A History of Bariatric Surgery: From 1954 to the Sleeve

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History

Gastric Bypass: how it works, results and long-term care SurgicalGastric Sleeve Surgery: eligibility, results, risks and cost SurgicalDuodenal Switch (BPD/DS and SADI-S): results, nutrition and risks SurgicalLap-Band (Adjustable Gastric Band): status, results and why it declined Medical deviceSurgical

A history of bariatric surgery from the original papers and FDA and Medicare records: the 1954 intestinal bypass, Mason's 1966 gastric bypass, bands, the duodenal switch, laparoscopy, the sleeve and the 2022 guidelines.

By marketing Updated October 7, 2026 Facts checked October 7, 2026

Fact-checked against FDA labels and official sources; not yet reviewed by a licensed clinician. This page is education, not medical advice. Talk to your doctor before starting, stopping or changing any treatment.

Key takeaways

  • The jejunoileal bypass, the first weight-loss operation in the 1950s, was abandoned after causing severe diarrhea, kidney stones, gallstones and liver damage.[4]
  • Edward Mason performed the first gastric bypass in 1966; the Roux-en-Y version became the bypass of choice in 1977.[2]
  • The first laparoscopic gastric bypass was reported in 1994, in five patients.[15]
  • The sleeve gastrectomy began in 2003 as the first stage of a two-stage operation and made up 58.2% of U.S. procedures in 2023.[17]
  • In 2022, ASMBS and IFSO replaced the 1991 NIH thresholds, recommending surgery from a BMI of 35 regardless of other conditions.[32]

In short: Weight-loss surgery began in 1954 with the jejunoileal bypass, an operation that skipped most of the small intestine and was later abandoned because of severe diarrhea, kidney stones and liver damage. In 1966 Edward Mason at the University of Iowa performed the first gastric bypass, and the Roux-en-Y version became the standard by the late 1970s. The 1980s and 1990s added stomach-stapling, adjustable bands and the duodenal switch; in 1994 surgeons first did a gastric bypass through small keyhole cuts. The sleeve gastrectomy began in the early 2000s as the first step of a two-stage operation and became the most common procedure in the U.S. by 2013. Today about 270,000 procedures are done a year, and in 2022 the specialty replaced the 1991 rules on who should be offered surgery.

This page tells that story from the original surgical papers, FDA approval records, Medicare’s coverage history and the American Society for Metabolic and Bariatric Surgery (ASMBS). It is history, not advice: for today’s options side by side, see every weight-loss procedure compared, and for how surgery works now, our bariatric surgery guide. The wider story of diets, drugs and programs is in our history of weight loss.

Seven decades of weight-loss surgery in four numbers

Checked on October 6, 2026

1954 to the 1970s: intestinal bypass (ABANDONED)

Modern weight-loss surgery started with the intestine, not the stomach. In 1954, surgeons A. J. Kremen, J. H. Linner and C. H. Nelson published an experimental study in the Annals of Surgery on how much of the small intestine the body needs to absorb food. A 2017 history in the Porto Biomedical Journal credits Kremen with the first metabolic operation, the jejunoileal bypass, which joined the start of the small intestine to its end and bypassed most of it in between. In 1963, J. H. Payne and colleagues reported on patients who had a “jejunocolic shunt”, connecting the small intestine directly to the colon, in the American Journal of Surgery.

Many versions followed in the 1960s and 1970s, but the Porto review notes that none gained wide acceptance, because patients developed severe diarrhea and dehydration. A 1977 randomized trial in the Annals of Surgery, led by W. O. Griffen Jr., compared the jejunoileal bypass with a gastric bypass in 59 patients: after the intestinal bypass, 56% had significant diarrhea, kidney stones and gallstones appeared that were not seen after gastric bypass, and fatty liver worsened at one year in 75% of the intestinal-bypass group, while it improved or stayed stable in everyone after gastric bypass. Results like these ended the jejunoileal bypass. Medicare’s national policy today lists intestinal bypass as not covered.

