She arranges visits to the hospital rooms of people just undergoing the surgery.
"Is this what I have to look forward to the rest of my life?"
Surgery could solve a major public health problem in a country obsessed with thinness yet facing an obesity crisis.
Hyped by celebrity testimonials and dramatic photos, surgery is now a favored treatment in the battle against fat.
But behind the lofty claims, serious concerns about safety and long-term effects are mounting, interviews with more than 40 doctors, researchers and patients show.
In the past two years, patient deaths have prompted at least 10 hospitals in six states to suspend their weight-loss surgery programs, the Post-Dispatch has found.
Shekelle said that while the RAND report found surgery was more effective than other tactics for treating the most seriously obese, the same conclusion could not be drawn for people who were less overweight but still morbidly obese.
And while the surgery helped resolve some conditions, like diabetes, it was not clear that patients live longer than obese people trying other treatments.
Many in the obesity surgery field have been eagerly anticipating an answer from the most rigorous, ongoing weight-loss surgery study in the world - the Swedish Obese Subjects study.
In North Carolina, Blue Cross Blue Shield tries guiding customers to the best and most experienced surgeons, something it does for only one other procedure: bone marrow transplants.
It was set off by Dr. Jeffery Thompson, chief medical officer for state Medicare, who was shocked by mortality statistics he received in the summer of 2003.
Dr. Harvey Sugerman, president of the American Society for Bariatric Surgery, accuses insurers of "doing their darndest" to block access to an operation effective at curing diabetes and perhaps easing other weight-induced conditions.