Abstract. Massive obesity is prevalent and associated with serious co-morbidities. For patients who cannot sustain weight loss, malabsorption and gastric reduction operations have been developed. Patients with the former operation require surveillance for protein malnutrition and other sequelae; those with gastric reduction require a permanent tiny reservoir and stoma. Long-term follow-up surveillance is necessary. Postoperatively, 15% to 40% of patients, depending on the operative procedure performed, fail to maintain adequate weight loss. Successful weight loss in most of these patients makes this challenging surgery worthwhile, with alleviation of devastating disease and marked improvement in quality of life.