After half a lifetime of trying and failing to lose weight, Nancy Kerins knew surgery was the only option.

"I just couldn't get myself to eat less," said Kerins, of Salem.

Hitting bottom was when she put on pounds after delivering her baby, and found herself weighing more than at the peak of her pregnancy.

"For a woman, weighing more than your ninth month weight is a big deal," she recalled.

Kerins, 36, weighed 321 pounds when she went in for Lap Band (laparoscopic adjustable gastric band) surgery at Salem Hospital on Nov. 1 last year.

The procedure, which uses an elastic band to shrink the stomach to a fraction of its normal size, is one of three kinds of bariatric surgery the hospital performs.

Kerins, who works at Salem Hospital as a patient safety specialist, has gotten down to 276 pounds so far. And as happy as she is with the results, she acknowledges that having surgery was a difficult decision.

"I discussed it heavily in therapy for a full year," she explained.

Around 1,000 people have made the same decision as Kerins and gone to Salem Hospital for weight-loss surgery since it started offering bariatric procedures 10 years ago.

"Generally speaking, these patients have tried calorie restriction, exercises, hypnosis," said Ann Stanton, a nurse practitioner who, along with dietician Melinda Vaturro, reviews each patient's weight, diet and psychological history prior to surgery.

As important as the consultations are with patients prior to surgery, Stanton said, the exercise, support groups and counseling that follow in a 12-week post-operative program at the hospital are also key.

"Change is always hard," she said. "We do let them know they can have lapses."

Weight loss surgery addresses the physical aspect of weight problems, but doesn't fix people's emotional issues that may be at the root of their obesity.

"A very high number have been victims of abuse — physical, psychological, sexual," Stanton said of the patients who seek bariatric surgery.

From blood pressure to fertility, doctors see results

Whatever their backgrounds, the number of people seeking bariatric surgery has grown each year, and Salem Hospital now performs around 200 procedures annually, according to Stanton.

That growth is partly because more doctors recognize the surgery's positive impact on general health, and are recommending it to their patients.

People who have had the surgery often experience dramatic improvements with their high blood pressure, sleep apnea, diabetes, arthritis and joint pain, according to Dr. Frederick Buckley, who along with Dr. Bernard Benedetto, performs weight loss surgery at Salem Hospital.

Bariatric surgery can also improve fertility for women whose obesity may interfere with their ability to have children, Buckley said.

In acknowledgement of these benefits, in February, the Food and Drug Administration approved lap band surgery for patients with body mass indexes (a measurement calculated from weight and height) as low as 30, down from a limit of 35, as long as they have one medical condition related to obesity. Kerins' BMI was 52 before surgery.

Even insurance companies benefit, reimbursing fewer doctor's visits, medications, and other forms of medical care for obesity-related conditions within a year and half of surgery, Buckley said, although in many states, insurance companies still "won't pay for any weight loss surgery."

"Folks in Massachusetts are lucky," he said, when it comes to getting help with the cost.

There are pros and cons to each of the procedures Salem Hospital offers.

Gastric bypass, which creates a permanently smaller stomach and shortens the intestinal route food passes through, causes patients to lose weight faster than with a lap band.

Kirk Brigham, 37, an EMT from Beverly, dropped 100 pounds within four months after having gastric bypass in May 2008, when he weighed 374 pounds. At present, he has lost a total of 160 pounds, which he considers his plateau weight.

But the permanence of this procedure can make people hesitate.

In fact, Brigham canceled surgery the first time it was scheduled and resolved, as he had before, to lose weight by dieting. But to no avail.

"I found myself in the exact same place," Brigham said. "I knew I couldn't do it on my own."

Brigham also knows that as effective as the surgery has been — including allowing him to be much more effective in the physical aspects of his job as an EMT — he still has to think about what he eats.

"This was a tool," he said. "It's part of the process."