Gastric bypass isn't just drastic, it can be deadly or have major life-altering side effects. Weight regain isn't all that rare, either. First reasonable-looking study on the subject that I found.

I haven't seen anything I'd call a rational look at the risk/reward for bariatric surgery, though maybe I haven't been looking in the right places. The world seems to be split between fat acceptance advocates who don't want to hear success stories and will tell you a tremendous amount about the disasters (which definitely do exist) and the people who say they know a moderate number of people in their social circle who are doing well after the surgery. I do run into people who know someone who ended up dead, but that's rare.