Currently, both strong consumer and insurer interest in weight loss surgery and increased societal awareness of patient safety has directed intense interest of bariatric surgery outcomes. The weight loss engendered by bariatric surgery leads to numerous down-stream benefits including co-morbidity resolution, quality of life improvement, and increased life span. Quality of life in the mobidly obese (MO) patient is clearly diminished due to poor self-image, economic discrimination, lack of medical access, and societal lack of acceptance. The risk of operative mortality and complications may temper some enthusiasm for bariatric surgery. Given the dramatic effects upon co-morbidities that bariatric surgery renders, it is apparent that bariatric surgery can also provide reduction in healthcare costs. In the United States, the volume outcome effect has been recognized by the Centers for Medicare and Medicaid Services that now require Medicare patients to undergo surgery only at Bariatric Surgery Centers of Excellence.