" Alison Helmer looked on the top shelf of her bedroom closet at the letter she'd stored; the unsealed envelope that told her in so many words that she had to make a choice."

" Her doctor had written the letter, a referral: She was a good candidate for gastric bypass surgery. Her weight, more than 250 pounds, much more than her 5-foot-6 frame could handle much longer, could become life-threatening."

" That meant going under the knife: Letting a surgeon staple her stomach so that it wouldn't hold the volumes of food that would make her gain more."

" "I felt like, 'If you don't do this, you're going to die,'" Alison said. "

" She went to a long-time friend who had struggled with the same challenge for as long as Alison had known her - her mother, Barbara Helmer. After a tense telephone call, Alison learned that her mother was considering bypass surgery, also."

" "After having me, that's when problems began" for Barbara, said Alison. "We got to a point where we kind of hit that wall - there was nowhere to go; feeling terrible about yourself - and decided we wanted to do something and do it together so we'd have the support.""

" They made a pact that they'd make that change and push and pull each other along until they succeeded."

" And what the heck, they decided that if eating habits could make a gastric bypass succeed, then changing eating habits was the way to succeed - without the surgery."

" They've both fought off insulin resistance and reversed their diagnoses of borderline diabetes. Alison is about 30 pounds from her goal weight; Barbara's goals are to be healthy and to lose 20 more pounds. They're confident, because the weight loss has been gradual and resulted from changes in bad habits, not radical fad diets."

" As a girl, Alison had always been large, even though she was healthy, athletic and active in school. Still, the tortures of childhood cruelties took a toll."

" In middle school, a girl Alison thought was a close friend held a sign behind her that said, "whale," and had another person snap a photo. The friend passed the photo around the school."

" But she remembers that life was pleasant around the house, other than the eating habits that are terrifying by modern standards."

" Dad would take her and her brother to school and each day stop at McDonald's for an Egg McMuffin, potatoes and a Dr Pepper. She'd eat lunch from the high-carb line in the form of pizza, pasta and fries."

" But she knew she had a problem. From the age of 10, she was in either Weight Watchers or other diet programs. Sometimes the diets worked, but not for long."

" Her size often perplexed her. At high school graduation, she was healthy and 200 pounds. In 2000, she walked a marathon in Alaska while weighing 203 pounds."

" Alison went to college, earned a master's degree in counseling and became a teacher. But in this successful, pleasant life was her Achilles' heel. "I'm a boredom eater," she said. "And that can be a problem.""

" Her "aha" moment came two years ago, when she and her fiance (now her husband) went on vacation in Alaska. At 250 pounds, she had trouble fitting in the airplane seat and suffered during the entire flight."

" That let her know that of all the things she had under control, food wasn't one of them."

" That's when she sought the answer from her doctor, and that's how she found herself staring at the letter in her closet."

" Barbara grew up in the day when food was the medicine cabinet. The more you ate, the more prosperous you were. "Healthy" was a euphemism for being overweight."

" When she became a mother at age 32, she weighed 130 pounds. In those days, it was common and expected that the family kept good food in front of an expectant mother - one meal for mom, another for the baby."

" She gained 70 pounds with the pregnancy. "I didn't think anything of it; I loved being pregnant," Barbara said. "And we had those A-line dresses. So I just thought that once (the pregnancy) was over, I'd take care of it.""

" Although she lost 50 pounds after the pregnancy, she had her son, Matthew, 17 months later. Her weight never looked back."

" The weight was due also to job stress. Her job as a registered nurse and nursing supervisor at St. John's Mercy Medical Center was intense. For her 28-year career there, she often turned to the hospital cafeteria for the calming effect of the pasta and meatballs, pizza or hamburgers."

" She tried diets. Atkins helped her lose 80 pounds, which she gained back in less than a year. "I have a record for joining Weight Watchers," she said."

" "People think it's not a struggle," Barbara said. "But it is. You don't just decide to lose and then it goes away. I've lost entire crowds in my life."

" "Any diet like Atkins works
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