The Impact of GLP-1 Drugs on Bariatric Surgery Trends
The increased use of Ozempic and other GLP-1 medications is influencing various sectors, especially those associated with food. Recent research indicates that weight loss surgery is also feeling the effects of this trend.
In a study assessing a large database of bariatric procedures in the U.S., researchers noted a significant dip in the number of surgeries in 2024, following a recent upswing. While the study does not definitively establish the cause of this decline, the researchers suspect that GLP-1 drugs may be impacting the decision-making of individuals, potentially steering those with severe obesity away from surgical solutions that could be more beneficial for them.
According to Tyler Cohn, a surgeon and associate professor at Loyola University Medical Center, the prominence of GLP-1 medications is overshadowing scientific support for metabolic and bariatric surgery as a highly effective treatment for obesity.
The GLP-1 Effect?
Ozempic and Wegovy both contain the active ingredient semaglutide. These medications mimic the GLP-1 hormone, which regulates hunger and insulin production. They are showing considerable effectiveness in weight loss, far exceeding traditional methods like diet and exercise alone. However, the standard bariatric surgeries, including gastric bypass and sleeve gastrectomy, still demonstrate the highest efficacy.
Patients who undergo these surgeries can typically expect to shed between 25% and 35% of their starting weight within the first year, while those taking Wegovy generally see about a 15% weight reduction. Newer GLP-1 options, such as tirzepatide, may facilitate slightly more weight loss, but still don’t quite match the results from surgery.
Bariatric surgeries not only yield greater weight loss on average, but studies also indicate they tend to be more cost-effective for patients with severe obesity. Furthermore, many individuals may struggle to maintain the ongoing costs associated with GLP-1 therapy compared to a one-time surgical procedure.
Researchers from Loyola University in Chicago focused on tracking bariatric surgery patterns amidst the rise of GLP-1 drug usage. They analyzed data from the American College of Surgeons’ Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and estimated the number of surgeries performed in the U.S. from 2020 to 2024.
During the early phase of the COVID-19 pandemic, bariatric procedures saw a decline. Following that period, there was a resurgence, with surgeries peaking at around 230,207 in 2022. However, by 2024, the number had dropped to an estimated 177,297, reflecting a 23% decrease from the peak and marking the lowest count since 2020.
In 2024, sleeve gastrectomy represented 58% of surgeries, down from 64% in 2020, while gastric bypass cases rose to 33% from 28%. Secondary revisions made up 11% of surgeries in 2024, increasing from 9% in 2020.
While GLP-1 drugs have undoubtedly improved obesity treatment options, there is concern that some individuals with severe obesity might be foregoing surgical intervention, even when it represents the most effective treatment path.
Cohn emphasized the importance of recognizing that metabolic and bariatric surgery has developed into a safe and effective approach for severe obesity, offering lasting weight loss for the majority of patients. Surgical options often lead to more significant weight reduction and reduced healthcare costs compared to GLP-1 therapies with long-term evidence.
These findings are being shared at the annual meeting of the American Society for Metabolic and Bariatric Surgery, with plans for publication in a peer-reviewed journal soon.
Implications for Obesity Patients
There’s a possibility the researchers did not fully capture the total number of surgeries conducted each year. The American Society for Metabolic and Bariatric Surgery estimates that over 270,000 bariatric operations were performed in 2023, illustrating a general downward trend in weight loss surgeries. Though it’s difficult to attribute this solely to GLP-1 drugs, the correlations are concerning.
A recent peer-reviewed study revealed that prescription rates of semaglutide and tirzepatide surged towards the end of 2022, paralleling a sharp decline in bariatric surgeries in 2023. Initially, factors like high out-of-pocket costs and limited insurance coverage for Wegovy might have delayed this trend.
The landscape of GLP-1 therapy relative to bariatric surgery may shift in the coming years, particularly as prices for these medications decrease and as cheaper generic options become available. Additionally, there are experimental drugs in late-stage development that might match the average weight loss associated with surgical procedures.
Ideally, both GLP-1 drugs and surgical options can coexist, potentially complementing one another. Some research indicates that using GLP-1 medications prior to surgery might mitigate post-operative complications, while post-surgery GLP-1s could help prevent weight regain.
It’s crucial to note that a significant number of individuals with obesity are still not receiving any treatment. According to ASMBS data, less than 1% of those eligible for bariatric surgery actually undergo the procedure each year. Additionally, while over 40% of privately insured adults under 65 might be eligible for GLP-1 medications, only about 12% are actively taking one.
Cohn stated that while metabolic and bariatric surgery isn’t suitable for everyone, it’s essential for eligible patients to explore all available treatment options before making a decision.
The research team aims to continue investigating this topic, particularly looking into why patients choose specific treatments for obesity.
