After years of struggling with attempts to lose weight, a poor self image and a significant family history of diabetes, I made the decision last year to undertake weight loss surgery. With a beginning weight of 232, I was actually at the minimum threshold to qualify for the Lap Band (Laparoscopic gastric banding) procedure which is the preferred method at St. Mary's Medical Center Bariatric Services Department. The Lap Band is an adjustable band that decreases the amount of space in your stomach for food.

The BMI and age requirements for lap-band surgery are set by the Food and Drug Administration, which approves medical devices for use in the U.S. Those include:

A BMI (Body Mass Index) greater than 40; or more than 35 with obesity-related health conditions You are twice your ideal weight or are at least 80 to 100 pounds overweight You are between the ages of 18 and 65 (Patients over the age of 65 will be evaluated on a case by case basis, including evaluation of medical history and current activity level.) You have been overweight for five years or more You have been unable to lose weight through diet and exercise You do not have an illness that has caused you to be overweight You do not drink too much alcohol You are committed to making changes in your diet and lifestyle You are willing to continue working with and be monitored by your doctor.

In my experience, the last two of these requirements are the most critical. When I was approved for the procedure, the rules required a six-month waiting period that included a variety of physiological and psychological tests, meetings with the doctor and continued attempts to lose weight through diet and exercise in order to ensure I was committed to this process. During this waiting period, the rules were relaxed to three months.

Following surgery, for the first two weeks, I was on a liquid diet to prepare my system for the changes necessary in eating habits. The next two weeks-pureed foods. In weeks four through six, I could eat soft foods. You learn to eat slower and chew your food more carefully. I was encouraged to use saucers instead of plates and baby spoons instead of standard spoons. I consistently am the last person to finish their meal at the table, even though I have far less food on my plate. I typically have about three to four ounces at a time.

I must limit my fatty and carbohydrate-rich foods. I've found some foods work for me better than others. Some bariatric patients have trouble with certain meats. I have a friend who has difficulty with red meat. My issue tends to be chicken. If I don't think I should eat a particular food, I don't.

One of the more difficult things that must be learned for bariatric patients is something most of us take for granted... belching. Belching can be difficult for bariatric patients as the band can trap bubbles in the digestive tract. Carbonated beverages, for bariatric patients like me are a thing of the past.

The other facet of this lifetime commitment - and it is for life is exercise. Exercise is no longer optional. I routinely work out between a half hour and an hour, at least five days a week.

I find myself defending my decision and am questioned about why I went through with this? On the bright side, a recent encounter with a friend I had not seen in months remarked, "You've changed something."

From 232 pounds, I now weigh 171 with a target weight goal of 145. I could not have achieved this without the Lap Band procedure, but most importantly - the work before and after the surgery that made it happen. As I've hit a plateau, which is common for bariatric patients, I must be even more diligent to get to my goal in the coming months.

Finally, a support network is critical to success. I credit the encouragement of family and co-workers for much of the progress I've made and will continue to rely on them in the future.

If you'd like more information about bariatric services at St. Mary's, call 816-655-5560, or visit .

Janice Downs is a bariatric patient at St. Mary's Medical Center in Blue Springs.