I've seen so many patients struggle with weight. There comes a point where weight loss is nearly impossible. I've started pushing my very obese patients to get surgery sooner rather than later, especially those who I know have tried many different things to lose weight. Insurance is getting better at paying for it, knowing that paying for the surgery will be cheaper in the long run than paying for the joint replacements, cardiac surgery, diabetes, end stage complications of uncontrolled sleep apnea, etc. For those with the life long struggle, I think it should be considered earlier.