Beneath his quick smile were years of pain. The 29-year-old small town Ohio mayor weighed nearly 400 pounds. Since childhood, he'd endured taunts like "Tubby" and "Lardo."

Finally, suffering from high blood pressure, gout and zero self-esteem, he listened when he doctor said: "Do something about the weight, or be dead by 40."

After numerous failed diets, he opted for gastric bypass surgery. It reduced his stomach to the size of an egg. No longer could he gorge. There was just no room for the excess food.

Also called bypass surgery, gastric banding, obesity surgery and Roux-en-Y gastric bypass, if, like the Ohio mayor, you're obese and diet and exercise have failed, the procedure might also be an option for you, says the National Institute of Diabetes and Digestive and Kidney Diseases (http://www.niddk.nih.gov/).

A newer procedure, called the Lap-Band, places a band around the upper part of the stomach. This creates a small pouch to hold food, limiting the amount of food you can eat, and increasing digestion time. The band can be adjusted later to allow food to pass more slowly or quickly through the digestive system. Possible complications include gastroesophageal reflux, nausea and vomiting.

Being grossly overweight is a major health problem in the United States, causing as many as 280,000 deaths per year, according to the American Medical Association (http://www.ama.org/). The AMA says that obesity is associated with many other health risks, including hypertension and type 2 diabetes mellitus.

Men who are at least 100 pounds overweight and women who are at least 80 pounds overweight may qualify for weight loss surgery. If you also have diabetes, heart disease or sleep apnea you may still qualify even if you aren't as significantly overweight.

The surgery limits the amount of food you can take in, says the AMA. Some operations also restrict the amount of food you can digest. Many people who have the surgery lose weight quickly. Keeping the weight off depends on how rigorously you follow diet and exercise recommendations. Infections, hernias and blood clots are possible complications and risks of the surgery.

The Food and Drug Administration (http://www.fda.gov/) lists the following risks:

Digestive

• Nausea and/or vomiting
• Gastroesophageal reflux
• Constipation
• Diarrhea
• Abnormal stools / Constipation

Body as a whole

• Abdominal pain
• Death
• Infection
• Fever
• Hernia
• Pain
• Chest pain
• Incisional infection
• Incision pain

Miscellaneous

• Abnormal healing
• Alopecia (hair loss)

The AMA says such complications can be related to how experienced your surgeon is, as well as patient conditions, such as sleep apnea and hypertension. Still, gastric bypass surgery is one of the most commonly offered surgical procedures for the treatment of obesity and appears to offer the best long-term results, according to the AMA. The Association cites studies that support the use of laparoscopic incisions as being at least equal in positive result to open gastric bypass, which requires a large abdominal incision.

Risks, according to the FDA, include:

Band- and port-specific

• Band slippage/Pouch dilation
• Mechanical malfunctions - port leakage, cracking of the kink-resistant tubing or disruption of the tubing connection from the port to the band
• Port site pain
• Port displacement

The National Institutes of Health (http://www.nih.gov/) says weight loss surgery reduces calories in two ways:

1. You eat less at any given time because you feel full faster. This is because the size of the stomach has been reduced.
2. Fewer calories are absorbed because part of your stomach and small intestines are literally bypassed. You may, however, lose nutrients as well.

Strict criteria determine who is eligible for surgery. They include:

A Body Mass Index (BMI) of 40 or more. According to the AMA, BMI is a calculation based on height and weight. It determines whether a person is of normal weight or is overweight. The AMA says someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.

• Your BMI can be just 35 or more if you also have a life-threatening illness such as sleep apnea, type 2 diabetes, and heart disease that may improve with weight loss, says the AMA.

No surgery will be performed until your doctor has given you a thorough examination to evaluate your general physical condition.

You psychological readiness for the surgery will be evaluated as well. Specifically, your doctor will determine if you will embrace a healthier lifestyle. Without changing your lifestyle, the surgery will fail.