1977 trial: problems in the intestinal bypass groupValues in %
1977 trial: problems in the intestinal bypass group
ItemValue
Significant diarrhea56%
Needed medication (late effects)74%
Fatty liver worse at 1 year75%

Share of the jejunoileal bypass group. In the gastric bypass group, kidney stones and gallstones were not seen and liver findings improved or stayed stable.

Source: Griffen WO Jr et al., Annals of Surgery 1977 (randomized trial, 27 intestinal bypass vs 32 gastric bypass patients) (checked on October 6, 2026)

1966 to 1977: the gastric bypass

Edward E. Mason was a surgeon at the University of Iowa. According to the Porto review, he proposed the first gastric bypass in 1966, building on observations of weight loss in patients who had had part of the stomach removed; he and C. Ito described it in “Gastric bypass in obesity” in 1967. The first version used a horizontal division of the stomach with a loop of intestine. Surgeons later rebuilt it with a Roux-en-Y limb, a Y-shaped connection that keeps bile away from the stomach and esophagus. ASMBS’s profile of Mason says that W. O. Griffen Jr.’s Roux-en-Y gastric bypass became the bypass of choice for most surgeons in 1977, when Griffen published his experience.

The basic idea has lasted: a small stomach pouch connected further down the small intestine. Today’s gastric bypass uses an egg-sized pouch joined 3 to 4 feet down the intestine, according to ASMBS, and it is still the second most common operation in the U.S.

1979 to 1998: diversion and the duodenal switch

In Italy, Scopinaro and colleagues reported the biliopancreatic diversion in the British Journal of Surgery in 1979, after studies in dogs. In their first 18 patients, average weight loss was 33.7% of body weight at 12 months, and the authors suggested it as an alternative to the jejunoileal bypass. In 1993, Marceau’s team at Laval Hospital in Québec reported a version that replaced the partial stomach removal with a long, narrow “parietal” gastrectomy and kept the valve at the stomach’s outlet, which reduced loose stools and protein malabsorption. In 1998, D. S. Hess and D. W. Hess at Wood County Hospital in Bowling Green, Ohio, reported their first 440 patients with “biliopancreatic diversion with a duodenal switch”, the operation now called the duodenal switch. Its stomach portion is essentially a sleeve, which became important later.

The duodenal switch is still done, along with a simpler variant with one connection, SADI-S. ASMBS says it produces the most weight loss of the approved operations but carries the greatest risk of vitamin and mineral deficiencies.

1982 to 2001: stapling and bands

Some surgeons tried restricting the stomach without bypassing anything. In 1982, Mason described the vertical banded gastroplasty (VBG) in the Archives of Surgery: a row of staples created a pouch of less than 50 mL, with a mesh collar around its outlet. He reported fewer complications and more weight loss in 42 patients than with any other operation he knew of. VBG and gastric bypass were the dominant procedures by the time of the 1991 NIH consensus conference, according to the 2022 ASMBS/IFSO guideline. Medicare’s national policy now lists open and laparoscopic VBG as not covered, and it has largely disappeared.

The adjustable gastric band came next. The Porto review credits Kuzmak with introducing it in 1986, adjustable without another operation, and says Cadière placed the first band by laparoscopy in 1992; Belachew’s team reported their laparoscopic series in 1994. The FDA approved the Lap-Band on June 5, 2001, for adults with a BMI of 40 or more, or 35 or more with a severe related condition, and expanded it in 2011 to a BMI of 30 to 34 with an obesity-related condition. The band was briefly very popular: it made up about 35% of U.S. procedures in 2011. Use then fell sharply, to 773 operations in 2023, as ASMBS lists slower weight loss and a high reoperation rate among its disadvantages. Our Lap-Band guide covers where it stands today.

1991: the NIH sets the rules

In March 1991, a National Institutes of Health consensus panel met on gastrointestinal surgery for severe obesity. Its statement recommended that people first be offered a non-surgical program combining diet, exercise, behavior change and psychological support; that surgery could be considered for well-informed, motivated patients with acceptable risk; that candidates be evaluated by a multidisciplinary team with medical, surgical, psychiatric and nutritional expertise; that surgeons be experienced and well supported; and that patients have lifelong medical follow-up after surgery. The thresholds that grew out of it, a BMI over 40, or over 35 with related conditions, were used by surgeons, hospitals and insurers for three decades, according to the 2022 guideline that replaced them.

