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At 5-foot-3 and 215 pounds, one thing J. never expected to hear was that she was not obese enough.

For years, the Boulder, Colo., woman dieted -- at times shaving calories to almost starvation rations. She ran until her knees begged for mercy. But the weight didn't come off. So she decided to have surgery.

That's when she learned that, heavy as she was, she wasn't heavy enough to have gastric banding surgery. Nationwide guidelines stipulate that only adults with a body mass index of 40 or greater -- 35 for patients with weight-related conditions -- qualify for bariatric surgeries.

For J., who asked that her full name not be used, that meant she had to gain 30 or 40 more pounds, or develop diabetes or high cholesterol.

Or, she could go to Mexico.

She chose the latter and became one of a growing number of Americans who leave the country for weight-loss surgery. They leave not just because it's cheaper (it is, but often only slightly) but because U.S. standards governing the surgery mean that for tens of thousands of overweight men and women, the procedure is not available in this country. Most return home healthy and on their way to significant weight loss. But for some, there can be serious complications.

In the nine months Dr. Matthew Metz has been with the Colorado Bariatric Surgery Institute, he has repaired eight gastric band surgeries done in Mexico, including J's.

There is growing consensus among bariatric surgeons -- who admittedly have a stake in the issue -- that the requirements for obesity surgery in this country are set too high, and that is driving untold numbers of people to foreign clinics.

"As a society we feel very strongly that the guidelines have to be reviewed," said Dr. Scott Shikora, president of the American Society for Metabolic and Bariatric Surgery.

Those guidelines, which surgeons credentialed to perform gastric banding commit to follow, were established in 1991, based on research dating to the 1970s and 1980s, before the advent of gastric bands.

The bariatric surgery society petitioned the National Institutes of Health four years ago to revisit the requirements, Shikora said.

Change was deemed unnecessary and the request was declined, Shikora said.

In defining obesity, the Centers for Disease Control and Prevention use a different standard. In its calculations of how many Americans are obese, the CDC defines obesity as a BMI -- a calculation based on a ratio of a person's weight to their height -- of 30 or greater.

By that definition, more than a quarter of the nation was obese last year.

It's hard to estimate how many Americans have crossed borders for weight-loss surgery. Shikora said the practice may be more common than people realize. "It's probably not an insignificant minority."

Significant enough that an Internet search of "lap band" and "Mexico" produces pages and pages of hits.

One of those describes a "basic package," including transportation to and from the airport, blood tests, hospital and surgeon's fees and a "nutriologist program" for $7,100.

At Presbyterian/St. Luke's Medical Center in Denver, where Metz performs surgery, the procedure costs roughly $10,000 to $15,000.

Another Web site describes the Obesity Control Center as "just 10 minutes from the San Diego Airport in the prestigious Zona Rio, Tijuana."

This particular clinic, which also has a site in Cancun, offers a link to a network of centers in the U.S. where patients can get periodic refills of the saline solution required to inflate the band. That inflation maintains the feeling of fullness that makes the bands effective.

In less than two years -- and with no major advertising -- the network, Fill Centers USA, has served more than 3,100 patients, said Julie Bingham, a company vice president.

Bingham said more than 95 percent of Fill Centers' patients had surgery outside the United States.

In the repairs he has done, Metz has seen no glaring examples of surgical sloppiness. He has noticed, however, that many of the bands are not approved for use in the United States.

The Food and Drug Administration has approved only two gastric bands. Allergan's Lap Band was the first, approved in 1991. Company spokeswoman Cathy Taylor said there are centers in Mexico approved to use the device and the company last year launched clinical trials to study the safety and effectiveness of Lap Bands on people with lower BMIs.

In the meantime, patients like J. continue to stream across the border.

J. never assumed the surgery would be easy.

She said she's painfully aware that many people perceive banding, gastric bypass and other procedures as the lazy man's -- or woman's -- road to effortless weight loss.

But J. works in health care, and knows what the surgery entails.

She knew it would require hard work and discipline.

Still, she wasn't prepared for the sheer misery that followed her surgery.

Back home about a week after her surgery, she vomited. Gastric surgery patients are warned to avoid coughing and vomiting, but J.

said she couldn't help it. After that, she was sick for months.

Her primary care doctor wasn't sure how to treat her, except to hospitalize her when she became dehydrated.

Doctors and surgeons who perform weight-loss procedures were reluctant to see her. "If you have it done out of the country nobody wants to touch you," J. said.

Shikora acknowledged that there is some truth to that.

"Many of us are not enthusiastic about taking care of these people. If you had surgery in my program, you'd have extensive pre-op training and preparation," he said.

When patients show up with devices installed elsewhere, "it may sound terrible but that means that the burden of all that lack of good care falls on my shoulders," he said.

J.'s condition deteriorated so much she needed a second surgery, which her insurance paid for because it was considered an emergency.

Because of all the vomiting, Metz couldn't say what caused the problem. But when he opened J. up, "the band was not where it was supposed to be."

J. was lucky. Metz was able to reposition her band, and, unlike some patients, she was able to keep it.

Now, she's lost 55 pounds, "and even at this weight, I'm treated much differently," with more respect at work, she said.

"If I could go back and do it over again, I would have to say I'd do the same thing, because I had no options in America."