A 40-year-old woman with lifelong obesity presented for consultation regarding a weight-loss procedure. Despite trying several weight-loss programs, she had been able to lose only 10 to 15 pounds and was unable to maintain this weight loss. Her medical history included polycystic ovary syndrome, hyperlipidemia, gallstone disease, and cholecystectomy. Her family history was notable for obesity, type 2 diabetes, and hypertension. Her physical examination results were notable for a weight of 228 pounds, height of 62 inches, and body mass index of 41.7 kg/m2.