1994 to 1995: keyhole surgery and a diabetes surprise

In 1994, Alan Wittgrove, G. W. Clark and L. J. Tremblay in San Diego reported the first laparoscopic Roux-en-Y gastric bypass, in five patients, with comparable weight loss and less morbidity and disability than the open operation. Laparoscopy changed the field: today most bariatric operations are done this way, according to the National Institutes of Health.

A year later, W. J. Pories and colleagues at East Carolina University published a 14-year follow-up of 608 gastric bypass patients in the Annals of Surgery with a title that captured the field’s surprise: “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.” Among patients with adequate follow-up, 121 of 146 (82.9%) with type 2 diabetes kept normal blood sugar, HbA1c and insulin levels. The society’s current name, the American Society for Metabolic and Bariatric Surgery, reflects that focus on metabolism, and later randomized trials such as STAMPEDE tested the diabetes effect formally.

2003 to 2013: the sleeve takes over

The gastric sleeve began as a safety step. For patients with very high BMIs, a full bypass or duodenal switch in one sitting carried more risk, so surgeons began removing most of the stomach first and doing the second operation later. In 2003, Regan, Gagner and colleagues at Mount Sinai in New York reported seven patients with a BMI of 58 to 71 who had a laparoscopic sleeve gastrectomy followed by a gastric bypass about 11 months later; patients had lost about a third of their excess weight after the sleeve alone. The Porto review notes that the sleeve was then increasingly used as a stand-alone operation. Medicare allowed its regional contractors to cover stand-alone laparoscopic sleeve gastrectomy from June 27, 2012.

The change in practice was fast. ASMBS estimates show the sleeve at 28,124 operations (17.8%) in 2011, ahead of the band and bypass by 2013, and at 157,254 (58.2%) in 2023.

Share of U.S. bariatric procedures by typeValues in %
Share of U.S. bariatric procedures by type
ItemSleeveBypassBandRevision
201117.8%36.7%35.4%6%
201451.7%26.8%9.5%11.5%
201759.4%17.8%2.8%14.1%
202061.4%20.8%1.2%11.1%
202358.2%23.4%0.3%11.9%

Shares computed from ASMBS best estimates (totals 158,000 in 2011 to 270,089 in 2023). 'Other' includes duodenal switch, SADI-S, one-anastomosis bypass, ESG, balloons and other procedures.

Source: ASMBS, Estimate of Bariatric Surgery Numbers, 2011-2023 (checked on October 6, 2026)

2004 to 2013: coverage and quality rules

As operations multiplied, the profession built quality programs. The society Mason helped found in 1983 as the American Society for Bariatric Surgery (now ASMBS) released accreditation standards for Bariatric Surgery Centers of Excellence in 2004, and the American College of Surgeons released its own in 2005. In 2012 the two merged into one program, MBSAQIP, which today covers nearly 1,000 sites in the U.S. and Canada.

Medicare’s coverage followed a similar arc. On February 21, 2006, it began national coverage of open and laparoscopic gastric bypass, laparoscopic adjustable banding and the duodenal switch for qualifying people at certified facilities. In 2009 it confirmed type 2 diabetes as a qualifying condition, in 2012 it allowed contractors to cover the sleeve, and from September 24, 2013, facilities no longer had to be certified. The same policy still lists gastric balloons, intestinal bypass and VBG as not covered.

