At her heaviest, Healani Ortiz carried more than 400 pounds on her 5-feet-6 frame.

The weight crippled the self-employed Mililani woman, bearing down on her frail knees and preventing her from doing simple tasks such as checking the mail. She eventually developed hypertension and became borderline diabetic.

There were times that Ortiz refused to leave her home for up to two weeks just to avoid moving around.

"I didn't have a future, and I saw that," said Ortiz, 29. "There was no tomorrow; there was only today and the pain that I was in."

Desperate for a better life, Ortiz decided to undergo bariatric surgery, also known as weight loss surgery, last February. In less than a year, she dropped from 405 pounds to 268 pounds.

To help cope with the emotional and physical challenges of going through gastric bypass surgery, a popular bariatric procedure, Ortiz created a Web site that features an online journal of her ordeal, pictures and a message board.

When she started the site in 2004, it received a few dozen hits, mainly from supportive family members and friends. But the hits soon grew to more than 350 a day — many from weight loss surgery patients also wanting to share their triumphs and tribulations.

Ortiz quickly learned she isn't alone in her journey. In fact, she's part of a rapidly accelerating trend in Hawai'i and across the nation.

From 1998 to 2002, the number of bariatric operations in the U.S. grew from 12,775 to 70,256 — a 450 percent increase, according to a study in the December Archives of Surgery.

In the following years, the numbers continued to rise: to 103,200 in 2003, 140,640 in 2004 and about 171,000 last year, reports the American Society for Bariatric Surgery.

Local statistics show a similar rapid rise. In 1995, doctors performed 37 inpatient surgical procedures for obesity statewide. The number spiked to 114 in 2000 and more than doubled again to 293 by 2004, reports Hawaii Health Information Corp., a source for statewide healthcare data.

Dr. John Balfour, chief of the division of surgery at Straub Clinic & Hospital, was the first in Hawai'i to perform surgery for obesity, in 1973. Since then, Balfour said, Straub has performed about 900 weight loss surgeries.

"The lion's share of them have been in more recent years," Balfour said, " ... and there's a big waiting list."

Experts don't see the trend slowing down.

Kaiser Hawai'i started its formal bariatric program in 1998 with one weight loss surgery. Last year there were 91 such surgeries, said Robert Frankel, program specialist for bariatric surgery at Kaiser Hawai'i.

"I think for '06 we're going to see our number probably increase by 25 (percent) to 50 percent," said Frankel, a physician's assistant. "The demand is definitely there. Demand for the surgery exceeds supply."

DEMAND ON THE RISE

There are several reasons for the booming demand for weight loss surgeries, doctors say.

"It's sort of that perfect storm, where several things happened relatively at the same time," said Dr. Kenric Murayama, director of the comprehensive weight management program at The Queen's Medical Center.

Contributing factors include increased public awareness of the obesity problem nationwide and a "big push" for everyone to be healthier in general, Murayama said.

Another major factor is the addition of minimally invasive techniques to bariatric surgery, said Murayama, who's also vice chairman of the Department of Surgery at the University of Hawai'i's John A. Burns School of Medicine.

Bariatric surgery is reserved for patients who are defined as morbidly obese. The gastric bypass procedure involves creating a smaller stomach — roughly the size of a thumb — and re-routing the small intestine.

Laparoscopic gastric bypass surgery, an increasingly popular option, involves five or six small incisions, each less than an inch long. In contrast, open gastric bypass surgery typically involves an incision from the bottom of the breast bone to the navel.

The more minimal techniques cause fewer complications and have a shorter recovery period; patients may go home two or three days after laparoscopic surgery.

Bariatric surgeries have been around since the late 1960s, but the use of minimally invasive techniques started only in the early 1990s, Murayama said.

"That's what really started the dominoes falling," said Murayama. "So in the last five to seven years, you see this geometric increase in the volumes across the country."

A spotlight on celebrities who have successfully shed pounds following bariatric procedures has also fueled the popularity; celebs include pop singer Carnie Wilson, rock singer Ann Wilson of the band Heart, "Today" show weatherman Al Roker and "American Idol" judge Randy Jackson.

BALANCING THE RISK

The surgery helps people lose weight, and that can improve appearance and self-image. But from a doctor's point of view, the surgery is justified because it helps reduce or eliminate other diseases that accompany extreme obesity, including high blood pressure, diabetes, high cholesterol, hypertension, gall bladder disease, asthma and sleep apnea.

"It's about health," Kaiser's Frankel said. "If they have illnesses or diseases that we can moderate by this surgery, that's what we want to do."

As with any surgery, however, there are risks.

"Anything we do in medicine is balancing the risk versus the benefit," Straub surgery chief Balfour said.

Such risks — common among any major surgery — include bleeding, wound infections, incision problems, hernias, blood clots, pulmonary embolisms and strokes, Frankel and Murayama said.

"The death rate in this country from gastric bypass surgery is probably all less than 1 percent," said Murayama. "But if you stratify that by ages of patients, risk class of patients and then also the surgeon's (years of) experience, then there are groups that are at a higher risk."

From 1995 to September of last year, doctors performed 1,554 surgical procedures for obesity statewide; of these, two patients died before being discharged from the hospital, reports the Hawaii Health Information Corporation.

Faye Irvine, who underwent laparoscopic gastric bypass surgery in June of 2004, finds it worth the gamble.

"There's always a risk that you can die," said Irvine, 45. "(Doctors) don't mean to scare you, but I was very grateful that they were open about it."

Despite the risks, Irvine decided she could no longer live with the pain in her back and ankles, and sleep apnea; she also was borderline diabetic. The 5-foot-1 Kailua resident weighed 247 pounds before her gastric bypass surgery; today she weighs 140 pounds.

"I want to make sure I'm around for my kids," said Irvine, whose children are ages 8 to 15.

NEW BEGINNINGS

Mary Talon, 60, a registered nurse, had laparoscopic gastric bypass surgery more than two years ago. At nearly 300 pounds, Talon suffered from arthritis, knee and back pains, high blood pressure and sleep apnea, and she was borderline diabetic.

Since the surgery, the Wahiawa resident lost nearly half her weight and today weighs 157 pounds. While Talon is grateful for her improved health, it's the little things that have made the biggest difference, she said.

"It's some of the most subtle things that people don't even think about," like sitting comfortably in a bus or in a restaurant booth, Talon said.

Ortiz shares the sentiment. Among her cherished "everyday" accomplishments: walking up a flight of stairs without getting winded, and buying a blouse off the rack, rather than having to special-order it online.

She also relishes walking by a group of children who don't point, tease and giggle, she said.

"That's how you know when you've achieved some kind of milestone — when you can pass kids and they don't even look at you," said Ortiz, a bright-eyed woman with a warm, easy smile. "Those are big moments."

For Irvine, an educational assistant at a middle school, the surgery has given her a second chance in life, she said.

"It's like starting all over again," Irvine said. "It's a new beginning."

And Irvine knows from personal experience that a growing number of people want a second chance. At her workplace alone, she knows of three teachers who have chosen to undergo bariatric surgery, all within three years.

Islanders' transformations

Reach Zenaida Serrano at zserrano@honoluluadvertiser.com.