"Bariatric surgery is probably the most effective intervention we have in health care says Laurie K. Twells a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weightloss surgerys ability to reverse the often devastating effects of being extremely overweight on health and quality of life. I havent come across a patient yet who wouldnt recommend it Dr. Twells said in an interview. Most say they wish theyd done it  years sooner. She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying  and failing  to lose weight and keep it off. And the reason is not a lack of willpower http_rmoduleinline. These patients have lost hundreds of pounds over and over again Dr. Twells said. The weight that it takes them one year to lose is typically back in two months often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate an effect not seen after bariatric surgery which permanently changes the contours of the digestive tract. In reviewing studies https that followed patients for five to  years after weightloss surgery Dr. Twells and colleagues found major longlasting benefits to the patients health and quality of life. Matched with comparable patients who did not have surgery those who did fared much better physically emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility pain daily activities social interactions and feelings of depression and anxiety among other factors that can compromise wellbeing. Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type  diabetes it nearly always puts the disease into remission and slows or prevents the lifethreatening damage it can cause to the heart and blood vessels. Even in the small percentage of patients who ultimately lose little weight after surgery significant metabolic benefits persist according to findings at the Cleveland Clinic. In a study of  obese diabetic patients https who had not lost a lot of excess weight five to nine years after surgery a modest weight loss of just  to  percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities Dr. Stacy Brethauer and colleagues reported. For the two most popular surgical techniques  the gastric bypass and the gastric sleeve  the metabolic benefits are independent of weight loss Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However the gastric band procedure which is reversible lacks these benefits unless patients achieve and maintain significant weight loss he said. Furthermore as a study last year of  surgical patients https at the Veterans Affairs Medical Center in Durham N.C. found those who underwent bariatric surgery had lower overall death rates up to  years later than comparable patients who did not have weightloss surgery. Experts in the field regard the reluctance of some medical insurers including Medicaid programs in many states to cover the cost of bariatric surgery as a pennywise poundfoolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical  price tag of bariatric surgery  sometimes even millions of dollars more. Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially the latest longterm research has shown otherwise. In a decadelong followup of  veterans httpjamanetwork.comjournalsjamasurgeryfullarticle who underwent gastric bypass a mere . percent returned to within  percent of their initial weight  years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of  percent of gastric bypass patients a task too challenging for most clinics. The study by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery found that  years later more than  percent of surgical patients lost more than  percent of their starting weight and about  percent had lost more than  percent. Gastric bypass an operation called RouxenY resulted in a somewhat greater weight loss at  years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band LapBand surgery which has fallen out of favor in the last two or three years Dr. Maciejewski said. Bariatric surgery regardless of the method used is also much safer nowadays than it was even a decade ago said Dr. Jon C. Gould a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary httpjamanetwork.comjournalsjamasurgeryfullarticle on the V.A. study. However he noted the surgery is vastly underutilized to the detriment of patients health and the nations health care costs. Less than  percent who would qualify for bariatric surgery are actually getting it Dr. Gould said. Although the vast majority have health coverage insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesityrelated health conditions and are taking a slew of medications to control them. For example he said to be covered for bariatric surgery Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure. He cited a further deterrent to bariatric surgery a perception that its dangerous and doesnt work beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions. Given the welldocumented safety and effectiveness of bariatric surgery it is now increasingly being performed in people whose obesity is less severe  those with a body mass index B.M.I. of  or perhaps even less  but who have a metabolic disorder like Type  diabetes related to their weight. In recent years the profession has promoted what Dr. Gould calls centers of excellence where  or more bariatric operations are usually done in a year. Practitioners at these centers learn from experience share their knowledge and push for quality improvements he said. Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery which have combined forces to promote quality control. While experts agree that money would be better spent on prevention than treatment Dr. Twells pointed out that we have yet to find a way to prevent obesity and people whose health is compromised by their weight deserve to be treated by the most effective method we have."