YearMilestoneStatus today
1954Kremen, Linner and Nelson’s intestinal studies; jejunoileal bypass beginsABANDONED
1963Payne’s jejunocolic shunt reportABANDONED
1966-1967Mason’s first gastric bypass; published with ItoEvolved into Roux-en-Y bypass
1977Griffen’s trial; Roux-en-Y bypass becomes the bypass of choiceSecond most common operation
1979Scopinaro’s biliopancreatic diversionEvolved into the duodenal switch
1982Mason’s vertical banded gastroplastyLargely abandoned; not covered by Medicare
1983American Society for Bariatric Surgery founded (now ASMBS)Active
1986Kuzmak’s adjustable gastric bandRare (773 in 2023)
1991NIH consensus statement on surgery for severe obesityReplaced in 2022
1992-1994First laparoscopic band (1992) and laparoscopic bypass (1994)Laparoscopy is standard
1993-1998Marceau’s and the Hesses’ duodenal switchIn use, with SADI-S
1995Pories: “Who would have thought it?” diabetes paper“Metabolic surgery”
2001FDA approves the Lap-BandApproved; rarely used
2003Sleeve gastrectomy as the first stage of a two-stage operationMost common operation
2006Medicare national coverageUpdated 2009, 2012, 2013
2012MBSAQIP accreditation program formedNearly 1,000 sites
2015, 2021FDA approves ORBERA and Spatz3 balloonsApproved; not covered by Medicare
2022FDA authorizes endoscopic sleeve gastroplasty; ASMBS/IFSO update who should be offered surgeryCurrent
2026FDA approves the Allurion balloon, the first swallowable balloon placed without endoscopyApproved; first U.S. patients April 2026
Dates from the original papers (PubMed), FDA PMA and De Novo records, CMS National Coverage Determination 100.1, ASMBS and the 2022 ASMBS/IFSO guideline. Checked October 7, 2026.

2007 to today: long-term evidence, devices and new rules

Long-term studies answered the question critics had asked for decades. The Swedish Obese Subjects study, published in the New England Journal of Medicine in 2007, found lower long-term death rates after surgery than with usual care, and people who had a bypass were about 25% lighter after 10 years. The STAMPEDE trial reported in 2017 that, five years on, 29% of people with type 2 diabetes who had a bypass and 23% who had a sleeve had an HbA1c of 6.0% or less, compared with 5% on medical therapy alone.

Less invasive options arrived through the FDA’s device pathway: the ORBERA gastric balloon was approved on August 5, 2015, the Spatz3 adjustable balloon on October 15, 2021, and endoscopic sleeve gastroplasty, which folds the stomach with stitches from the inside, was authorized on July 12, 2022. The newest device is the Allurion balloon, approved on February 20, 2026, for “short-term limited weight loss” in adults aged 22 to 65 with a BMI of 30 to 40: it is swallowed as a capsule, filled through a thin tube without endoscopy or anesthesia, and empties and passes on its own after about four months. Not every approved device lasted: our overview of FDA-authorized weight-loss devices shows which are still sold. Also in 2022, ASMBS and IFSO published new indications, describing them as major updates to the 1991 NIH guidelines: surgery is recommended from a BMI of 35 regardless of other conditions and can be considered from 30 with metabolic disease, there is no upper age limit, and insurer-required diets before surgery were called “scientifically unfounded”. The guideline puts the risk of dying around the operation at 0.03% to 0.2%.

The newest chapter is medicines. U.S. procedures fell from an estimated 279,967 in 2022 to 270,089 in 2023, while GLP-1 medicines came into wide use, and revisions of earlier operations now make up about 12% of all procedures. Surgery and medicines are increasingly discussed together; our GLP-1 vs bariatric surgery comparison and history of weight-loss drugs pick up that story.

Five lessons from 70 years of surgery

  1. Side effects decide what lastsThe intestinal bypass worked for weight but harmed too many people, so it was dropped.
  2. Simpler often winsThe sleeve spread fastest because it was simpler and safer for many people.
  3. Long-term follow-up mattersProblems such as deficiencies and reflux show up years later, so lifelong care is part of every operation.
  4. Weight is not the only outcomeDiabetes and other conditions changed how surgery is judged.
  5. Rules change with evidenceThe 1991 thresholds were replaced in 2022 after decades of new data.

If you are considering a procedure today, start with our procedures hub, read about life after bariatric surgery, and use our guide to finding a bariatric surgeon to check accreditation. Your own decision belongs with you and a qualified bariatric team.

