It's important to realize, though, that surgery isn't the quick fix it once was thought to be. There are risks; though an editorial in the Archives of Surgery in October put the one-year risk of death for the average patient at about 1 percent, that figure varies from institution to institution. Patients really have to do their homework to find a good surgeon. And the rewards aren't automatic; people can "eat around" these operations and regain the lost weight—bringing the disease back with it. "Surgery is a tool," says Stiles. "Unless you learn your triggers and address your lifestyle issues, diabetes won't stay in remission.""
Mary Stanford says her surgery—at New York-Presbyterian/Weill Cornell—provided an instant silencing of the "demon of wanting to eat all the time." But she was extremely careful to set up new habits to keep herself on the right path. "I made a decision that I'd had my share of cakes and candies in my life and I didn't need to have any more," she says. "The surgery was like a reset button that gave me a second chance." But she had to totally revamp her behavior, from eating to exercise. "You have to understand that it's a chance to make a lifestyle change," she says. In her case, that might even mean a new marathon habit. "I told everyone I wasn't sure if I'd do another one," Stanford says. "But when I crossed the line, I immediately said, 'I'm doing it next year.'"