New in Obesity (Albaugh, Schauer et al., Pennington): 1.26 million US bariatric cases from the MBSAQIP registry, 2015 to 2023. 5.3% had a BMI of 60 or more. About 1.1% a year were 70 or more. At BMI 70+ vs under 40: Serious complications 2.6% vs 0.7% Mortality 0.35% vs 0.05% Functional dependence 4.5% vs 0.5% The relative jump looks frightening. The absolute numbers are still low, and the authors conclude extreme BMI on its own shouldn't rule out treatment. As a surgeon building a programme, my takeaway is that the operation is rarely the bottleneck. The clinic scale, the transfer, the table rating, the CT gantry and a recovery bed ready for sleep apnoea decide whether that patient ever reaches theatre. One honest caveat: the registry only counts people who had surgery. Those turned away never show up in it.