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Tom Saridis is having the time of his life.

He bombs around in a little Mercedes, buys his clothes off the rack at any store he chooses, and gets a kick out of flying in the close confines of economy class.

Two years ago, such simple pleasures would have been impossible.

At 508 pounds, driving meant buying the roomiest vehicle he could find - a full-sized Ford Expedition, and even with that he couldn't get the seatbelt around his girth. Clothes came from a shop for big and tall men - size 72 jeans at his largest, held up by a 200-centimetre belt. There was no way to travel by air - he had even outgrown the seats in first class.

"Exercise at 500 pounds was walking to the car from the front door of my house," explains the 6-foot Mr. Saridis. "Walking up a flight of stairs was a thought. You would think and plan for it, making sure you didn't forget anything in your car."

And it's not as if he hadn't tried to scale down his weight, which he began packing on at age 14.

Over the next two decades Mr. Saridis tried - and initially succeeded - at almost every diet out there. But the pounds always came back, and then some.

"I decided something had to be done."

He went to a Toronto cosmetic clinic for a $17,000 out-of-pocket operation to have a band placed around the opening to his stomach, a procedure that severely limits the amount of food he can ingest.

And while the surgery has proved successful - at 221 pounds, the 36-year-old is half the man he was - there were no concurrent services to deal with other issues he struggled with, from proper nutrition to physiotherapy to psychological counselling.

"I left there that day with a stomach that could only hold a hard-boiled egg," says Mr. Saridis, whose typical pre-surgery dinner was as much rice as a plate could hold, topped by two or three chicken breasts, maybe salad to fill up the corners and a 500-millilitre tub of ice cream. Any leftovers were gone before bed.

"Who's going to fix my mind? ... I'm feeling full, but I'm eating with my eyes - and there's no satiety for my eyes."

Mr. Saridis, who owns a dry-cleaning business, decided he could build a better mousetrap. He invested about $4-million to open the Canadian Institute of Bariatric Options, a private Toronto clinic that provides gastric banding surgery via minimally invasive laparoscopic surgery and related services to promote and sustain weight loss.

Clients pay $18,000 for the day surgery (which is not provincially insured), periodic tightening of the band as weight is lost, and a year of nutritional, psychological, fitness and chiropractic support.

"It's until they feel okay to stand on their own two legs and deal with things," he says. "Let's be honest: We don't have a secret pill to losing weight, nobody does. What we're teaching is sensibility; what we're teaching is practicality and helping to implement it into your life."

Nicolas Christou, one of Canada's pre-eminent bariatric surgeons, says one thing CIBO is doing right is providing nutritional and other services to help patients make a success of their surgery.

But Dr. Christou argues that CIBO and similar gastric-banding providers cannot call themselves true bariatric clinics because they offer only a single surgical procedure - and when it comes to the morbidly obese, one size does not fit all.

"Bariatric surgery includes the whole spectrum of procedures that are suitable for the individual patient and include backup procedures if procedure A does not work," says Dr. Christou of McGill University in Montreal. He notes that gastric banding carries a significant risk of complications, such as the band slipping down on the stomach, or erosion of the tissue it encircles.

North America's gold-standard surgery is gastric bypass, in which a pouch is created and connected to the small intestine, bypassing the stomach. Another standard surgery is biliopancreatic diversion, which reduces stomach size and allows food to bypass part of the small intestine so fewer calories are absorbed.

While both are insured services in most provinces, Dr. Christou laments that the notion of "bariatric surgery being covered in Canada has to be taken with a grain of salt."

Waiting lists for surgery have swelled to inexcusable lengths, he says. The average wait in Canada is 5.2 years; his own patients at Montreal's Royal Victoria Hospital face a 13-year wait.

One day a week he operates at the private Weight Loss Surgery clinic, which offers bariatric procedures to non-Quebec residents for $15,000 to $22,000. "Even then I have a waiting list," he says.

Yet despite the burgeoning demand and the obvious long-term health benefits of weight reduction, the health-care system is doing little to improve access, Dr. Christou says.

There are only a dozen or so fully trained bariatric surgeons in the country and the specialty is not attracting more. A major reason, he says, is that the procedure remains near the bottom of hospitals' surgical priority lists: His own hospital gives him only one day of operating-room time a month.

Such lack of accommodation simply mirrors society's negative attitudes toward the morbidly obese, Dr. Christou believes.

"The public perception is that these are big, fat slobs that should be on a diet, and 'Why should I be paying for their treatment?' The reality is that they are people that have most likely a genetic predisposition to energy conservation," who are also subject to "maladaptive socioeconomic factors," he says.

"And you get these people putting on weight and then they feel more depressed," he says. "They eat more to feel better, and it's a vicious circle that cannot be broken other than by the mechanical rearrangement of their gastrointestinal anatomy."

Given that there are about 900,000 morbidly obese people in Canada, many of them desperate for help, it's no wonder private clinics are opening to fill the void.

Still, CIBO's surgeon, Monali Misra, says gastric banding or any bariatric surgery is not for every person with weight issues. To qualify, patients must have a body mass index of 40 or more, or of 35-plus with two related illnesses such as high blood pressure and diabetes.

Surgery is just a tool that must be combined with healthy eating and exercise to be successful, she says.

"If you take in a high-calorie diet, you're not going to lose the weight," says Dr. Misra, citing the case of a woman with gastric banding who blended up six Big Macs so she could drink them down.

"We operate on the stomach, not the brain," she quips, stressing that her motivation for doing bariatric surgery is to improve patients' health; enhancing how they look and feel about themselves is a bonus.

"I want them to live longer. And that's what they need to want as well."