BACKGROUND: Surgery is increasingly used for weight loss in morbidly obese patients. The authors evaluated the safety and efficacy of bariatric surgery in patients older than 50 years. METHODS: Prospective data on 62 consecutive patients (Male = 13, Female = 49) undergoing bariatric procedures between 1985-1994 were reviewed. Mean follow-up was 30 +/- 2 months (3-48 months). All data are mean +/- SEM. RESULTS: Age was 57 +/- 1 year (range 50-71 years). Patients had a mean preoperative weight of 125 + 4 kg (275 +/- 9 lb) and 119 +/- 6% excess body weight. A total of 68 procedures were performed: vertical banded gastroplasty (VBG = 23), Roux-en-Y gastric bypass (RYGB = 43), and billopancreatic diversion (BPD = 2). Six patients were converted to RYGB (5) and BPD (1) after failed VBG. Hospital mortality was nil. Complications were wound infection (5), pulmonary (4) gastric leak (2) abscess (1) and others (4). Mean weight loss at 3 year; was 55 +/- 7 and 33 +/- 6% of percent excess body weight for RYGB and VBG, respectively. Postoperative use of medications for arthritis, diabetes mellitus and asthma was reduced by 23%, 62% and 100%, respectively. Satisfaction with the outcome of treatment and weight loss was reported by 81 % of patients. Six patients that were converted from jejunoileal bypass (metabolic complications) to VBG gained weight. CONCLUSIONS: Bariatric surgery is safe and well tolerated in morbidly obese patients older than 50 years. Weight loss parallels that of younger populations and is greater in patients treated with RYGB in this subgroup. Age should not be a contraindication to bariatric surgery provided the patient has obesity-related medical morbidity. Control of obesity-related co-morbid conditions is improved by weight loss.