Records in this article

SurgicalGastric Bypass: how it works, results and long-term careSurgical · 2+ weeksSurgicalGastric Sleeve Surgery: eligibility, results, risks and costSurgical · 2+ weeksSurgicalDuodenal Switch (BPD/DS and SADI-S): results, nutrition and risksSurgical · 2+ weeksMedical deviceSurgicalLap-Band (Adjustable Gastric Band): status, results and why it declinedSurgicalMedical deviceEndoscopicGastric Balloon: the endoscopic, temporary optionEndoscopic · 1-3 daysMedical deviceEndoscopicEndoscopic Sleeve Gastroplasty (ESG): what to knowEndoscopic

Related guides

Every Weight-Loss Procedure Compared: Surgery, Endoscopic and BalloonEvery weight-loss procedure compared: gastric sleeve, bypass, duodenal switch, SADI-S, band, endoscopic sleeve gastroplasty and gastric…Medical Weight-Loss Procedures: surgical, endoscopic and devicesMedical weight-loss procedures compared: sleeve, bypass, duodenal switch, band, revision, endoscopic sleeve gastroplasty and gastric balloons…Find a Bariatric Surgeon: credentials, accredited centers and what to askHow to find a qualified bariatric surgeon: board certification, MBSAQIP accredited centers, the evaluation steps, risks,…Life After Bariatric Surgery: diet stages, vitamins, follow-up and the long termLife after bariatric surgery: guideline diet stages, protein, vitamins and minerals for life, follow-up visits and…

Questions to ask a professional

  • Which procedure would you suggest for me today, and why?
  • How have results and safety for that procedure changed over the years?
  • What long-term follow-up and supplements does it need?
  • How would medicines such as GLP-1s fit before or after surgery?

Frequently asked questions

What was the first weight-loss surgery?

The jejunoileal (intestinal) bypass, which grew out of work published by Kremen, Linner and Nelson in 1954. It bypassed most of the small intestine and was abandoned because of severe diarrhea, kidney stones, gallstones and liver damage.

Who invented gastric bypass?

Edward E. Mason at the University of Iowa performed the first gastric bypass in 1966 and described it with C. Ito in 1967. The Roux-en-Y version became the bypass of choice for most surgeons after W. O. Griffen Jr. published his experience in 1977.

When did the gastric sleeve start?

Surgeons first used the sleeve as the first step of a two-stage operation for people with very high BMIs; a 2003 Mount Sinai report described it. It became the most common U.S. operation by 2013, and Medicare allowed its contractors to cover it from June 2012.

When was the Lap-Band approved?

The FDA approved the Lap-Band on June 5, 2001, and expanded its use in 2011 to people with a BMI of 30 to 34 and an obesity-related condition. Its use has since fallen to fewer than 1,000 operations a year.

When did Medicare start covering bariatric surgery?

Medicare began national coverage of gastric bypass, the laparoscopic band and the duodenal switch on February 21, 2006, added type 2 diabetes as a qualifying condition in 2009, and allowed contractors to cover the sleeve from June 27, 2012.

