The safety and efficacy of bariatric surgery in adolescents and especially in Medicare population has been challenged (JAMA 2005) and remains controversial. AIM: To determine short-term (30-day) and long-term outcomes of bariatric surgery in patients ≥60 years and ≤18 years old. METHODS: Query of our 20-year Mayo Clinic bariatric surgery database (n=1786 patients) identified 155 patients ≥60 years (range 60-76) and 12 patients ≤18 years (range 12-18) who underwent bariatric surgery. 98% had a Roux-en-Y gastric bypass, 40 of which were re-operative revisions of prior bariatric procedures. We obtained morbidity and mortality rates from medical records and sent a questionnaire to all surviving patients; 127 of 139 survivors ≥60 years and all 12 adolescents returned the questionnaire (92%) at a mean of 5 years (range 1-19 years). Time and cause of death was determined in all non-surviving patients. Current follow-up was available in all 167 patients. RESULTS: For patients ≥60 years, indications for bariatric surgery included serious co-morbidities (diabetes, severe hypertension, sleep apnea and/or joint arthropathy). 30-day mortality was 0.7% (1 of 155 patients), serious morbidity delaying discharge was 14% (6 wound infections and 1 seroma, 5 bowel obstructions, 3 anastomotic leaks, 4 cardiovascular or respiratory events, and 1 each with renal failure, gastric stasis and gastro-intestinal bleed). 5-year mortality was 6%. Mean follow-up was 5 years (range 1-19 years). Body mass index (BMI in kg/m2) decreased from a mean (±SEM) of 46±1 to 33±1 with a 51% resolution of weight-related co-morbidities and an 89% subjective overall satisfaction rate. For patients ≤18 years, indications for operation included insulin-resistant diabetes mellitus (n=3), sleep apnea (n=3), obesity-induced asthma (n=3), and prevention of impending weight-related morbidity or psychosocial retardation (n=12). There were no deaths and no serious co-morbidities. BMI decreased from a mean of 55 (range 39-74) to 36 (range 27-53) at a follow-up of 3 years (range 1-8 years). Resolution of weight-related co-morbidities was 82%, and satisfaction with outcome was 83%. SUMMARY: 30-day hospital mortality (<1%) and 5 year mortality (6%) were much lower than reported previously in the senior population (JAMA 2005), with acceptable morbidity and importantly, with good outcomes. CONCLUSIONS: Bariatric surgery is both safe and effective at high volume centers for patients with morbid obesity at both extremes of age.