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Bariatric surgery has increased tenfold over the past decade. Approximately 150,000 Americans get it each year. Most insurance pays for it and most patients have successful outcomes, like Anthony Davis. But the surgery has significant risks and is not for everyone.

NPR's Patricia Neighmond reports.

PATRICIA NEIGHMOND reporting:

Dr. Paul Shekelle directs the Evidence-Based Practice Center at the RAND Corporation. He says there's no question gastric bypass surgery works. Patients lose, on average, about 100 pounds or more in just one year, and they also lower their risk of obesity related diseases like hypertension, diabetes and high cholesterol.

At the same time, Shekelle worries that the surgery may be too appealing to patients who don't need it, and to surgeons who aren't expert at it.

Dr. PAUL SHEKELLE (RAND Corporation): Just in our own newspaper here in our city, you can open it up and there's ads for bariatric surgery. So this is being marketed directly to the public. They're generally of the type of, you know, are you overweight? You know, have you tried everything? Then, you know, consider coming to our bariatric surgery center.

NEIGHMOND: And not all bariatric surgery centers are equal, says Shekelle. Some have better results than others. Outcomes are important because complications can be significant.

Dr. Ed Livingston is Chief of Gastrointestinal Surgery at the University of Texas Southwestern Medical School. He's performed gastric bypass for the past 13 years, with extremely positive results for most patients. But, he says, there can be problems.

Dr. ED LIVINGSTON (Chief of Gastrointestinal Surgery, University of Texas Southwestern Medical School): The major complications are leaking, where we put all these parts together, and if the intestinal contents leak into the abdominal cavity, it's a very major problem. People get infected and they have - they can be bed-bound for months.

NEIGHMOND: One out of every 200 patients die as a result of the surgery. Patients can get blood clots in their legs or lungs. They can get hernias at the site of incision, as well as the dumping syndrome, where they get physically ill, nauseous and sweaty if they eat foods high in fat or sugar. Paul Shekelle.

Dr. SHEKELLE: Patients that get gastric bypass have to know that they are getting a permanent change in the way their body is going to absorb food.

NEIGHMOND: While bypass surgery might be the right answer for certain severely obese individuals, it's clearly not for everyone. The surgery is more risky for those who are over 55 and suffer problems like hypertension and diabetes.

Shekelle also worries that people with lower body mass index may want to get the surgery. The BMI measures body fat based on height and weight.

Dr. SHEKELLE: So initially, it's people who are 40, a body mass index of 40 and over, and then its people who have a body mass index of 35 and over. Pretty soon there's going to be people that - who look at their own body image and they may not be that much overweight, but they don't like it and, darn, they just don't or can't diet and they want to get this thing fixed.

NEIGHMOND: Unfortunately, Shekelle says, there may be a surgery center or doctor willing to help them do that.

Bariatric specialists are now trying to figure out how to evaluate results from surgical centers and make that information public.

Patricia Neighmond, NPR News.

INSKEEP: You're welcome to send along your questions about gastric bypass surgery and the clinical evidence behind it. Those questions will get to Dr. Livingston and Dr. Shekelle if you send them to npr.org/yourhealth.

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