Weight loss surgery declines by 25 percent as anti-obesity drug use climbs

A recent study reveals a significant shift in obesity treatment approaches among privately insured patients, with a marked increase in the use of anti-obesity medications, such as Ozempic and Wegovy, paralleled by a substantial decline in weight-loss surgery. This research, conducted by Brigham and Women’s Hospital in collaboration with Harvard T.H. Chan School of Public Health and the Brown School of Public Health, has been published in JAMA Network Open.

The study tracked a large cohort of over 17 million adults with private health insurance who had been diagnosed with obesity, excluding those with diabetes, between 2022 and 2023. Findings indicate a 132.6 per cent rise in patients prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs), with rates climbing from 1.89 to 4.41 per 1,000 patients. During this same period, however, the proportion of patients undergoing metabolic bariatric surgery dropped by 25.6 per cent, from 0.22 to 0.16 per 1,000 patients.

Senior study author Thomas C. Tsai, a metabolic bariatric surgeon at Brigham and Women’s Hospital, highlights that this is “one of the first national estimates of the decline in utilisation of bariatric metabolic surgery among privately insured patients corresponding to the rising use of blockbuster GLP-1 RA drugs.”

In the study’s analysis, the researchers observed that only a minority of patients pursued either pharmacologic or surgical treatment, with 94.7 per cent of patients with obesity receiving neither intervention. Of those who sought treatment, 5 per cent opted for GLP-1 RAs, while just 0.3 percent underwent bariatric surgery. Among the individuals who opted for surgery, a higher medical complexity was noted compared to those choosing GLP-1 RAs.

“Metabolic bariatric surgery remains the most effective and durable treatment for obesity. National efforts should focus on improving access to obesity treatment — whether pharmacologic or surgical — to ensure patients can receive optimal care,” said Tsai, who also serves as an assistant professor of surgery at Harvard Medical School and in health policy and management at Harvard T.H. Chan School of Public Health.

Despite the promising efficacy of GLP-1 RAs in managing obesity and its associated health concerns, such as diabetes, Tsai cautioned that these medications come with limitations, including high costs, restricted supply, and gastrointestinal side effects that may lead to discontinuation and potential weight regain.

The surge in GLP-1 RA use raises important questions about the long-term impact of this shift away from surgical intervention. “As patients with obesity increasingly rely on GLP-1s instead of surgical intervention, further research is needed to assess the impact of this shift from surgical to pharmacologic treatment of obesity on long-term patient outcomes,” Tsai said. “With the national decline in utilisation of metabolic bariatric surgery and potential closure of bariatric surgery programmes, there is a concern that access to comprehensive multidisciplinary treatment of obesity involving pharmacologic, endoscopic, or surgical interventions may become more limited.”

This change in treatment patterns also presents an opportunity to expand accessibility to both surgical and pharmacologic interventions, according to co-author Ateev Mehrotra, chair of the Department of Health Services, Policy and Practice at the Brown University School of Public Health. “Metabolic bariatric surgery and GLP-1 RAs are both effective interventions for patients with obesity, yet less than 6 percent of patients in our study received either form of treatment,” he noted.

The authors call on clinicians and policymakers to monitor this evolving treatment landscape carefully, ensuring that patients have access to effective obesity management options. The findings emphasise a need for further research to understand the benefits and drawbacks of surgical versus pharmacologic treatments, especially as the latter gains popularity in clinical practice.

Funding and Disclosures:
Tsai disclosed receiving grants from the National Center for Advancing Translational Sciences, National Institutes of Health to Harvard Catalyst, the Harvard Clinical and Translational Science Center, as well as financial support from Harvard University and its associated academic health care institutions.