The major immediate risks are mechanical, but the longer-term risks are metabolic, nutritional, and emotional. Most patients worry the most about the risk of the surgery itself. But with our improved surgical techniques, skilled surgeons and more experience, the risks of the surgery itself are becoming small compared to the risks of remaining obese.

The long term nutritional effects are especially important with those surgeries that interfere with food absorption. When part of the intestine is bypassed, certain vitamins and minerals can pass through without an adequate amount being absorbed into the blood stream. These include certain B vitamins, vitamin D and minerals such as calcium and iron. It is extremely important that the patient receives a full education about the long-term effects of whichever surgery is chosen and that they understand that long-term they will have to be skilled at getting enough protein, fiber, water and vitamins and minerals in their diet through food, and possibly through supplements.

Nor should emotional risks be ignored. There is a temptation to believe that ideal weight can lead to an ideal life. Of course, this is seldom if ever true and change, even positive change, can be very disruptive. I encourage patients to discuss their surgical decision with all the people they want in their world after surgery. Spouses, parents, children, friends and other close family often are as frightened by what may happen as the patient. Spouses wonder what will happen to the marriage with a more active and possibly more attractive and confident partner.