Weight loss drugs alter bariatrics

Some bariatric surgeons are noticing a decrease in referrals because of the increasing popularity of GLP-1s, which mimic a gut hormone that suppresses appetite and makes patients feel full. 

The American Society for Metabolic and Bariatric Surgery estimates that nearly 280,000 bariatric operations were performed in 2022, a slight increase from the prior year, when about 262,000 were performed. Recently, the frequency of these surgeries is reducing between 10% and 20%, according to experts and national data. 

Tim Schaffner, MD, bariatric surgeon at Bon Secours in Hampton Roads, Va., told Becker's he has seen 15% fewer referrals for procedures than normal, and Marc Bessler, MD, chief of minimal access/bariatric surgery at New York City's Columbia University Department of Surgery, is noting a "temporary lull" in operations. 

At the same time, comprehensive weight management programs have ever-growing waitlists. 

The chief of Pittsburgh-based UPMC's minimally invasive bariatric and general surgery program, Anita Courcoulas, MD, said there has been a 50% increase in demand for the new weight loss medications, such as Wegovy and Zepbound. The interest in these drugs is reaching other healthcare service lines, too, including transplant programs and spine and orthopedics care

Dr. Courcoulas said the number of bariatric surgery cases is still rising, but there has been "a huge rise in the number of people seeking out nonsurgical obesity treatment, and in particular, the new class of medications."

These injectable therapies are getting closer to achieving weight loss results seen from gastric sleeve and bypass procedures, the two most common surgeries for weight loss. The looming question is which weight management treatment is more cost-effective: a surgery that has an upfront cost between $15,000 and $23,000, or injections that can cost about $1,000 each month in which the weight may or may not return after the prescription ends. 

Dr. Schaffner, whose surgical volume is remaining steady, described the durability question as the "elephant in the room."

"I often say that where the drugs are right now is where surgery was about 15 to 17 years ago, which is great, we have a new tool that appears to be really effective. It's super exciting," Dr. Courcoulas said. "But guess what? We have to wait for long-term results to make sure the weight loss is durable, and to see what the long-term side effects are."

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