Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.

The study looked at safety results for gastric bands and stomach stapling at 10 U.S. hospitals specializing in these procedures from 2005 through 2007. For every 1,000 patients, three died during or within a month of their surgery, and 43 had a major complication.

'The expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health-care system.'— Dr. Malcolm Robinson

That is much better than the 20 or so deaths per 1,000 patients that studies found just a few years earlier. And it's surely lower than the longer-term risk of dying of heart disease, diabetes and other consequences of lugging around more pounds than an obese person's organs can handle, experts say.

Many studies have compared those odds, and "all show a higher risk of dying if you do not have surgical treatment than if you do," said Dr. Eric DeMaria, weight loss surgery chief at Duke University Medical Center.

He had no role in the new study, which was led by Dr. David Flum at the University of Washington in Seattle. Results appear in Thursday's New England Journal of Medicine.

About one-third of American adults are obese, with a body mass index of 30 or more. The index is based on height and weight. Someone who is five-foot-four is obese at 175 pounds, for instance.

Federal guidelines say obesity surgery shouldn't be considered unless someone has tried conventional ways to shed pounds and has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

Last year, at least 220,000 obesity surgeries were done in the United States, says the American Society for Metabolic & Bariatric Surgery. The most popular method is a gastric bypass in which a small pouch is stapled off from the rest of the stomach and connected to the small intestine.

People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. This can be done with traditional surgery or laparoscopically, through small keyhole incisions.

Another solution is a gastric band. A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

The new study looked at the safety of these methods in 3,412 gastric bypass patients and 1,198 given stomach bands.

Death, serious complications or the need for another procedure occurred in one per cent of people receiving bands, nearly five per cent having laparoscopic gastric bypass, and nearly eight per cent of those given a traditional surgical bypass.

DeMaria cautioned against comparing the numbers, because healthier people may have been steered toward laparoscopic procedures that may not have been an option for others with more health risks.

'Safe, effective and affordable'

Complication rates were greater in people with a history of clot problems, sleep apnea and certain other medical issues, the study found.

The results put the spotlight on cost issues, Dr. Malcolm Robinson, a surgeon at Harvard Medical School, wrote in an editorial accompanying the study.

"In the past, now outdated bariatric procedures carried unacceptably high risks. The weight loss associated with the procedures was questionable, and the long-term health benefits were unproven," he wrote.

Now, the evidence shows that "surgery is safe, effective, and affordable," because it can lower doctor visits, medication use and other medical expenses, Robinson wrote. However, "the expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health-care system."

In Canada, all provincial health insurance programs pay for gastric bypass surgery, but the procedure is not available in all provinces. Waiting lists varied across the country, from a few months to as long as seven years, CBC News found in February 2008.

Not every province covers the cost of lap band surgery and some provinces that do won't cover the cost of the band, which can mean an out-of-pocket expense of about $5,000 for the patient.

The U.S. government paid for the study. Many of the researchers have ties to companies that make obesity treatments, and several have testified in surgery lawsuits.