Not judging, but I don't think ANYONE begins with a BMI of 45 or 50. I am guessing that other methods of weight loss are tried before this point. At some point, after NUMEROUS failed attempts, the weight just gets out of control. The FDA recently approved Lap Band for patients for BMI's of 30 (Perhaps with comorbids? not sure). In essence, it seemed like a better idea to help people with a genuine weight issue SOONER rather than LATER. I am at a lower BMI as well (admittedly, a bit higher than 30). I have been overweight since I was 7 or 8, with various doctor and self interventions. Making this decision is HARD, and from what I have researched, it recovery is HARDER. As long as you know that this is not a quick fix or use this as a way to lose those last few pounds before a special event, I say GO FOR IT!!! If this is a decision to just avoid dieting and exercise, the long timers will tell you IT DOESN'T WORK!!! It looks like the only way to TRULY lose weight with the sleeve, after the inital weight loss, it with diet and exercise (go figure lol). Otherwise, you WILL gain the weight back, and the next surgery will have to be MORE drastic; you've already removed 90% of your stomach. JMHO, and GOOD LUCK!!!!