References

  1. Kremen AJ, Linner JH, Nelson CH. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Annals of Surgery, 1954. PMID 13198079 (accessed October 6, 2026) Other
  2. Faria GR.. A brief history of bariatric surgery. Porto Biomedical Journal, 2017. PMID 32258594 (accessed October 6, 2026) Review
  3. Payne JH, DeWind LT, Commons RR. Metabolic observations in patients with jejunocolic shunts. American Journal of Surgery, 1963. PMID 14042557 (accessed October 6, 2026) Other
  4. Griffen WO Jr, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Annals of Surgery, 1977. PMID 907395 (accessed October 6, 2026) Randomized trial
  5. Mason EE, Ito C. Gastric bypass in obesity. Surgical Clinics of North America, 1967. PMID 6073761 (accessed October 6, 2026) Other
  6. Edward E. Mason (ASMBS past presidents). American Society for Metabolic and Bariatric Surgery. (accessed October 6, 2026) Society statement
  7. Scopinaro N, Gianetta E, Civalleri D, et al.. Bilio-pancreatic bypass for obesity: II. Initial experience in man. British Journal of Surgery, 1979. PMID 497645 (accessed October 6, 2026) Other
  8. Marceau P, Biron S, Bourque RA, et al.. Biliopancreatic diversion with a new type of gastrectomy. Obesity Surgery, 1993. PMID 10757900 (accessed October 6, 2026) Other
  9. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obesity Surgery, 1998. PMID 9678194 (accessed October 6, 2026) Other
  10. Mason EE. Vertical banded gastroplasty for obesity. Archives of Surgery, 1982. PMID 7073493 (accessed October 6, 2026) Other
  11. Belachew M, Legrand MJ, Defechereux TH, et al.. Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity: a preliminary report. Surgical Endoscopy, 1994. PMID 7831615 (accessed October 6, 2026) Other
  12. PMA P000008: LAP-BAND Adjustable Gastric Banding System (approval order and current applicant). U.S. Food and Drug Administration, 2001. (accessed October 7, 2026) Government page
  13. FDA Expands Use Of Banding System For Weight Loss (FDA news release, republished). Med Device Online, 2011. (accessed October 6, 2026) News (reported facts only)
  14. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Annals of Internal Medicine, 1991. PMID 1952493 (accessed October 6, 2026) Guideline
  15. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obesity Surgery, 1994. PMID 10742801 (accessed October 6, 2026) Other
  16. Pories WJ, Swanson MS, MacDonald KG, et al.. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Annals of Surgery, 1995. PMID 7677463 (accessed October 6, 2026) Other
  17. Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obesity Surgery, 2003. PMID 14738671 (accessed October 6, 2026) Other
  18. Estimate of Bariatric Surgery Numbers, 2011-2023. American Society for Metabolic and Bariatric Surgery. (accessed October 7, 2026) Society statement
  19. Bariatric Surgery Procedures. American Society for Metabolic and Bariatric Surgery. (accessed October 6, 2026) Society statement
  20. Types of Weight-loss Surgery. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 6, 2026) Government page
  21. National Coverage Determination 100.1: Bariatric Surgery. Centers for Medicare and Medicaid Services. (accessed October 7, 2026) Government page
  22. MBSAQIP: history of the accreditation program. American Society for Metabolic and Bariatric Surgery. (accessed October 6, 2026) Society statement
  23. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). American College of Surgeons. (accessed October 7, 2026) Society statement
  24. Sjöström L, Narbro K, Sjöström CD, et al.. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. New England Journal of Medicine, 2007. doi:10.1056/NEJMoa066254 · PMID 17715408 (accessed October 6, 2026) Other
  25. Schauer PR, et al.. Bariatric Surgery versus Intensive Medical Therapy for Diabetes: 5-Year Outcomes (STAMPEDE). New England Journal of Medicine, 2017. doi:10.1056/NEJMoa1600869 · PMID 28199805 · NCT00432809 (accessed October 6, 2026) Randomized trial
  26. PMA P140008: ORBERA Intragastric Balloon (approval order). U.S. Food and Drug Administration, 2015. (accessed October 7, 2026) Government page
  27. PMA P190012: Spatz3 Adjustable Balloon System (approval order). U.S. Food and Drug Administration, 2021. (accessed October 6, 2026) Government page
  28. PMA P250023: Allurion Gastric Balloon System (approved 2026-02-20). U.S. Food and Drug Administration, 2026. (accessed October 7, 2026) Government page
  29. Summary of Safety and Effectiveness Data: Allurion Gastric Balloon System (P250023), AUDACITY trial. U.S. Food and Drug Administration, 2026. (accessed October 7, 2026) Government page
  30. Allurion treats first commercial patients in the United States (company-reported). Allurion Technologies (press release), 2026. (accessed October 7, 2026) News (reported facts only)
  31. De Novo DEN210045: APOLLO ESG, ESG SX, REVISE and REVISE SX Systems. U.S. Food and Drug Administration, 2022. (accessed October 7, 2026) Government page
  32. Eisenberg D, et al.. 2022 ASMBS and IFSO Indications for Metabolic and Bariatric Surgery (full text). Obesity Surgery, 2023. doi:10.1007/s11695-022-06332-1 · PMID 36336720 (accessed October 6, 2026) Guideline

Facts checked on October 7, 2026

Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.

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