Obesity has important adverse health consequences associated with multiple metabolic, structural, degenerative, neoplastic, and psychological effects that reduce quality of life and increase mortality.1 Given the epidemic of obesity in the United States and worldwide, treatment of obesity has emerged as 1 of the greatest present unmet medical needs and a target for pharmacological interventions. Factors underlying the population's rapid increase in excess weight, as well as reasons for difficulty achieving and sustaining weight loss, remain incompletely understood. Medications have been used to assist in weight loss for almost 80 years, but adverse effects frequently restrict their utility. Norepinephrine reuptake inhibitors are available for short-term administration to promote weight loss, but weight regain is common when use is discontinued. The weight loss drugs fenfluramine and dexfenfluramine, intended for long-term use, were removed from the US market in 1997 because of the occurrence of left-sided valvular heart disease; phenylpropanolamine was withdrawn in 2000 for its association with hemorrhagic stroke; and rimonabant was available briefly in Europe but was withdrawn because of its association with depression and suicidal ideation before its approval in the United States. Currently, there is only 1 medication (orlistat) approved for the long-term treatment of obesity by the US Food and Drug Administration (FDA) after the recent voluntary withdrawal of sibutramine from the US market. In contrast, surgical treatments for obesity have become important alternatives to pharmacotherapy, especially since the advent of less invasive laparoscopic techniques.2 Surgically induced weight loss is often substantial and is associated with improvements in obesity-related diseases such as diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea, as well as with reductions in cancer risk and mortality.3–6 With the development of less invasive techniques, apparent reduced procedure-related morbidity, and the absence of alternatives, bariatric surgical procedures are being performed …