CLARKSBURG, W.Va. -- Nancy Robinson was always a bit "chunky," even as a kid, she said. "I was always a free spirit and dressed cute anyway. I didn't really care if I was a little too big or my skirt was too short."
She played sports in school and "ran around the neighborhood playing all year."
But 20 years later, looking back on her childhood eating habits, she cringes: midday snacks big enough for meals, butter-slathered vegetables at every dinner.
Her eating habits caught up with her in her 20s. At 28, Robinson, of Clarksburg, weighed about 350 pounds. She was morbidly obese with severe diabetes and sleep apnea caused by her weight.
Then she and her husband decided to have a baby. "The doctor said if I got pregnant, taking so much insulin, it would probably kill me," she said.
"I looked at my husband and realized that food was ruining my life, and I had to do something drastic." She had tried fad diets for years. She lost, then regained, 30 pounds many times. She'd seen trainers and doctors. But the amount she needed to lose to have a baby safely was daunting.
Both her parents were obese. When her dad died of obesity-related causes, the emotional toll caused her to eat and gain even more.
In 2011, she underwent Roux-en-Y gastric bypass surgery, a common weight-loss tactic.
"A lot of times, people kind of give me flak for taking the 'easy way' out," Robinson said, "but I'm here to tell you it's not the easy way out."
In gastric bypass surgery, a person's stomach is stapled into a small pouch that can hold only about 4 ounces, a fraction of what it previously could. The surgeon connects the pouch to the small intestine.
Robinson's stomach pouch was so small after surgery that she struggled to consume 600 calories a day. Like many other patients, she had "dumping syndrome" for a while, in which the person feels nauseated and vomits or defecates after eating because their small intestine can't handle the food.
The surgery was only a first step, Robinson said. Now she exercises vigorously six days a week, often with a trainer, and weighs everything she eats. "I needed the surgery," she said. "But it didn't end there. I still had a lot of work to do, and a lot of adjusting to do to this new lifestyle.
"I want to be the kind of mom who runs with her kids, not the one who sits on the bench and watches," she said.
She takes a daily vitamin regimen to make up for what her body isn't absorbing through food. About 10 percent of patients develop lactose intolerance and can't digest milk or milk products. Robinson escaped that but did develop psoriasis. "My doctor wasn't sure if it was because of the surgery or the sudden weight loss," she said.
After surgery, patients often lose between 62 and 70 percent of their excess weight, though many patients regain up to 20 percent, bariatric specialists say.
Robinson's blood sugar dropped into normal range after surgery. According to a 2012 study published in the New England Journal of Medicine, the blood sugar of 42 percent of gastric bypass patients drops into normal range after the surgery restricts the amount they can eat. There are no long-term studies showing if blood sugar stays low.
National experts disagree about the lasting impact and safety of the surgery. "I'm very cautious about who I recommend it to," said Holli Neiman-Hart, residency director in family medicine at the WVU Health Sciences Center. "I think a lot of us who are overweight just want a quick fix, and it's really not that."
Not a decision to take lightly
In 2009, about 250,000 Americans had weight-loss surgery, according to the American Society for Metabolic and Bariatric Surgery. The number has doubled in the past decade. More than 20 million are morbidly obese, so about 1 percent of the eligible population have the surgery.
Guidelines from the National Institute for Health recommend bariatric surgery when a person is morbidly obese (heavier than 99 percent of people at his or her height) or has a BMI of at least 35, with at least one chronic condition such as diabetes or heart disease.