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David and I met online in 2002. Along with my irreverent, sexually forward profile, I'd included a close-up photo of my face. As the day of our first physical meeting drew near, I panicked that once David was confronted by the actuality of my hugeness, our prospective romance would quickly fizzle. I kept mentioning in our e-mails that I was "not small." He ignored such comments until finally, the day before our first date, he wrote, "Look, I know you're overweight. I have no problem with that." Upon meeting him, I was shocked to learn that David was one of those people I had heard about but, like dragons and unicorns, had come to accept did not exist -- a person not half as concerned with appearance as he was with character.

Having somebody treat me like a woman rather than a taken-for-granted friend with privileges boosted my sense of self-worth and gave me a newfound appreciation for life. David made me want to become the woman he made me feel I already was. Within a few months, with the determination and ease of pruning a rosebush in winter, I quit smoking, ceased my recreational drug use, and stopped wasting my time on toxic people.

Losing weight was not as simple. After all, I'd been fat all my life; it was a part of who I was, and I was married to it, for better or worse. People don't "get" fat. It's not something that "happens." You have to work at it. You have to consume a significantly larger number of calories than you burn every day, every week, every month, for years. I had been on the path to morbid obesity since the age of five. "Morbid obesity." Literally translated, it means "so fat as to inspire disgust or horror."

Two days after my embarrassing tumble, both my legs were swollen and bruised from thigh to ankle. I couldn't ambulate without wincing. I realized that this inability to move, and a growing incapacity to experience life the way other people did, would be my fate if I remained fat. I began to fear mortality -- not just my own, but also David's. Though only 35 pounds overweight, David was older than I and had dangerously high blood pressure. I was preoccupied with thoughts of death and loss, with feelings of self-loathing and despair.

Dieting did not sound appealing to either of us. As a foodie, David lived to eat; as a fatty, I couldn't help but assign a stigma to the word "diet." I'd yo-yoed since I was ten, when my mother put me on Richard Simmons's Deal-A-Meal program. Weight Watchers, Jenny Craig, Rader Institute, I'd had a fling with all of them, each time running one step forward to slim only to fall two steps back to stout. I'd often complained that programs don't work. But it wasn't the programs that failed -- it was I. I wanted change to happen without having to do anything, the way I'd allowed myself to believe that getting fat was something that happened without my involvement. I wanted to be instantaneously slim without any discomfort. The truth that I'd refused to accept was that, no matter which method I adopted, there was not going to be anything quick or easy about ending my life as a fatso.

I flirted with the idea of gastric bypass. People close to me had undergone the surgery, and I'd seen firsthand how effective it could be. I also saw how violently invasive it was -- as drastic as having one's jaw wired shut. What turned me away from pursuing it further was my belief that if I underwent surgery I was, in effect, saying, "I am a victim of my behavior and I am unable -- scratch that -- unwilling to change it, so I would rather someone else change it for me by making it impossible, or at the least, very difficult and/or painful, for me to eat the excessive amounts of sugar and fat I somehow can't stop stuffing into my face." Call it a control issue.

The people in my life who'd had bariatric surgery had, as with many fad diets, lost a lot of weight in a short amount of time, then gained a good portion of it back. They were not willing to accept dietary changes, meaning that when their new, shrunken bellies could hold only two ounces, they still chose to fill it with junk. They had done nothing to alter their sedentary ways, which meant most of their muscle, starved of protein, was lost with the fat. This is not the fault of doctors, who explain to their patients the importance of lifestyle changes until they run out of breath.

"So many people think they're going to have bariatric surgery and they're fixed," says George Mueller, a bariatric surgeon for Sharp Memorial Hospital. "We'll be seeing patients doing very well, and then they come back for their yearly visit, and they'll be snacking or won't be exercising. We hammer it over and over and over that this is a lifestyle change. They aren't real hard concepts."

Charles Callery, a surgeon for Pomerado Hospital and Sharp Memorial, has performed around 3000 gastric bypass surgeries since 1991. "We try to educate people and encourage them, but we're not superparents; we can't make [patients] do the right thing," says Callery. "Noncompliant behavior is very frustrating. It's like giving advice to kids -- some follow the advice, some don't, and some are just plain reckless and get themselves into a lot of trouble." No amount of lecturing can penetrate a meticulously crafted shield of denial. For years, doctors had implored me to lose weight, a fact that played no part whatsoever in my decision to do so.

According to Mueller, rapid weight loss can have a negative impact on some organs, like the gall bladder. "When you lose weight rapidly, you oversaturate your bile with cholesterol and excess fats, and you get gallstones," he says. The liver can also be affected. "If there's fatty infiltration on the liver, you can get hepatitis -- not the infection, but inflammation of the liver, steatohepatitis -- you get an inflammatory response, and liver enzymes go up. If a person loses weight, the liver function improves, but if they go up and down, you can get fibrosis, or scarring, in the liver, [which can] compromise the function of the liver."

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