For Tyrissa Barco, the price of obesity hit hardest when her doctor told her she would not be able to bear a child because of her weight and its effect on her womb.

Her extended family lives in a five-bedroom house they built in Waianae, and she helped raise her nieces and nephews.

"For me not to be able to have kids of my own," she said, "I was devastated."

"We all cried," added her mother, Leora Loughmiller.

Loughmiller and her husband, Ivan, both weighed more than 300 pounds at the time, and their diabetes had reached the point that each needed 100 units of insulin a day. Ivan was shocked when a sleep apnea test showed that he stopped breathing at night roughly once a minute.

"That’s mini-strokes going on," said the genial 54-year-old, a standout baseball player at Kamehameha Schools who picked up weight over the years.

In September 2011, all three underwent gastric bypass surgery at Pali Momi Medical Center. Within two days, the Loughmillers were off insulin completely, before any weight loss.

Their daughter had special-ordered a size 32 dress for her wedding, but she dropped to size 18 before the ceremony in December 2012.

This month, her baby girl, Carlee, turns 1 year old.

"She is a vegetable freak," Barco said proudly. "She loves celery sticks, apple slices, spinach."

A growing number of Hawaii residents are resorting to bariatric surgery, not just for weight loss, but to tackle a host of medical problems related to obesity, in particular diabetes. The procedure has been shown to have a dramatic and often immediate effect on that chronic and potentially crippling disease.

"A lot of people think that bariatric surgery is a cosmetic procedure to help you lose weight from a cosmetic standpoint," said Dr. Mark Grief, medical director of Pali Momi’s Bariatric Surgery Program. "This is not anything I would say is a prime reason. It is a side effect that you’re going to be thinner, it’s not the impetus."

"The main reason I’m doing bariatric surgery is for the diabetic patient. Having said that, there are multiple impacts that will occur — hypertension, cholesterol, sleep apnea, all of those can improve with weight loss."

The annual count of bariatric procedures statewide has almost doubled since 2005, reaching 540 last year, up from 282 statewide in 2005, according to the Hawaii Health Information Corp., which collects health care data for the state.

That’s still just a tiny fraction — roughly 1 percent — of the population considered medically eligible for bariatric surgery, according to Dr. Steven Fowler, president of the Hawaii Bariatric Society and medical director of Castle Medical Center’s Surgical Weight Loss Institute.

The latest evidence on its potential in fighting diabetes, published March 31 in the New England Journal of Medicine, comes from a randomized trial at the Cleveland Clinic known by its acronym, STAMPEDE, involving overweight patients with poorly controlled diabetes.

More than 90 percent of patients who had bariatric surgery had lost 25 percent of their body weight and controlled their diabetes without insulin three years after surgery, the study found.

Dr. Cedric Lorenzo, medical director of the Comprehensive Weight Management Program at the Queen’s Medical Center, said it appears that gastric bypass surgery affects hormones that govern pancreatic regulation and ultimately sugar control.

"What we found out after doing this for decades is that patients who have this operation, their blood sugar is nearly normal the day after the surgery, not having lost a pound," he said. "It’s not just anecdotal. It’s a trend … It’s very effective for diabetics, which has been the game changer."

The dominant health insurer in Hawaii just widened the pool of potential candidates for such surgery. As of April 1, Hawaii Medical Service Association lowered the body mass index requirement to 30 from 35 for patients with adult-onset diabetes to be eligible for gastric bypass under certain conditions.

BARIATRIC SURGERY is a radical solution. It severely restricts food intake by shrinking the size of the stomach. The most common procedures are Roux-en-Y gastric bypass, which reduces the stomach to about the size of an egg and bypasses part of the intestine; and sleeve gastrectomy, which lops off 80 percent of the stomach.

Either operation requires dramatic changes in eating habits. Because people can eat so little at a time, they must pack nutrients into each calorie they consume, focusing on protein and vegetables. If they cheat, they risk miserable intestinal reactions, including vomiting and diarrhea. And they can end up regaining the weight.

"The biggest change has to happen in the head," Lorenzo said. "The surgery is only a tool. Patients will have a great period of weight loss six to eight months after the operation. They still have to exercise consistently and make good dietary choices. If they fall back to bad habits, then the weight will creep back up."

He estimated that about 25 to 30 percent of people who undergo bariatric surgery fail to keep the weight off over the long term because of diet and lack of exercise.

That’s why it’s important to have the procedure done at a facility with comprehensive and long-term follow-up care including nutrition, exercise and psychological counseling and support groups, he and other doctors emphasized.

"Bariatrics is not a place where you have it done and you leave, like your appendix and your gallbladder," Lorenzo said.

The protocol has changed over the years to help people through what is inevitably a difficult adjust­ment.

One 67-year-old retiree who had the surgery a decade ago said she was nauseated for 10 months. She lost close to 100 pounds, but has regained about half of it by returning to some of her old eating habits.

"I would not recommend the surgery to anyone if it can be avoided, because I went through the wringer with aftereffects," she said, asking that her name not be published. "Lots of throwing up. It was just miserable."

DINNERTIME at the Loughmiller household used to consist of "meat and rice, Spam and rice, hot dogs and pork and beans," Barco said.

"Now we know what kind of vegetable we’re having and we figure everything else out from there," she said. "It’s not a matter of denying yourself the pleasure of food. It’s knowing when enough is enough. I still like to eat. But don’t need the whole roast. I just need a sliver."

Her mother said there are a lot of misconceptions about the surgery. The Loughmillers each have lost 100 pounds or more, but it took discipline and perseverance.

"It’s not a magic wand," Leora Loughmiller said. "Many people have said, ‘You guys took the easy way out.’ It’s not easy."

The surgery had a hidden benefit for Leora. She used to be so bashful about her bulk that she avoided getting a mammogram. After she dropped the weight, a mammogram found cancer in one of her breasts, early enough for treatment.

Ivan Loughmiller had been on medication for high blood pressure and high cholesterol, along with insulin and pills for his diabetes. He doesn’t have to take anything anymore.

As he aged, it was so easy to gain weight, and so hard to lose it.

"When I was like 240, I would say I’ll never be 275," he recalled. "In a matter of years, I’d be 275. Then I’d say I’ll never be 300 pounds, but there I was, tipping the scales. I went up as far as 326."

His doctor explained that diets often fail because the body has been conditioned to respond to a big reduction in caloric intake by hanging on to fat to stave off starvation.

"Once you get the weight on, your body has protective mechanisms to reduce your metabolism to slow weight loss," Grief said.

Barco, who stands 5 feet 11 inches, once reached 376 pounds. She is down to 205, and a size 14. As her daughter trundled around at her feet, she reflected on her past and Carlee’s future.

"I wouldn’t change my childhood for the world," Barco said. "But it comes with issues when you’re bigger. For her to not have to go through that" — she paused as her voice caught with emotion.

Her mother ended the sentence for her: "Life is a lot harder when you’ve got to deal with obesity."

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