I'm a 53-year-old, fairly healthy women who weighs 302 pounds. I have borderline hypertension, as well as pain and discomfort in both knees. I have dieted since age 12 with no success. Now I'm considering vertical banded gastroplasty. How can I be sure that I am picking the best physician for this procedure?

M.F.

Patients who are severely obese despite weight-reduction diets and medications or who have obesity-related complications such as high blood pressure, heart disease, diabetes or arthritis may be candidates for weight-reduction surgery. Before surgical evaluation, candidates must undergo psychological evaluation to make sure that they will be able to tolerate the potential long-term effects, including the possible complications, of the operation.

The surgical procedures performed for weight reduction have evolved over the years. Currently, the most common procedures involve a bypass of part of the stomach and/or a stapling of part of the stomach to reduce its size. Both are effective in leading to significant weight loss. However, both procedures also can have significant complications, including leakage at the surgical sites and obstruction of the stomach.

Any patient who is a good candidate for weight-reduction surgery should find a surgeon who is very experienced in these procedures. The crucial factor in preventing complications and having a good outcome is the experience of the surgeon. Usually, the more weight-reduction surgeries a doctor has performed, the better your chances are of a good outcome.

Patients living in smaller communities where few of these operations are done should seriously consider traveling to a major medical center for the procedure. One can also get information about a surgeon's experience by asking the doctor directly or by talking to some of his or her patients. Finally, you may want to search the Internet or go to your library for medical journals with articles on this topic. Besides giving you general information on the procedures available, the articles may help you identify those surgeons who are on the cutting edge of weight-reduction procedures.