Introduction

Abstract

Bariatric surgery is widely recognized as a powerful and preferred treatment for extreme obesity. The factors driving this recognition include the proven cost-effective improvement in health and quality of life as well as longevity for patients suffering from extreme obesity and the steady improvement in surgical outcomes. The steady improvement in surgical outcomes is related to the establishment of fellowship training programs and the exposure of junior resident learners to bariatric surgery, the development of minimally invasive surgical approaches, and the establishment of programs for the credentialing of bariatric surgeons and programs. The public awareness and improved outcomes have resulted in a rapid increase in bariatric surgical procedure numbers until the last several years when procedure numbers have stabilized, perhaps related to cost containment efforts by managed care insurance providers. At present, only a tiny fraction of the eligible patient pool actually receives bariatric surgery leaving millions of deserving patients without access to these procedures. The challenge to improve patient access to bariatric surgery is to improve the value of this treatment by improving outcomes and reducing costs. A major component of improving value is to improve the patient preparation and selection process by introducing evidence-based risk–benefit decisions in a setting of expanded comprehensive multidisciplinary patient evaluation.