In general, surgery is not the first tool we recommend for weight loss. Saying that, it may be a “right thing” for those who have seriously worked at nonsurgical weight loss but haven’t been able to achieve and maintain a healthy and acceptable weight.

In addition, it may be the best move for those who have medical issues that just won't wait. Joint replacements, transplants and other surgeries may carry weight limits that make rapid surgical weight loss more urgent. Patients with sleep apnea, diabetes and hypertension may all benefit from weight loss by reducing medications and long-term risks.

More and more insurers are insisting on a period of medically supervised weight loss prior to approving bariatric surgery. This makes sense for the insurer, in that it can allow for a period of reflection by the patient. It may help avoid the desperate decisions that can lead to a surgery a patient hasn’t thoroughly researched and may not be fully prepared for. On the other hand, the process of obtaining surgical permission may drag on through many obstacles and become a seemingly endless emotional nightmare. If you have no patience for the process and can't afford surgery out of pocket, you may want to try medical weight loss (diet, exercise and behavioral modification) one more time.