Presurgery consultation will give you the nutritional counseling you need to succeed.

According to the NIH, the surgery involves two steps:

STEP 1 -- The first makes your stomach smaller. Using staples, the surgeon will divide your stomach into a small upper section and a larger bottom section. The top portion, called the pouch, will hold your food.

• STEP 2 -- The surgeon will connect a section of the small intestine to the pouch, through which food will pass. The food will bypass the stomach's lower portion. The new connection is called a "Roux limb." Its base is reconnected at the bottom of the stomach, in a y shape. The "y-connection" lets pancreatic fluid and bile mix with food, which aids absorption of vitamins and minerals, although you may still miss important nutrients. This risk is higher in gastric surgeries that bypass a larger portion of the small intestines. Such surgeries are used less often than Roux-en-Y gastric bypass.
• As mentioned, gastric bypass can be performed using a laparoscope. This less-invasive technique allows the surgeon to make smaller incisions. This in turn lowers the later risk of large scars and hernias.

To use the laparoscope, small incisions are made in your abdomen. The laparacope, or camera, allows the surgeon to see inside your abdomen to perform the surgery.

Not everyone is a candidate for the laparoscopic weight loss surgery. If you weigh more than 350 pounds, you may not be eligible, according to the NIH. Scarring from past abdominal surgeries may also render you ineligible.

Other risks of gastric bypass surgery, according to the NIH, also include:

• Bleeding
• Infections
• Follow-up surgeries to correct complications, or to remove excess skin
• Gallstones due to significant weight loss in a short amount of time
• Gastritis (inflammation of the lining of the stomach)
• Vomiting from eating more than the stomach pouch can hold
• Iron or vitamin B12 deficiencies (if they occur) can lead to anemia
• Calcium deficiency (if it occurs) can contribute to the development of early osteoporosis or other bone disorders

Follow up surgeries may be less likely if gastric bypass is performed with a laparoscope.

Another common complication from gastric bypass, according to the NIH, is "dumping syndrome." The symptoms often include:

• Nausea and vomiting
• Diarrhea
• Bloated feeling
• Dizziness
• Sweating

Following your dietitians guidelines - especially during the first two months of surgery - can reduce these symptoms.

After gastric bypass surgery, most patients lose an average of 10 pounds per month. Weight stabilizes between 18 and 24 months after surgery. In the beginning, when patients are on liquid diets, the greatest weight loss typically occurs.

During regular follow up visits, your doctor will assess your physical and mental health status, including any change in weight and your dietary needs.

The surgery is not a quick fix. You'll still have a lot of work to do. Diet and exercise remain key.

After surgery, most patients usually stay in the hospital for a few days or less, although a 4-5 day stay is sometimes needed. You'll be able to go home, says the AMA, when you can move without too much discomfort; hold down liquid and/or pureed food, and no longer need injected pain medication.

At home, you'll eat small meals frequently throughout the day, once you're past the liquid diet at home regimen.

You won't be able to handle large amounts of fat, alcohol, or sugar and should cut back your fat intake, especially fast food meals and sugary desserts.

You may benefit from joining a support group of others who've had weight loss surgery. Exercise can resume after 6 weeks, although you'll be able to take short walks sooner.

Weight loss, which can take up to a year and a half to stabilize, may result in unsightly excess loose skin. According to the Cleveland Clinic (http://www.clevelandclinic.org/). A cosmetic surgery procedure called body contouring can help fix the problem.

Excess skin from around the entire waistline, hips, thighs and buttocks can be removed using a technique called circumferential abdominoplasty.

Seek out an experienced, board-certified plastic surgeon to reduce risks. Patients who have uncontrolled co-existing conditions such as diabetes or heart problems may not be eligible for body contouring.

Some insurance companies will cover part of the cost of body contouring surgery, which may take several sessions to perform completely.

For more information, contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. You can also visit www.clevelandclinic.org/health.