There was once a dress that hung from Julia Skudders' door.
For about two years the dress hung there waiting to be worn - but Skudder was waiting to lose a couple of kilograms.
Last week she tried it on but it is far too big after the Rotorua woman lost 52kg in two years.
Fifteen people from the Lakes District Health Board area have laid on the operating table in the past three years for bariatric surgery. Skudder was not one of them.
However, she did have a gastric band of some sorts put on - through hypnosis.
"I was miserable. I was overweight. I didn't like myself. I was unhappy.
"I had to do something about it. I had to take control of me," Skudder told the Rotorua Daily Post Weekend.
After a number of failed diets, the former marathon runner knew it was time to make a change. And she hasn't looked back.
The "virtual gastric band" was delivered in a series of sessions by Rotorua hypnotherapist Justine Lette.
Lette said the mind often held on to moments of trauma and, in Skudder's case, kept the weight on as a protective mechanism.
Lette's role was to clear it all away, then she applied a "virtual gastric band", meaning Skudder would eat small portions.
"Clear the emotional reasons underneath and then the band goes to work for them," Lette says.
"I have seen people that have had the real thing and put the weight back on. But when you don't clear the emotional reasons, why the weight is there in the body, it will find a way to either get bigger or they'll get depression or they'll turn to something like alcohol."
Lette says she has had thousands of clients receive the treatment and, while it was something she never imagined herself doing, she can't give it up.
"People come in here and tell me, this is the first time they have loved themselves. That is why I do it."
It took Skudder a decade to put the weight on. She believes it started when her father died, leaving the care of her mother in her hands.
Combined with a broken foot and workplace bullying, Skudder put her own life on the "back burner", she said.
Skudder said she was so ashamed of how she looked, she would get exercise by walking from light pole to light pole, under the shade of night.
But the smile that exudes off her face now tells a different story.
When Skudder first met Lette, she was wearing a size 26. Now she can fit into a 12.
Skudder's route to weight loss might not suit everybody but the chance of going under the knife for bariatric surgery is slim.
All patients referred for publicly funded bariatric surgery are prioritised on the National Bariatric Prioritisation tool, a set of criteria that scores patients' need and ability to benefit.
Surgeons doing bariatric surgery generally wish to do a minimum volume of cases per year to maintain experience and support a high-quality service, Waikato Hospital's bariatric surgeon Rowan French says.
The hospital provides the service for Lakes District Health Board.
French says eligible patients are assessed for suitability and, in most cases, asked to make lifestyle changes to lose weight before the operation.
"In our programme, a certain amount of pre-op weight loss is a prerequisite to proceed to surgery. Our usual target is 5 to 10 per cent of body weight."
On top of that, a three to five-week diet is also required to shrink the liver which ensures the surgery can go ahead safely, he says.
The average cost per patient admission is $13,318, based on the last financial year. The range was $9163 to $20,507.
Five Lakes patients have received the specialised procedure in each of the past three years and the local DHB is not accepting any new referrals, the health board confirmed.
Treatment paths for patients who have been waiting for some time were being "worked out", a spokeswoman said.
French says bariatric surgery could fix obesity-associated problems.
The resolution rate of type 2 diabetes is more than 90 per cent.
Sleep apnoea, hypertension and infertility also had a high chance of improving following the surgery, he says, and it doesn't stop there.
"Often surgery is required to bring a patient into the weight range to be able to have hip or knee joint replacement."
On average, 80 per cent of excess weight is lost in the first nine to 12 months.
"Psychological benefits of weight loss including improved social engagement and ability to resume employment can be positive spinoffs," French says.
For Skudder, the "positive spinoffs" are what she is most proud of.
"I knew I had to do it, for my sanity, because I didn't like myself. Now I do."