About a decade ago, I was on the National Institutes of Health panel that wrote the clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. We agreed that:

• Diet and exercise should be the first interventions for losing weight, because they are the least intrusive and have few negative side effects.
  
  
• If those strategies were not effective, weight-loss drugs should come next.
  
  
• If drugs were not helpful, then surgery might be considered.
  

The main problem that we found: Weight losses achieved through diet, exercise and drugs generally were quite modest, around 10 to 20 pounds on average, and regaining the lost weight was common. Often, these strategies were especially ineffective for people needing to lose a lot of weight. On the other hand, surgical interventions for weight loss generally produced large weight losses, often 100 pounds or more over one year, with less initial regain.

A decade later, the results are even more pronounced. Weight-loss surgery is an effective intervention to limit caloric intake and subsequently to lose large amounts of weight. For severely obese adults who have struggled unsuccessfully in their weight-loss attempts, bariatric surgery today is an acceptable and effective approach for losing clinically significant amounts of weight.