When you’re severely obese is there ever a point in which you can’t get better with just diet and exercise alone? Yeah that’s a good point most of the time we’re gonna treat obesity with diet and exercise that’s what’s the long proven way to treat it and that’s what we’ve all been taught in medical school the difference is the morbidly obese patient and the severely obese patient that group of patients are a little bit different and there’s been studies and the first study was done in 1991 it was a consensus at the National Institute of Health and what they did it studied many patients and they put them on diet and exercise for a extended period of time and what they noticed that the severely obese and the more real obese patients there a chance of actually losing weight and keeping it off was one out of every 100 so there was a 99 percent failure rate so we’re not talking about the normal person who’s 10 20 pounds maybe 30 pounds overweight those patients or those people can actually lose weight on diet and exercise okay the long proven way to do. Are we talking over 30 over 40 pounds? So it’s not really the member it’s not really the weight it’s BMI and I because you can have a 200-pound man it’s different than you know a woman who’s only 5 5 and that kind of thing so what we’re talking about is the is the severely obese and the more than the more below based patients those patients have a difficult time losing weight and just standard fashions of diet and exercise. So people who are in that situation there are some options for a weight loss surgery they have evolved over time right so tell me a little bit about the treatment and the options that people might have right now. So usually what we do is when we see our patients they come to us as morbidly obese patients we’re going to see the severely obese and then the morbidly obese patients okay and what we’ll do is we’ll actually put them on a diet and it’s usually anywhere from three to six months of diet and exercise program if they fail to lose the amount of weight that they need to lose then they’re going to qualify for a bariatric procedure.