My son lives near Dallas, Texas. He has no insurance coverage, though no insurance I know of will pay for the procedure he wanted anyway. So, on 8-10-12, he went to TJ for his mgb. He researched beforehand into various doctors, etc. He spoke with his pcp to let him know what he was doing. Pcp was fine with it, perhaps in part because he was concerned about Michael's co-morbidities of diabetes and hypertension.
Michael is doing well, progressing well with his protein intake and other food and down 40 pounds, much to his surprise and delight.
I know he doesn't get the exercise I would hope for him. He is a "local" truck driver, spending up to 18 hours away from home. Finding time for dedicated exercise is problematic, at best.
Out-of-country surgery definitely isn't for everybody. It is, however, a viable option for some.