The physical dimensions of Americans have changed over time. Today, men and women are about one inch taller and about 25 pounds heavier than their counterparts in 1960.*  An abundance of energy-dense food choices and decreased opportunities and motivation for physical activity are believed to be largely responsible for the weight gain documented in American adults and children over the last three decades. Flegal and Carroll et al. estimate that in 2008, 68% of Americans over the age of 20 years old were overweight or obese.*

There is no consensus on the amount of body fat that is unhealthy. However, the World Health Organization considers a persons with a body mass index (BMI) >25 to be overweight and a BMI >30 to be obese. Overweight and obesity are associated with the incidence of multiple comorbidities. Obesity has been found to be significantly associated with the incidence of: type II diabetes, cancer, cardiovascular diseases, asthma, gallbladder disease, osteoarthritis and chronic back pain.*

The healthcare system has had to supersize to safely meet the needs of a larger and more complex patient. For example rooms and fixtures were once designed to serve a maximum patient weight of 300 lbs. Today bariatric rooms and fixtures are being designed for patients weighing 1000 lbs or more. This means larger: rooms, beds, doorways, elevators, radiology facilities and equipment, surgical fixtures and instrumentation and much more labor to safely treat and transport the overweight and obese patient.*

Social pressure, pharmacotherapy, dieting and exercise have been shown to produce only short term weight loss. Medicine has had to develop new methods and guidelines for treating the overweight and obese. Today, surgical weight loss procedures and lifelong multidisciplinary care can reduce adiposity sufficient to blunt the progress of many comorbidities.