On a Sunday morning last January, Laura Helms made a trip to the Chico Mall with her husband to look for the protein drinks she would need a few days later.

At 403 pounds she had difficulty walking the short distance from the car to the mall entrance without needing to stop and rest.

Halfway down the mall corridor she needed to stop again.

She took several more breaks on this short trip.

"My back was hurting and I had shortness of breath," she says. "I've allowed myself to get this bad and I don't know how to stop."

The lightest Helms ever weighed is 225 pounds. The heaviest: 450 pounds.

She's lived through being teased as a child and endured stares at restaurants because of her size.

She was hoping all that would change on Jan. 31.

Helms is a bariatric patient at the University of California, Davis Medical Center in Sacramento. On Jan. 31, she was scheduled to undergo gastric bypass surgery, a little more than one year after she began the process that would lead her to rapid weight loss.

The procedure is meant to create a smaller stomach pouch to reconnect with the small intestine at three-quarters the original length, giving the organs less time to absorb food.

Doctors expect her to lose 60 to 80 percent of her weight overall after the procedure – between 170 and 200 pounds.

"I have no frame of reference for that," she said, "and that scares me so much."

Life as the 'fat kid'

One day before the surgery, Helms sits on a couch in the living room of her Gridley home reflecting on the events that led to this moment.

The walls she would put up to protect herself started materializing in the fifth grade. A classmate had told her she couldn't fit through the classroom door because she was so fat.

Helms didn't go to class that day. She sat on the curb and cried until her teacher came out to find her.

The classmate had inflicted some deep cuts on her, she says. Even when she ran across him in high school, she avoided him. In seventh grade, the teasing continued when kids would laugh at her because she could not fit in her desk.

One day, a girl called Helms "fatso." Helms responded by throwing a glass jar at the girl. She was suspended for three days.

Helms started a new school in the eighth grade. A heavyset teacher jokingly told her she should stand on one side of the classroom and he should go on the other side to "even out the room."

She never wanted to go to school because of those types of comments.

"It put me more into my own world," she says.

Without many friends at school, Helms would occupy her time playing with her animals on the family farm in Tudor.

Her mother tried to throw Helms a 13th birthday party, complete with a DJ. But Helms still felt out of place in the clothing she was forced to wear.

"I didn't have the cute dresses and the cute clothes," she says. "It was polyester pants. They didn't make jeans for big kids back then."

Then as a teenager, Helms tried to avoid other students in the halls of Lindhurst High School. Instead of going outside for lunch, Helms would sit in her mother's office, where she worked as a secretary.

Helms' attempts to avoid socializing because of her weight, though, did not stick with her as she grew older.

Today, as a news assistant in the Appeal-Democrat newsroom, Helms enjoys a lot of interaction with reporters and editors. The girlish giggle she lets out when she tells a joke while delivering mail prompts several co-workers to join in on the conversation.

Back in high school, Helms started making friends when she learned to drive and had her own car.

Looking back, it was the wrong crowd.

She started drinking and doing drugs to fit in because she wanted to be the fun one, not the fat one.

She thought she was popular, though she admits she probably wasn't. She just didn't want to be alone after spending so many years as a child hiding.

"Being the fat and lonely kid isn't all that fun," she says.

As an adult, her ex-husband would make disparaging remarks about her weight and her grandmother would tell her she would be pretty if only she was thin.

"When you're told that enough by other people you begin to believe it," she says. "It's hard to change that image."

Surgery decision

Surgery is not Helms' first weight-loss technique.

At the age of 13, Helms and her mother went to weekly Weight Watchers meetings. Helms was more self-conscious about her age than her size, she says, because she was among middle-aged women, not young teens. The weight she lost didn't stay off.

When she turned to illegal drugs years later, Helms would get down to a comfortable size, between 250 and 300 pounds, but when she would stop using, she would gain back the weight.

Helms began to consider surgery four years ago. She's well aware of the potential complications — a family member died from an incision infection 20 years ago — but she's ready for the change.

Then she turned 40 and quit smoking. It was time to go through with surgery.

"I need to take care of myself," she says. "Half my life is over, what am I going to do for the next half?"

She wants to shed the image of the "fat girl" she's carried around most of her life.

"I've always been the fat kid," she says. "Ever since I can remember I've always been bigger than everyone else."

Family support

Although her family is nervous about the change, they are excited as well.

Rick Helms, who has accompanied his wife to several medical appointments, fidgets in his chair at UC Davis as he discusses the changes his entire family faces.

"We'll all lose weight even if we're not trying to," Rick Helms said. "I'm nervous for her."

Helms and her family all struggle with weight. Her 18-year-old daughter has even considered the surgery, but Helms refuses to let her go through with it.

Helms wants to get healthier for the benefit of her husband and three children, but she also has goals of her own. At 41, she still has not had the simple pleasure of walking into a clothing store and buying something straight off the rack. She also wants to climb Mount Lassen and she wants to be able to see her toes.

