Up to two million people in England could be eligible for weight loss surgery, experts say.
Bariatric surgery, such as the fitting of gastric bands, can cut the risk of death from obesity-related problems such as heart disease and diabetes.
Although it has been growing in popularity, only 8,000 people a year are currently receiving the treatment.
Researchers from Imperial College London believe more than 5% of the adult population would qualify for it.
However, they acknowledge that if it were carried out in such huge numbers it would have significant financial implications for the NHS.
End Quote Dr Sonia Saxena Lead researcherDespite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than 1% of those eligible have weight loss surgery each year"
Guidelines recommend that bariatric surgery be offered to the morbidly obese and those who are not quite morbidly obese but already have other problems, such as heart disease and high blood pressure.
Researchers tested how many were actually eligible by looking at the health of nearly 9,500 people, the Journal of the Royal Society of Medicine reported.
'Budgets squeezed'Lead researcher Dr Sonia Saxena said: "Despite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than 1% of those eligible have weight loss surgery each year.
"This raises questions about why more procedures are not currently being carried out."
The researchers said there were several reasons why the rates of surgery were so low.
One theory was that the socio-economic groups most likely to need the treatment - the lowest ones - were the ones who made the least use of healthcare services.
The researchers said another barrier was that people might be struggling to make the lifestyle improvements required before having surgery.
Access to treatment may also be being restricted as budgets are squeezed.
While the numbers having the surgery have increased threefold in five years, there was actually a small dip in patients last year.
Tam Fry, of the National Obesity Forum, said: "The failure to provide appropriate bariatric surgery is a disgrace, the worse so since the surgery pays for itself in two to three years."
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