In 1991, the National Institute of Health Consensus Development Panel recommended criteria for patient selection for Bariatric surgery. Patients whose BMI exceeds 40, or whose BMI is between 35 and 40 and have co morbid conditions of obesity such as cardiopulmonary problems, diabetes, or sleep apnea, may be considered for surgery if they have failed medical therapy. Patients should be selected carefully by a multidisciplinary team with medical, surgical, psychological and nutritional expertise. Patients need to be motivated, be well informed, have realistic weight loss expectations, and be committed to long term follow up after surgery.