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PATRICIA ANSTETT Detroit Free Press

DETROIT — Todd and Brenda Wallen had visions of sugarplums this past holiday season.

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Cindy Millard prepares dinner for two days of holiday get-togethers for her family in Metamora, Mich. Millard lost 60 pounds after bariatric surgery.

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More resources

www.weightlosssurgerychannel.com has videos, cookbook reviews and more.

http://recipes.sparkpeople.com, search for bariatric recipes shared by readers.

“Eating Well After Weight Loss Surgery: Over 140 Delicious Low-Fat High-Protein Recipes to Enjoy in the Weeks, Months and Years after Surgery,” by Patt Levine, Michele Bontmpo-Saray, William Inabnet and Meredith Urban-Skuros; DaCapo Press; $22.53 at www.amazon.com.

But the morsels they selected were bite-sized portions of foods they know they can tolerate.

The Wallens of Clinton Township, Mich., are part of a new group of Americans who have undergone bariatric weight-loss operations. Now, food is a necessity and a choice, not an opportunity to pig out.

Bariatric surgery reduces the size of the stomach through gastric banding with an implanted medical device or by removing a portion of the stomach (gastric bypass surgery). The procedure costs, on average, $17,000 to $26,000, according to the American Society for Metabolic and Bariatric Surgery. In 2008, 220,000 people underwent the procedures, according to the ASMBS.

Many patients have dieted for years, and for the millions who have had the surgery they must approach meals with caution to avoid the misery they feel if they eat just a little too much, or if they digest the wrong foods.

The most successful become masters in portion control, bringing lessons others can heed at a time of new year’s resolutions.

“You find out what you really like and you eat what you really, really want to,” says Brenda Wallen, 53, who underwent Lap-Band surgery in April 2006, six months after her sister did. Todd followed in April 2007. “You just taste it,” she explains. “Nibbles. You skip the rest.”

“Two platefuls used to be nothing for me,” says Todd, who now weighs 172 pounds, down from 443. He had a type of bariatric surgery called sleeve gastrectomy, designed for severely obese people.

Low risks

Most weight loss after the surgery is lasting, with many people reaching maintainable weights 12 to 18 months after an operation, says Dr. John Birkmeyer, the bariatric surgeon at University of Michigan who runs the registry with his wife, Nancy, U-M associate professor of surgery.

Many are able to stop taking or can reduce blood pressure, diabetes, cholesterol and sleep apnea medicines, Birkmeyer says. Deaths have been virtually eliminated and complications have been reduced significantly, he says. (For details about outcomes with each procedure, go to freep.com/surgerypdf and freep.com/surgerydatabase.)

The surgeries have spawned blogs, cookbooks, support groups and more.

“Each operation has its own niche,” says Dr. Mark Pleatman, a bariatric surgeon at Doctors’ Hospital of Michigan in Pontiac. Throughout the year he organizes activities, including food-buying trips with a dietitian.

“I tell people this isn’t a cure,” Pleatman says. “There are risks. People do have complications.” People need to “eat a small amount and feel full,” he says.

Deaths from all bariatric surgery, always rare, are extremely unusual now. They dropped from 0.3 percent in 2007 to less than 0.1 percent for 2009. Lap-Band procedures had the fewest complications.

Patients can’t eat anything but liquids for two weeks before the surgery and several weeks afterward. But many return to normal activities or work as little as two weeks later. Sometimes, no one knows what they did.

Todd Wallen, a truck driver, “told everyone” he had the surgery. His wife, Brenda, “didn’t tell anybody at first.”

She discovered she can fill a plate, then request to take it home. Or she’ll discard it. “Nobody will know what you’re eating,” she says. Others, like her mother, a terrific cook, used to say “eat, eat, eat,” Brenda says. “She’s more conscious of it now,” with two daughters having the surgery. “She now asks, ‘Can you eat this?’”