Surgery is not an answer to treating an epidemic that is primarily due to health behaviors. Obesity is nearly always caused by poor health behaviors on the individual level, which is nested within poor environmental/social conditions. In other words, people may overeat, or eat poorly because society promotes such behaviors (fast foods are cheap compared to healthy food alternatives, stress due to poor social economic conditions, etc.). The list goes on and on...

However, you can't give everyone surgery and expect the issue to be resolved. First, there is sufficient evidence that this surgery is successful for only those individuals who adhere to healthy behaviors after the surgery. So again, we're back to behavior change at the individual level. Second, surgery carries risk. While bariatric surgery has improved since it first was introduced, there are still plenty of patients with bad outcomes, including death. That is not something you would impose upon a society to improve the population's health.

If we take smoking as a example of a population approach to reduce a health hazard, we can see that a variety of different interventions are necessary, at the societal level (laws against smoking in public places, increased taxes on cigarettes, public health messages and campaigns) as well as at the individual level (smoking cessation interventions, and medications/patches, etc.)

These interventions also have high attrition rates and high recidivism rates. It doesn't mean that we give up or resort to unreasonable measures...

"We should admit that behavioral change result in moderate changes in weight and that most people regain lost weight."

That is a logical fallacy. Obviously people do not regain the lost weight magically, they settle back into their old poorer life-style practices.

I concur with Ariel that bariatric surgery alone (without behavior modification) is not going to solve the obesity problem.

Perhaps the approach of better education from childhood should be given a serious consideration. But on the practical level, we are heading in the opposite direction by gutting the public educational system and feeding the worst kind of food to school children at lunch.

Expect the obesity problem to get only worse for another generation; once habits are formed, they are difficult to change!

Obesity is a chronic inflammatory /degenerative disease,that is associated with progressive alterations of the psyco-neuro -endocrine -immune metabolic functions. Being a multi- systemic disease, ,obesity can not be treated with a single approach.Perhaps ,a better knowledge  on the role of  adaptive mechanisms in the pathogenesis of obesity,is needed

A very good question indeed. Is Bariatric surgery the only option. May be yes and no. First the option 

Yes. If the answer is Yes. Bariatric surgery for all. Let us see what the surgery is offering. Smaller size of stomach and easy satiety. Eating in small quantities at regular intervals. apart from this it is not offering anything extra.

Which means Man cannot control his hunger and desire to eat more.

If the option is 2 NO then he should be volunteering to cut down food this is done by behavioral change so what is the difficulty.

It is obvious that Surgeons cannot think beyond the knife

Obesity is now  considered as a medical ,surgical or nutritional business. This a metabloc abnormality with a lot of envirnmental factor and few genetic factors. Obviuosly resaerch is going in the wrong direction . Without an avyyd multidisciplinary research teams  humanity will suffer a lot from this diroder  

Another way to think about it  - Obesity - is as a malfunction of our energy management system brought on by the interaction of our genes with our environment.  We should think about prevention and about treatment.  

Prevention means changing our environment - added sugar; processed foods; marketing of high sugar, low fiber food; providing poor quality food to the needy; opportunities for activity; appreciation of obesogens; appreciation of the microbiome; appreciation of stress, etc.  

Treatment means changing the abnormal physiology that has resulted from the interaction of our genes and the environment.  The physiology is complex and the abnormalities are complex.  Obesity is a heterogenous disease. Changing the abnormal physiology has to be done recognizing how the physiology got abnormal - our environment.  Surgery is  currently the best changer of abnormal physiology but we need better tools - more effective, cheaper, safer, more acceptable.

And in the background lurks bias - the patients are biased against themselves, healthcare providers are bias against the patients, and the public is bias.  This is not a behavioral, self determined problem.  It is a physiological aberration caused by changes in our environment.  The adults are not "slovenly gluttons" and the children are not "lazy slugs".

The disease of obesity is a public health problem.  We should determine the cause, treat those who are affected, and learn to prevent the disease.

Everyone seems to struggle with the obvious -

Preventing obesity is a vastly different problem from managing established (severe) obesity. In this group diet exercise and all the other lifestyle modifications are very rarely effective. Hence the need for bariatric surgery. But bariatric surgery is not for everyone. Surgery will most certainly fail unless psycho-social factors are addressed. Our very conservative group only operate on 1 in 4 patients referred to our clinic...

please stop Colas and Pepsi in your meetings and stop offering them to your guests. The change begins with you.

although initially bariatric surgery appeared to be magical in reducing weight especially in morbidly obese individuals -obviously lot of lacunae have appeared ,one the cost,2nd maintainance,3rd the risk of surgery in such an obese person but now more insights have been tried to look into why bariatric surgery was so effective-firstly it is the bile acids acting on TR5 receptors in brain ,then effects on FGFgroup right from FGF16-21 and although GLP1 was initially thought to be one of the most important but in rodent models it couldnt be reproduced and a condition which is epidemic alternate solutions have to be sought with newer drugs being developed in combination like qsymia,naltrexone and buprion ,lorcarserin ,exenatide and now lot of work is being done on development of browning of adipocytes with detection of PRDM16 as the transcriptional activator of brown adipocytes and how with exercise FNDC5 a myokine is developed whivch gets converted to irisin a 112 aa  compound whic causes browning and further it has been found with exercize there is ibncrease in BDNF in brain as well which is througfh FDCN5 gene and which helps in hippocampal plasticity and cortical growth etc so in all trying to find aetiopathogenesis along with role of probiotics and immune cell alteration newer podssibilities like alterations in miRNAs are being taken into consideration besides maintaining a changed in life style,

http://www.ncbi.nlm.nih.gov/pubmed/24120943

http://www.ncbi.nlm.nih.gov/pubmed/24464712