On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 70/min, and respiration rate is 12/min. BMI is 29. Waist circumference is 92 cm (36 in). Head, neck, lung, and heart examinations are normal. The abdomen is obese without striae.
In addition to continuing calorie restriction and exercise, which of the following is the most appropriate management to help this patient achieve weight loss?
D. Roux-en-Y gastric bypass