Gastric Bypass Surgery: has a long history of success and clinical studies to vali­date its effectiveness [1, 2].

There are trade-offs. Bariatric surgery carries some long-term risks for patients, including: Dumping syndrome, a condition that can lead to symptoms like nausea and dizziness. Low blood sugar and malnutrition.

According to data from the Centers for Disease Control and Prevention (CDC), over a third of adults in the United States live with obesity.

Obesity is the next major epidemiologic challenge facing today’s doctors, with the annual allocation of healthcare resources for this disease and related comor­bidities projected to exceed $150 billion in the United States.

This new option now offers the patient a pill to swallow, and a balloon is then inflated and left in the stomach for six months. This results in reduced hunger and an increase in the feeling of satiety.

As for the effect of the industry, Sa Dang et al. [10] recently showed the impact of economy and competition in the medical tourism industry among six south-east Asian countries. In addition to excellent innovative and relatively cheaper medical services, additional tourism activities are a factor in driving more patients to that region. Healthcare facilities and infrastructure, together with the quality of medi­cal tourism providers are the first conditions to any traveler, prior to considering lower costs of care. Governments in those countries play a major role in reducing other burdens: providing educational information on the travel experience, lower air fare costs, tax returns, and travel insurances. Among many reports, Thailand seemed to perform best among countries in that region. Cosmetic surgery is the number one reason to travel to Thailand, but bariatric surgery is second on the list and gaining momentum as a reason to travel [2], although this differs according to the different sources (Fig. 3 and Table 1).

Rokni et al. [16] summarized all of these into push and pull factors: push fac­tors pushing patients away from their current national health system, while pull factors pulling them into another medical tourism healthcare system or provider (Table 2).

Unfortunately, the countries with national health systems with long waiting lists, are on the receiving end of their own residents returning at times with complica­tions, after undergoing bariatric or other procedures elsewhere. Before we delve into such reports, it is important to note that patients doing well otherwise are pos­sibly not well represented in the medical literature, as they either follow up with their primary care only, or are just not following up with any physician. Eventually patients tend to seek medical advice if they are vigilant on maintaining their good health, or are experiencing a health problem. Those who only see physicians due to a health problem, will never do so if they are well in their own opinion. This raises the possible matter of medical tourism being impacted with a larger number of negative publications, especially among the countries on the receiving end of complications.

Other social difficulties were reported by Awano et al. [21] in Japan. Language barriers, inadequate or inaccurate referral information, difference in cultural habits led to more confusion in some patients, with a few going elsewhere for treatment. Caregiver-companions; family or friends traveling with medical tourists, also face a great burden while abroad [22]. They have a heightened sense of responsibility, with most feeling vulnerable emotionally and strained financially if complications occur while abroad.