There’s still no free lunch, but a recent analysis by doctors in the Journal of the American Medical Association suggests that, for the morbidly obese, the benefits of weight loss through surgery are compelling.

The reasons to be concerned about obesity have been well documented. People who are significantly overweight suffer from a reduced quality of life and a shortened life expectancy. They are more likely to have hyper-tension, diabetes, asthma, sleep apnea, heart disease, cancer, stroke and osteoarthritis. More than 30 percent of Americans are obese, according to the National Health and Nutrition Examination Survey, up from 23 percent 10 years ago. Across gender, age and ethnicity, Americans are fatter and are feeling the effects of it.

Diet and exercise – the simple, difficult acts of eating well and in proportion, exerting yourself physically regularly – work for some people. But most people, for countless reasons, give up on these. Their weight problems remain and may even worsen to devastating effects. Certainly, an environment that emphasizes cars and fast food makes the situation worse and deserves reform of its own. Consider: The JAMA authors note in their Oct. 13 article that a morbidly obese 25-year-old man has a 22 percent reduction in expected remaining life span, a loss of about 12 years.

Their survey examined the results of morbidly obese patients submitting to the next step: bariatric surgery. This comes in several forms in which surgeons remake the body to deny itself calories: gastric bypass, bilio-pancreatic diversion, stomach stapling and banding. The authors reviewed hundreds of studies of these procedures, concentrating on 136 that included more than 22,000 patients, and found, “Even after accounting for the pain and anxiety of surgery, the inconveniences of dietary restrictions, and possible complications including reoperation, quality of life should improve for the majority of bariatric surgery patients.” In addition to the health benefits, the study notes those who underwent the surgery could expect “improved appearance, improved social and economic opportunities.”

These conclusions are not new – groundbreaking work in bariatric surgery was published nearly 10 years ago. But as a meta-analysis, the work supports reappraisal of health care policies toward weight loss. Medicare this week began reviewing whether to expand coverage for this type of surgery, a bellwether for other insurers. Medicare officials have several questions to answer, such as to what extent should these increasingly popular operations, at a cost of $20,000 or more, be covered and at what level of obesity or related illness? What is the cost savings for covering them and where should these operations take place?

The JAMA analysis offers a reassuring view of bariatric surgery. An effective, permanent regimen of diet and exercise is preferable, but given the lack of success with these, here’s an option that could save many lives and, the Medicare review might find, a lot of money.