Credit: AP Photo/Monroe Evening News, Kim Brent

For the morbidly obese, the lack of effective obesity drugs has made surgery an increasingly attractive option. Bariatric surgery, in which surgeons bypass a large part of the stomach, leads to dramatic, largely permanent weight loss. Since the early 1990s, use of the procedure has grown exponentially, with an estimated 170,000 procedures expected in 2005.

Those who have the surgery lose about 60% of their excess weight on average. What's more, obesity-related conditions such as diabetes and high blood pressure improve markedly (JAMA 292, 1724–1737; 2004). The procedure costs about $25,000, but the health benefits prompted about half of insurance companies to reimburse the expense.

In the last year, however, soaring costs and safety concerns have struck a note of caution. In October, David Zingmond and colleagues at the University of California in Los Angeles reported that of 25,000 Californians who had the surgery in the past decade, 40% returned to a hospital in the three years following their surgery, most often as a result of to post-surgical complications (JAMA 294, 1918–1924; 2005).

That may signal a more favorable outlook for obesity drugs. “The managed care industry is terrified of the high costs associated with bariatric surgery,” says Donny Wong, an obesity market analyst at the Massachusetts-based Decision Resources—“terrified enough that they might start wanting to reimburse for obesity drugs.”