What's the best way to get thinner?

That figure is set to increase by another 20 per cent this year yet experts estimate that the number of gastric band and bypass operations, costing between £6,000-8,000 each, represents only two per cent of the need for them.

Is surgery really the answer or should the NHS be encouraging people to shed pounds through diet and exercise instead? Here two women, who have each halved their body weight in  different ways, argue each case.

THE DIY REGIME

DIANE STEPHENSON, 48, is an administrator and training to be a nutritional therapist. She lives in Warfi eld, Berkshire, with husband Kim, 50, a psychology consultant. She says:

AT 24 stone I was morbidly obese and would have qualified for weight-loss surgery. But while I don’t begrudge anyone who chooses that route what concerns me is putting your body through a general anaesthetic with all the inherent health risks, made greater when you’re obese.

I also worry what it does to your  general health when you mess about with the stomach. When the weight has gone and you haven’t exercised to help lose it are you left with so much loose skin that you have to have a tummy tuck?

Instead I chose to take ownership of my weight problem with a complete overhaul of my lifestyle so that sensible eating and daily exercise would become a permanent part of it. It’s no use “going on a diet” because the implication is that you will ultimately come off it. Losing weight and getting fi t has to be a lifelong commitment.

The turning point was a trip to New York with my husband a few years ago. By then I was 24 stone and in the humidity of a New York summer I was breathless and couldn’t enjoy it properly. I had to do something to lose weight and get fi t so that I could enjoy life.

Until then chocolate had been my best friend. If I was anxious or  worried I could happily eat three or four chocolate bars a day. At various stages in my life breakfast was a glass of Coke and a Kit Kat. I’d spent my life trying all the different diets, losing a bit of weight then putting it back on and more besides. Though I’d walk and do workout DVDs at home I wasn’t exercising consistently.

Determined to lose weight and get fi t I went to a health farm for a kick-start and an expert there recommended a book called Slimming With Pete by coach and TV weight loss expert Pete Cohen.

It was better than a diet book, it taught me about feeding my body with the right foods, plus simple tricks to make sure I enjoyed food more like sitting at the table to eat and not reading a book at the same time. I joined a gym and worked out with a  personal trainer for a while to learn how to keep my exercise varied to burn optimum fat and calories. Chocolate had to go. For four years not a morsel passed my lips. I started to lose weight seriously when I kept a food diary – if you eat it you have to write it down and that’s powerful.

The perception is that it’s impossible to lose a lot of weight if you’re very fat but it’s not true. However it does take effort, commitment and you have to change your habits. Change is uncomfortable for most people.

It took me two-and-a-half years to lose 12 stone. After the first three or four stone people started to give me compliments, even strangers in the gym. I felt so much better too because I was nourishing my body with fruit, vegetables and protein instead of having sugar highs and lows. By simultaneously exercising and losing weight slowly I toned up and my body has pulled in nicely in all the right places.

I’ve been the same weight now for four years and will continue to listen to my body and feed it with good stuff. The key is everything in moderation, including moderation itself. I’m partial to wine and three-course meals at weekends but I’m sensible during the week so it has no effect on my weight.

SURGERY SAVED ME, SUE SMITH, 50, is a housewife who lives in Southampton with husband Kent, a teacher. They have two children aged 22 and 25. She says:

People can be quick to criticise weight-loss surgery but it is  absolutely not a quick fix or a cheat’s way to get slim. Surgery is not to be taken lightly but when my GP told me I had between three and fi ve years left to live because I was so obese it was a relatively straightforward decision to have a stomach bypass. I wanted to live to see my children settle down and have kids.

Like most women, my weight problems really started after  having kids. I had problematic pregnancies, spending a lot of time in hospital. Then we moved to a new area where we didn’t know anyone. At home with two small children I felt isolated and turned to food.

Over the years I tried every diet going to lose weight but I’d shed a couple of stone and then couldn’t sustain it because I used food as comfort. We live near a farm shop and every Thursday when they got a delivery of home-made cakes I’d buy a family-sized sponge and eat a third of it in one go.

I was so huge I needed  constant care from my husband and  children just to get washed and dressed. They were never anything but supportive. I was too big to move around, relying on sticks, a wheelchair or mobility scooter and my body had a huge calorifi c requirement to function.

The turning point was when our old GP retired in 2008 and we got a new one. He told me I would die within fi ve years if I didn’t lose weight and that I should consider a bypass. He knew top bariatric surgeon Shaw Somers, who worked for a company called Streamline Surgical, performing operations at St Richards Hospital in Chichester. I had asthma, high blood pressure and an enlarged heart so I had to think carefully about surgery. But in truth the decision had been made – I didn’t want to die in my 50s.

On July 16 2008 I had a four-hour gastric bypass, the offi cial name is a Roux en Y (RNY). Mr Somers reduced the food space in my stomach by cutting and stapling it to form a small pouch the size of an egg which means I can’t eat a lot. The small intestine was shortened as the duodenum (the fi rst section of the small  intestine) is bypassed. This results in a reduction in the number of  nutrients and calories absorbed from food so I’d have to take multi-vitamins for ever.

Mr  Somers explained the operation should result in a loss of 60 per cent of excess weight. The gastric bypass procedure also has the added advantage of curing some obesity-related conditions such as type 2 diabetes.

I promised Mr Somers I would abide by every rule to make the most of my surgery. That includes not eating anything high in fat or sugar and avoiding very starchy foods such as pasta because they all swell in your stomach and cause what’s known as dumping  syndrome, which has an effect like a diabetic hypo.

I cheated once and ate a shortbread. Immediately afterwards I was sweating, shaking and had a terrible headache. Never again. Hand on heart I’ve never eaten a cake since the operation.

Despite having a 10cm scar on my abdomen I was home three days after the operation. I had to see a dietician and psychologist because even though the surgery was a positive change to my life it was a huge one emotionally.

For the first 10 months I lost a stone and one dress size per month. I joined a gym where I’d use the reclining exercise bike several times a week and learned to swim. I eat healthy food in starter-sized portions which is all my stomach will allow.

It took me a year to lose  12 stone and I’ve lost more since. I’ve now got a lot of loose skin as a result of the weight loss but I can apply for funding from the NHS to have surgery to remove the loose skin on my breasts and tummy which could harbour infections. I’ve been told the skin itself could weigh up to a stone and a half.

People may disapprove of my surgery because it’s cost the NHS money but it’s probably saved the NHS more because I was on a one-way ticket to diabetes, stroke and even blindness.

Last year we had a holiday in Greece which would have been unthinkable before as I wouldn’t have been able to sit on the plane.

I have absolutely no regrets whatso ever about the route I took to lose weight. It has given me my life back quite literally and you can’t put a price on that.