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"You'll have to lose 20 pounds before we can schedule gastric bypass," the surgeon said to Paulette Szalay. "It'll reduce the risk of complications, speed recovery and improve long-term success." The New Jersey grandmother sighed. "Twenty pounds," she repeated softly. For most people her size, it wasn't much. But due to a slow thyroid, her body was basically stuck in gain-gain-gain mode. She tried diets, but just got bigger and sicker. She was always tired, her reflux and blood pressure steadily worsening. Surgery was my best hope to feel good again, she thought. Now I can't have it unless I lose weight. "I don't know if I can do it," Paulette admitted to the doctor. Was it time to give up?

As a cold winter dragged on, Paulette and her husband, Keith, went to visit her parents in Florida. Unable to stop using snacks and sweets for energy and stress relief, she arrived miserable, too tired and sad to put on a bathing suit. So she found herself on the beach fully clothed, watching everyone have fun. She spied plenty of women about her age—in the water, playing with grandkids, basking in the sun. She stared and stared. And a longing stirred inside her. I want to be like them, Paulette realized. I want to be healthy and happy.

Paulette recalled the surgeon promising weight loss was possible despite her thyroid. She’d even referred Paulette to a nutritionist. I’m going to try, Paulette decided.

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