Bariatric surgeries on the decline as use of GLP-1 drugs rises
Among U.S. patients with obesity, overweight, or diabetes diagnoses, use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is increasing while metabolic bariatric surgery (MBS) is decreasing, according to a new study by researchers at the Analysis Group and Harvard T.H. Chan School of Public Health.
The study was published May 13 in JAMA Surgery. Harvard Chan School’s Thomas Tsai, associate professor in the Department of Health Policy and Management and co-director of the Healthcare Quality and Outcomes Lab, was a co-author.
Previous studies have suggested that MBS use is declining in the U.S. as GLP-1 RA prescribing grows. But this earlier research was conducted before the Food and Drug Administration approved tirzepatide, a newer and increasingly popular GLP-1 RA (sold under names including Mounjaro and Zepbound).
To update the evidence base, the researchers examined national insurance claims data from 11.7 million adults with a diagnosis of obesity, overweight, and/or diabetes between 2022 and 2024. Using this data, they examined trends in the share of patients who were prescribed GLP-1 RAs compared to those who underwent MBS. They also compared characteristics of patients who received GLP-1 RAs versus MBS.
During the study period, use of GLP-1 RAs increased by 140.4%, the researchers found. Meanwhile, MBS use decreased by 34.1%—and this decline accelerated from a 14.4% decrease between 2022 and 2023 to a 23.0% decrease in 2024.
The study also found that despite the increase in GLP-1 RA use, obesity remains undertreated. More than 90% of the study population received neither form of treatment during the study period (while 9.2% received GLP-1 RAs and 0.4% received surgery). Compared to patients who were prescribed GLP-1 RAs or who had no treatment, patients who underwent surgery tended to be more medically complex.
According to the researchers, the findings suggest that MBS utilization will continue to decline as GLP-1 RA use increases. They noted that as insurance coverage for GLP-1 RAs becomes limited due to high cost, patients should know that MBS may remain an important treatment option. They also noted that clinicians and policymakers should continue to monitor how these trends affect long-term multidisciplinary management of obesity amid a rapidly evolving landscape of treatment options.
Read the study:
Trends in Metabolic Bariatric Surgery Utilization in the Era of GLP-1s, 2022-2024
Read a Medscape article about the study:
As GLP-1 Uptake Rises, Metabolic Surgery Rates Decline
