Amanda Berschied is half the person she used to be.

Berschied, an Oakley resident, had long struggled with her weight. Like many other Americans working to slim down, she tried various diets but always seemed to regain any weight she had lost. When the scale finally tipped at 338 pounds, she decided she needed professional help.

Berschied sought advice from her doctor and, like 200,000 Americans last year, opted for bariatric surgery. Today, at 163 pounds, she says she feels "unzipped." She runs 5k races. She's unrecognizable to people who haven't seen her in a while. She's going back to college. And, sometimes, clothes shopping leads to tears.

Recently, she tried on a pair of size 10 jeans. They fit, and she cried.

"When I started crying, the salesperson said "¢Oh, I'm so sorry.' I had to tell her, "¢No, I'm crying because I'm happy!'" Berschied says.

Berschied is just one of the success stories emerging from a boom in medically supervised weight loss clinics and hospital programs across the nation, fed by an alarming obesity problem. According to the American Medical Association, 68 percent of American adults are obese "” carrying 30 pounds more than their ideal weight. That figure is an increase of more than 24 percent since 2000. Meanwhile, 15 million American adults are morbidly obese, defined as more than 100 pounds overweight.

Range of Options

Along with advances in surgical procedures, the near-epidemic health problem has fueled an explosion of weight loss centers. But while some centers market the surgical option as a seemingly quick fix to a lifelong problem, doctors say it's important for patients to get the full story.

"Patients should seek out a practice with a lot of experience. An experienced surgeon is key, but also a comprehensive team," says Dr. Trace Curry, a partner in the Evendale gastric banding practice JourneyLite and founder of the Center for Metabolic and Bariatric Surgery. "Patients are going to need a lot of support both before and after surgery. I tell my patients that the surgery is the tip of the iceberg. What happens after surgery is much more important than the surgery itself."

Curry knows. He's not only a doctor who performs gastric surgery, but also a patient. He had banding surgery 18 months ago, and has lost 50 pounds since. "Now, when I tell a patient to do something, it's not because I read it in a book, it's because I know first-hand what they need to do to succeed."

The best centers, those who earn "Center of Excellence" designation by the American Society for Metabolic and Bariatric Surgery, give patients a full range of options, from non-surgical (dietary supervision and behavioral modification classes to supervised exercise regimes) to surgery, experts agree.

"Options are what patients want. We give them options," says Dr. Joseph Northup, director of Mercy Healthy Weight Solutions and its principal bariatric surgeon. "Most people come in thinking about surgery. They've been bombarded with information about it. They may not qualify for it. It may not fit them and their circumstances. The best places give them the full range of options."

Mercy Healthy Weights Solutions earned its Center of Excellence designation earlier this year, just 18 months after performing its first bariatric surgery. When it did, it became Mercy Health Partners' second center to earn the accolade, and the fifth center in the area to be recognized for the highest standard of weight loss services.

Jewish Hospital's Center for Weight Loss was already recognized by the ASMBS for exemplary care, as are Good Samaritan Hospital's Weight Management Center, which serves all TriHealth patients, St. Elizabeth Weight Management in Florence, and Christ Hospital's bariatric center, which also serves University Hospital patients.

That number gives Greater Cincinnati more recognized centers than most cities of its size, and as many, if not more, than some larger cities. Cleveland, a much larger city, has five. Columbus has three. But while more is not always better, in this case it is.

"We're seeing it go to fewer, but larger centers," Northup explains. "That's a good thing. It's not something that should be done everywhere. Every hospital doesn't have the expertise that we have, or the quality of the programs that we have here in Cincinnati."

Prescribing Caution

That expertise is often shown in doctors' caution in approaching the surgery.

Patients seeking information on surgery at Center of Excellence facilities are provided months of consultation before a decision is reached.

Afterward, explains Dr. George Kerlakian, medical director of Good Samaritan Hospital's Weight Management Center, they can expect to see a dietician to examine the food they eat and information on low-protein or liquid diets. They can expect a consult with a physiologist to look at increasing their physical activity and exercise. And they will be seen by a psychiatrist to gauge their commitment to the necessary lifestyle changes.

Still, in many cases, Kerlakian admits, surgery is indicated.

"It really depends on the patient, but if they have a Body Mass Index (BMI) over 50 "” meaning they're at least 100 pounds over their ideal body weight "” most of the medical diets, the behavioral modification and exercise will fail for all but 2-3 percent of patients," he says. "Sometimes, surgery is the best option."

When it is, there are even more options for patients: gastric banding, more commonly known by the popular brand name Lap-Band; or traditional gastric bypass, which removes part of the stomach. Both have their pros and cons.

Gastric banding, which involves a laparoscopic surgery to insert an adjustable silicone band around the upper part of the stomach to restrict food intake, has gained popularity in recent years. Along with narrowing part of the stomach, the band creates a small pouch in the stomach, causing a feeling of being full, so patients eat less.

"The surgery itself is minimally invasive, and the benefits are wonderful," says Dr. Lisa Martin Hawver, a bariatric surgeon with Christ Hospital's bariatric surgery unit. "It's been a very successful product. The band itself should last at least 30 years, according to the most recent studies. Banding hasn't been around for longer than that, so the study's incomplete. It could last a lifetime, with proper care."

Weight loss attributed to banding is often gradual "” five to 10 pounds a month "” with patients losing two-thirds of their excess weight within two years of surgery. The surgery is typically suggested for patients with a BMI from 40-50 or as low as 35 if other health problems, like diabetes, are looming.

Gastric banding has risks, Martin Hawver says, but they are outweighed by the benefits.

"The band can move in position, especially if there's persistent vomiting or the patient hasn't made behavioral changes, but maintenance on the band can be made surgically," Martin Hawver adds.

Though some doctors disagree, banding isn't widely suggested for patients with a BMI over 50. For those patients, gastric bypass surgery is the gold standard in care.

Different types of gastric bypass are performed. Roux-en-Y gastric bypass leaves the stomach intact while the surgeon creates a smaller pouch from it. Meanwhile, biliopancreatic bypass or "sleeve bypass" surgeries remove a portion of the stomach to create the same effect.

All can be done laparoscopically, through small incisions. Though recovery time is longer "” patients can expect to remain in the hospital a few days and not return to normal activity for weeks "” and patients will have to be monitored afterward to ward against malnutrition. Their weight loss is usually complete within two years.

Level of Care

It's also very safe.

"When (doctors) first started doing gastric bypass in the 1970s and "¢80s, there were horror stories," Kerlakian says, "but the level of care has risen over the last several years. Mortality is very low. It's safer now than coronary bypass surgery or even joint replacement. You're seeing an entire different landscape in the level of care."

As important as the surgery is aftercare. Patients are required to adjust their diets and increase their activity. Centers of Excellence see patients through that with gym access, aftercare visits and support groups. Berschied, who had her bypass surgery at Good Sam, still attends those, as well as all the information sessions for prospective patients that she can.

"I can tell you how big a difference the surgery made in my life. The only regret that I have is that I didn't do it sooner," she says.

Northup, who has performed more than 700 bariatric procedures during his career, says seeing his patients long after they've left the operating room is a joy.

"The best thing I've ever done for anyone is to do their bariatric surgery. You see them a year later, two years later and you've help cure their diabetes. You've cured their hypertension, alleviated joint pain. You've given them a longer life and a better life," he says. "As a doctor, it's very gratifying."