Hi, trained bariatic surgeon here, experiences from the first line of battle Hi everyone First disclaimer, I'm not a first language English speaker but I'll try my best. Second, I can't say much about the health care in the US of A, not in details at least, as is rather different (and in my personal opinion a lot worse) than in my (European) country. But, as stated.. I'm a surgeon in a senior position with 11 years of experience.  I'm not exclusively bariatric, originally specialized as a colorectal surgeon but we all do lots of other stuff as well, the specialities are not as rigid as in the UK/US.  So, I've been doing bariatric surgeries since about 2,5 y, and have my fair share of morbidly obese "normal" patients as well, ones with cancer or appendicitis and stuff like that. We do Roux - Y Bypasses, if you want to look it up, except for people over 250 - 260 kg (kg mind you, not pounds) where we sometimes start off with a sleeve resection especially if they're older or very ill and come back for Roux- Y later, when they have lost 10% excess body weight. Oh yes, all those percentages of weight loss post-surgery are given as % of excess body weight, not total weight so  Mister 280 kg loses 18-20kg and we're happy. Really.  Roux-Y post surgery tend to do rather well, 20-40% weight loss, no diabetes any more. Goes overnight.  Everything else is up to them.  It is difficult to cheat a Roux-Y, but they find ways. Down-side is that they are malnourished and have a vitamin deficiency for the rest of their lives.  HAES is absolutely frustrating for me. It is not very prevalent in my country but slowly creeping up in the corners. But I'm used to hearing so many excuses and bullshit from the alcoholics, the drug addicts, the smokers, the people who believe they won't get cancer if they "live healthy" the anti-vaxxers etc. it's exactly the same sentences you hear from the fats. They all lie. HAES is on the same level of delusionist bullshit as chemtrails and Moon-landing Hoaxers.  No, you are not healthy. Your bloodworks are all fine? Well congrats girl, so are the ones of the patients on the stroke-unit, all perfect for cholesterol and glucose and what other useless shit your doc is measuring. No hypertension? Well, yet. Are you under 45? Just wait what happens. You fall and break your foot? Have fun heaving your 150 kg of excess weight around on one leg, oh.. Yeah right.. You can't. You stay in bed, be a burden on your family, society paying for all the extra costs.. Every normal person would be up on crutches within days, hobbling around life, but you can't.. But your so fucking healthy. I don't mind my bariatric patients. They are assessed for 1 year prior to surgery (insurance won't cover unless they comply), have to do nutrition teachings, exercise lessons, psychiatric evaluation.. If they don't complete the year, they are kicked out of the program.. Most are very motivated, there are some lazy fucks as well, but they leave soon.  None of them would manage without surgery though, not  a single one. Success-stories of weight loss without surgery are far and few, I have one (ONE!!) confirmed case, a young women who lost 120 kg  about 8 years ago and has stayed on that level since.  So.. I'll probably tell fat medical anecdotes from time to time (I've got tons, like the time we tried to CRP a 450kg guy with a heart attack and it just wasn't physically possible to compress his chest adequately)  And am willing to take any questions, of course