APPROXIMATELY TWO-THIRDS of the US population is overweight or obese. The effects of the comorbidities that accompany obesity often are severe and can be life threatening over time. Currently, the most effective and sustainable method of substantial weight loss is bariatric surgery. Bariatric surgery also has been successful in reversing comorbidities. THE BENEFITS, RISKS, AND COMPLICATIONS of common weight-loss surgical procedures (eg, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, vertical-banded gastroplasty, biliopancreatic diversion and duodenal switch) are discussed. THE HEALTH CARE FIELD OF BARIATRICS is growing rapidly. More information is needed to support and guide changes in current standards of practice to better meet the needs of this patient population.

On a journey to the future, an initial strategy of engagement and design is essential but inevitably inadequate. Instead, as bumps in the road emerge, the ability of leadership to regroup and refocus is the key. This is the story of one such journey-a journey pursuing the triple aim of excellence in patient care, patient and staff satisfaction, and economic sustainability. It is one chapter in the transformation of an 1800-employee patient care services organization. It is not the first chapter nor will it be the last.

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