed more than 300 pounds, but now weighs about 180 pounds. She hopes to lose an additional 25 to 30 pounds.

The single mother of three - ages 14 to 23 - is one of 35 patients to have undergone the procedure at St. Joseph Hospital's Bariatric Center. Administered by Dr. Dale Sloan of Indiana Surgical Specialists LLC, those patients account for all of the bariatric surgeries done in the Fort Wayne area. Since the first surgery in April growth has been swift, hospital officials say.

Many say the rewards are worth it, but the risk of complications is real as well - the combination of surgery and other health problems left one local patient temporarily comatose. While more insurance companies are covering the procedure, liability insurance premiums for surgeons performing the procedure are much higher, and many carriers won't offer the liability insurance at all.

In four years, bariatric surgeries in a 23-county area of northeast Indiana jumped from 58 from July 2000 to June 2001 to 316 from July 2004 to June 2005, according to statistics submitted by Lutheran Health Network, which includes St. Joseph Hospital. Nationally, the American Society of Bariatric Surgery estimates that 177,000 people had bariatric surgery last year compared with 50,000 four years earlier.

In addition to the rise in bariatric surgery, individuals who wish to make more minor changes - including former bariatric patients who have successfully lost a lot of weight - turn to cosmetic surgery to remove excess skin and recontour their bodies. While such procedures as liposuction have their place, doctors caution that they are not a weight-loss measure.

As for bariatric surgery, Roux-en-Y gastric bypass surgery is the most common bariatric form and the one used at St. Joseph Hospital. The procedure reconnects the stomach and upper small intestines in somewhat of a Y-shape. It closes off a portion of the stomach and reduces the usable portion of a patient's stomach to around a 2-ounce capacity - down from one liter.

By nature, the stomach muscle stretches somewhat to accommodate consumption. But overall, the procedure reduces the amount of food and drink it takes to get full, although effects on appetite vary by patient.

"It's growing more and more popular," said registered dietitian Misti Evans, manager of Lutheran Hospital's Weight Management Center and St. Joseph Hospital's Bariatric Center. Still, it's not for everyone battling obesity.

Potential patients must meet body mass requirements and provide a medical letter of necessity from a doctor, Evans said. They are screened to ensure that they will follow through with post-operative requirements, including taking vitamins. The surgery by its nature reduces the body's absorption of minerals and nutrients and limits how much patients can eat.

Post-operative patients who overeat may experience nausea and vomiting, she said. Among possible surgical complications include internal bleeding, infections and spleen injury.

But after a see-saw battle with weight, Lebamoff is confident that bariatric surgery provided her the tool she needed for a permanent fix. She's experienced no major side effects.

Not so for Sue Walstra, another St. Joseph Hospital bariatric patient. She has undergone four complication-related surgeries since her gastric bypass in July.

Shortly after bariatric surgery, Walstra, 48, began vomiting blood. She underwent surgery to stop internal bleeding required. Blood loss, along with pre-existing medical problems landed her in a coma - where she drifted in and out of consciousness for about a week.

She also underwent three post-operative surgeries for a bowel obstruction (blocked by scar tissue), pain and nausea and gall bladder removal. She has had two ulcers related to the bariatric surgery.

"It is high risk as surgeries go," said Walstra - who is also a physician, currently out of practice for an unrelated disability. "This hasn't been easy," she said.

Like Lebamoff, she no longer suffers from sleep apnea. She's seen her blood pressure drop, no longer has trouble with gastric reflux or urine incontinence, and she has avoided diabetes, which she said she believes would have otherwise been a forgone conclusion. Where she was once taking 39 medications, she's now taking a third of those.

If she had it to do all over again - even knowing about the complications - she said she wouldn't hesitate to go through the surgery. Morbidly obese most of her life, she has lost 110 pounds since the surgery (she lost another 90 pounds in preparation for her operation) and now weighs about 150 pounds.

Given the number of obesity related health problems - from Type 2 diabetes to high blood pressure to high cholesterol - she ultimately felt the risks of forgoing the surgery were greater than the surgery related risks.

Typical patients have myriad medical conditions and complications are more likely to require additional medical care, said Rich Hively, business administrator for Indiana Surgical Specialists. That pushes liability insurance premiums higher and even scares many insurance companies away altogether.

Hively said Indiana Surgical had to seek out alternative liability insurance for Sloan when he decided to start performing bariatric surgery at St. Joseph Hospital. Though Sloan had done similar surgical procedures for cancer patients, Hively said annual premiums jumped from about $30,000 to $80,000.

In addition to gastric bypass surgery, St. Joseph Hospital hopes to offer another bariatric procedure, gastric banding, by this summer, Evans said. The procedure involves using an adjustable band to reduce stomach size.

Still, since it is less invasive than gastric bypass, she said it would be a better initial fit for severely obese patients who run a higher risk of complications from surgery. After some weight loss they may then undergo gastric bypass, she said.

These days, insurance providers are more likely to cover weight-loss surgery, which was once considered purely cosmetic. This has been credited to savings insurers see in other areas of health care - such as medications - resulting from significant weight loss.

But cosmetic measures such as liposuction and tummy tucks aren't given the same credence. Health officials agree it is absolutely necessary to distinguish between the two.

Stephens, one of eight physician owners of Summit Plastic Surgery in Fort Wayne, says "body contouring" procedures are most effective after individuals have already lost weight. He stresses that patients need to be in the best shape possible to maximize the effectiveness of procedures.

Bariatric patients typically plateau about 18 months after surgery, stabilizing at a given weight and shape, Evans said. This is a good time to consider what she characterized as reconstruction, such as removing excess skin.

Other body contouring procedures include the lower body lift to smooth out leg and abdominal areas, Stephens explained. And some patients opt for arm or breast contouring to improve shapeliness.

She was fully covered for her bariatric surgery - which cost about $40,000. But it's less likely her insurance will pay for cosmetic surgery, which is typically paid out of pocket. Regardless, Lebamoff feels she has come out ahead - her life forever altered.

The most common form of bariatric surgery performed today and the weight loss procedure used at St. Joseph Hospital's Bariatric Center is Roux-en-Y gastric bypass surgery.

Connecting the stomach and upper small intestines in somewhat of a Y-shape, the surgery uses restriction and malabsorption to combat weight problems.

"It's not an easy way out," said registered dietitian Misti Evans, manager of Lutheran Hospital's Weight Management Center and St. Joseph Hospital's Bariatric Center. Rather, it requires lifestyle changes. But it's a useful tool for some who have exhausted all other options, she said.

Patients must take vitamins and be careful not to overeat, which can cause nausea and vomiting, Evans said. Regular physician contacts and support groups help patients with postoperative discipline.

•Because the stomach is a muscle, the thumb-sized result can stretch to the size of an egg and hold several ounces. But overall, the procedure reduces the amount of food and drink it takes to get full, although effects on appetite vary by patient.

•Gastric bypass surgery also changes the body's ability to absorb calories and nutrients from food to help patients lose excess weight. Through surgery, food is rerouted past a large part of the stomach and a portion of the small intestine, and much of the calories and nutrients pass through without being absorbed.

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