Body image is a very important concept and I think in the modern era we are trying to teach people that you have to be comfortable with your own body and you shouldn't let people tell you what you should look like. The flip side of that is that there are patients out there who are morbidly obese who are comfortable in their skin and they ask: "Why should I have weight loss surgery?" The answer to that is: Yes, it is important to be comfortable with your body. On the other hand, it's not safe to be morbidly obese for the rest of your life because most people that are morbidly obese will develop complications of obesity and those complications include things like: type 2 diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea. All of these things can be potentially fatal to an individual if left unchecked. Weight loss surgery is a really important for anyone that is morbidly obese.
The main qualification to have weight loss surgery is based on an individual's body mass index (or BMI.) This is something that's easy to calculate and is really just a formula that takes your height and weight into consideration and it spits out a number. In order to have weight loss surgery and to have your insurance company cover it, a patient needs to have a body mass index of 40 or greater if they have no medical problems. Or it can be as low as 35 and greater if they do have some medical problems that are related to their weight - things like diabetes, high blood pressure, high cholesterol, and sleep apnea, for example.
The medical problems that you can develop from being morbidly obese are things like: type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, heartburn and reflux, problems with your bones and joints, and the list goes on and on.
There is a genetic component when it comes to obesity. We don't have a clearcut gene that we've identified, but it's obvious that obesity runs in families where there are certain families (or even countries) where large populations of people and families are all morbidly obese.
Exercise and dieting - while very popular - are actually very unsuccessful in the morbidly obese population. Greater than 95% of people that are morbidly obese fail with diet and exercise, which means that surgery really is the only option.