OBJECTIVE We examined national trends in bariatric surgery for adults, focusing on differences in utilization by race and access to health care. METHODS We analyzed subjects eligible for bariatric surgery in the National Hospital Discharge Survey and the National Health and Nutrition Examination Survey for 1999-2010. Primary outcome measures included population-based estimates and comparison of blacks and whites eligible for surgery with those who actually received it. RESULTS A higher percentage of black than white women and of black than white men were eligible for bariatric surgery. But a higher proportion of eligible white women and men than black women and men received bariatric surgery. 69.8% of eligible white women and 72.9% of white women who received bariatric surgery had private health insurance, compared with 49.9% and 71.1% of black women. 71.4% of eligible white men and 75.9% of white men who received bariatric surgery had private health insurance, compared with 52.4% and 74.7% of black men. Among men eligibility and surgery rates were lower than for women of the same race, and significant differences were found by race in the same directions as for women. CONCLUSIONS Eligible whites received bariatric surgery at higher levels than eligible blacks, apparently partly because of differences in insurance coverage.