I'm in the same position low BMI 30-31 with weight increasing each year and medical problems increasing as well. I don't want to wait until it's out of control in 5-10 years. I want to be proactive. I know insurance won't pay so it will have to be self pay. I would prefer to stay in the US but would consider Mexico if I have to. Please keep me update what you find out. I have a consultation next week.