Gastric surgery—operations that dramatically alter the digestive system, limiting how much food a person can consume or absorb—has become a $3.6 billion industry with an estimated 400 Americans a day going under the knife this year. For many who struggle with their weight, it seems a miracle cure. But surgery isn't a quick, easy or even permanent fix. "It's a jump start," says Dr. James Ostroff of UC San Francisco Medical Center. Patients may lose up to 50 percent of their pre-op weight, but then, estimates Anchorage surgeon John Snyder, about 20 percent will regain a significant amount. How? By downing high-calorie liquids like alcohol or milkshakes or snacking continuously. Basically, says Ostroff, "they figure out how to eat around the operation." The one-year mark is a particularly dangerous time. "Hormonal changes following surgery may result in a loss of appetite," says Snyder. "After a dramatic weight loss, the appetite often returns." Above all, surgical procedures do nothing to address patients' emotions, which may compel them to overeat. These women found out that gastric surgery comes with no guarantees.

Stress of Divorce Led to Weight Gain
Real estate agent Holly Harwig knew she needed help when, meeting with a homeowner in the spring of 1998, she fell right through his wood deck. "I laughed it off," she says. "But inside I was dying." After a workshop with Dr. Daniel Baker, a bariatric surgeon in the Minneapolis area, she had bypass surgery and "the weight just fell off," she says. Within 18 months, the 5'1" Harwig, 42, had gone from 285 to 132 lbs. But over the next three years, she added 18 "bounce back" lbs. Then, last year, dealing with a difficult divorce, she turned to alcohol and gained 42 more. Although she has now been sober for three months, the weight has stayed put. Harwig, who met third husband Jim, 43, at a bypass-support group in '02, says she's still happier than she was presurgery. "I was a size 28 and now I'm a 16," says the mother of three. "I have to look at that and say, 'Hey, that's really good.' I'm a work in progress."

Wasn't Prepared for Her New Thin Self
Four months after her surgery in 2000, Beverly Keating no longer recognized herself. "I'd always had a double chin, and it was gone," says Keating, who had lost 108 lbs. from her high of 294. "I could never see my collar bone, and now I could. I could see my cheekbones—I had definition!" Perhaps even better, Keating, 37, no longer suffered from diabetes or asthma. Still, some aspects of the change were difficult. "For someone who's been overweight their entire life, I didn't know how to be thin," recalls Keating, who fluctuated from 250 to 310 even in high school. "Men were taking notice where they didn't before. It was odd and scary." She did what she'd always done when faced with stress: She ate. Her doctor, John Snyder, whose practice is near Keating's home in Anchorage, recommended a post-surgery diet high in protein, with little sugar or dairy, since they make many patients sick. (The self-policing effect usually wears off after about a year). But Keating, who is married to Doug, a medical biller, and has a son, Eldon, 11, from a previous marriage, "developed my own diet," she says wryly. "I guess that's where I went wrong." Keating's system reacted badly to meats, so she began to graze on cheese and yogurt, snack on bread at her bakery job and drink soda. Over the next two years she added back 54 lbs. to her 5'3" frame, plateauing nine months ago at 240, where she remains today. "A realistic goal would be to be under 200," she says. "I would have the surgery again if I had to." Still, she knows now that surgery is no cure-all. "To anyone contemplating it, I'd make sure they're prepared for that day when they look in the mirror," she says. "A lot of obese people use fat as a security blanket, and they should make sure they're ready to give it up."

Sought Solace in Food
At 512 lbs., Darlene Cates seemed like an ideal candidate for gastric bypass surgery when she appeared as the mother of Johnny Depp and Leonardo DiCaprio in 1993's What's Eating Gilbert Grape. In fact Cates, who has since appeared on shows like Touched by an Angel, had already undergone another version of the procedure, called stomach stapling, back in 1981. "I thought maybe this was the magic bullet," she says. For a while, it was. She quickly dropped from 412 to 310 lbs. and felt "on air," she says. But her weight loss stalled after a year, and she began putting on pounds. "One day it dawned on me, Wait, I should have been able to eat just a fourth of this burger; how was I able to eat half?" she says. By the mid '80s she was back to her former habits as well as her former weight. "That thing that made you fat in the first place? They don't cut that out during surgery," she says. "The pressures that caused you to seek solace in food are still there when you come home from the hospital." Cates, 56, who lives in Forney, Texas, with husband Bob, a former Marine, now weighs 542 lbs. and relies on a motorized wheelchair to get around. Her daughter Sheri, 38, has been urging her to get a gastric bypass, but Cates worries that she would die on the operating table. "I'm afraid this has become a panacea for everything," says Cates. "'If you're fat, have a gastric bypass.' They don't help people think about the consequences down the road."

CARNIE WILSON FIVE YEARS LATER: "Some Days Are More of a Struggle"

This August will mark the fifth anniversary of Carnie Wilson's gastric bypass surgery. Although the 5'3" singer went from 300 lbs. to 148 lbs. and even posed for Playboy, she still battles her weight—and the media, who are quick to report any apparent gain. Wilson, 36, says she's now at 158, and though tabloids have routinely hinted that she's packing on weight, she says she has been fighting "these darn 10 lbs. for two years."

It's time to crack the whip and go down 10 lbs. But when people are waiting outside my door to take pictures of me walking, I get upset because they only want to focus on the negative. That's why I'm on the treadmill inside my house now! I'm working on maintaining success every day. I try not to be so hard on myself. I have to say, "Wait a minute, you're battling 10 lbs., not 160!" The bottom line is, it's just as hard to keep the weight off after gastric bypass surgery as it was to lose the weight before. If you don't get over your emotional snacking and don't exercise, you will gain weight. I still get full really quickly, especially if I eat protein first, like a chicken breast, but I can definitely eat more food than when I first got out of surgery. I think a lot of people test themselves. They see how much they can eat. If I'm out with friends and there's a bunch of food, I'm tasting a little here and there and then I have to stop and say, "Okay, if I have another bite of that mac and cheese, I might not feel so good, so I'll stop now." You have to be conscious. The most important thing is that you don't become lazy about your responsibilities. When I follow the rules, it works. That's when I smile and think, "Oh my gosh." It's wonderful.