"Everybody laughs at that," she says with a toothy smile while peering over her stomach in search of her feet.

Although her family members support her decision now, there was a time when that support didn't exist.

Helms' mother, Rosetta Kilgore, 68, whose cousin died 20 years ago of complications related to gastric bypass surgery, did not initially support the idea.

"Until (Laura's) all healed up, I'll worry," Kilgore said.

Kilgore's apprehension faded after she met the surgeons at UC Davis.

"I'm behind her 110 percent," she said. "This is a lifetime commitment; it's not my commitment. She has to be the one to commit to it."

Helms personally knows six gastric bypass patients who've had complications and are still taking medications years later. But that knowledge did little to deter Helms from this weight loss surgery.

"I want my family to support me," she says, "but I'm doing this for myself. They can either get on for the ride or get out of my way."

Physical preparations

With her family on board, Helms still needed consent from medical experts.

When Helms started the process, her body mass index was 61. She was at 56 the day before surgery.

A BMI of 30 or above is considered obese.

But physical preparations were a particularly challenging task for Helms.

To prove to doctors she could shed the weight and keep it off, she was required to lose 10 percent of her body weight before surgery — about 50 pounds.

She also had to change her eating habits and start exercising, something she hadn't done in years.

She did as she was told though. She introduced exercise by taking 20 minutes out of her day to walk around the Appeal-Democrat offices without stopping. She would eventually get to one loop around a city block.

Helms also had regular visits to the dietitian to help with her food choices and portion sizes. Before signing up for surgery, for example, Helms would have a super-sized Big Mac meal and a Filet-O-Fish at McDonald's.

Now she's lucky if she can eat one hamburger.

A psychiatric evaluation to look for addictive personalities and signs of obsessive-compulsive behavior was also a part of pre-surgery exams.

Dozens of medical tests over the past year were also administered, including sleep tests and stress tests to see if Helms could handle surgery.

The stress test took place over two days.

Helms was injected with an isotope that would allow doctors to see her heart valves, to make sure blood can flow OK. She was also given a drug to increase her heart rate to judge how her body would handle the sudden increase during surgery.

Her body offered no reaction to make doctors question her preparedness.

She only had one obstacle left to overcome: the diet exam.

The final hurdle

Sitting in a stark white exam room at the Cypress Building at UC Davis in early January, Helms breathes deeply and her left leg bobs up and down.

She's waiting for dietitian Toni Piechota to give her final written exam. It tests Helms' knowledge about portion size and the specialized diet of protein shakes and soups she can consume following surgery.

"I'm not good at test taking," Helms says nervously.

She has a "cheat sheet" with answers written on it, but doesn't use it.

After 20 minutes, Piechota informs Helms she's passed.

But Piechota is still concerned about Helms' weight. She wants to see the patient weigh below 400 pounds before surgery.

Helms' weight had fluctuated over the past few weeks. Before Helms could drop an extra five pounds, the bariatric team moved her surgery date up nearly a month.

Time to change

The day before the surgery, Helms checks to see that her bag is ready for her hospital stay.

Helms looks tired. She fidgets when asked if she's at all nervous for the procedure. Before answering, she looks down and pats one of her two Lhasa Ahpsos and says she's ready.

With a deep breath and a look of confidence in her eye, Helms looks up from petting her dog Suzie.

"It's time," she proclaims.

Contact Appeal-Democrat reporter Andrea Koskey at 749-4709 or akoskey@appealdemocrat.com

The series

Over the past year, Appeal-Democrat reporter Andrea Koskey and photographer Nick Adams followed colleague Laura Helms during her weight-loss journey as a bariatric patient at the University of California, Davis Medical Center in Sacramento.

The three-part series to be published on consecutive Sundays looks at Helms' decision to undergo surgery, the procedure itself and the long recovery.

Today: Helms recalls the torment she received as an overweight child, among the events leading to her life-altering decision.

Dec. 7: Inside the operating room: anxiety levels are high for the patient and her family.

Dec. 14: A look at how Helms is doing today — the goals she's achieved, where she's failed and the road ahead.

Facts and figures

- Metabolic and bariatric surgery, the treatment of morbid obesity and obesity-related diseases and conditions, limits the amount of food the stomach can hold, and/or limits the amount of calories absorbed, by surgically reducing the stomach's capacity to a few ounces.

- Candidates for bariatric surgery have a body mass index (BMI) of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as Type 2 diabetes, heart disease or sleep apnea.

- An estimated 220,000 people with morbid obesity in the U.S. will undergo bariatric surgery in 2008.

- About 15 million people in the U.S. have morbid obesity; only 1 percent of the clinically eligible population is being treated for morbid obesity through bariatric surgery.

- Bariatric surgery costs an average of $17,000 - $25,000; insurance coverage varies by provider.

- Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including Type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol.

Source: American Society Metabolic and Bariatric Surgery