GLP-1 medications are reshaping the weight management landscape — and beginning to take a bite out of bariatric surgery volumes in hospitals.
Between 2022 and 2023, bariatric surgery rates fell 25.6% as GLP-1 prescriptions rose 132.6%, according to a study from researchers at Boston-based Harvard Medical School and Brigham and Women’s Hospital. Vizient projects inpatient bariatric surgery volumes will decline another 15% by 2034, driven in part by increasing GLP-1 use.
With uptake accelerating, what will bariatric surgery programs in health systems and hospitals look like in 5 years? Here’s what three experts told Becker’s:
Editor’s note: Responses are listed in alphabetical order and have been lightly edited for length and clarity.
Judy Chen, MD. Associate Clerkship Director of Medical Student Surgical Education and Director of Adolescent Bariatric Surgery at UW Medicine Center for Weight Loss and Metabolic Surgery (Seattle):
In 2012, the American Medical Association first recognized obesity as a disease. This is incredibly recent compared to other diseases — and even compared to The Bachelor, which premiered in March 2002. It’s safe to say that it is early in the specialty of obesity care.
Class 3 severe obesity is now trending up from the current prevalence of 41% and is predicted to encompass nearly 50% of Americans by 2030. This disease is not going anywhere, and more than half of the population lacks access to current treatment options. Treatment bias plagues all of medicine, and obesity faces even more bias due to the significant stigma associated with the disease.
Currently, it is an early and exciting time due to new medications expanding treatment options for this chronic metabolic disorder. There are many parallels in the history of how new medications change the paradigm of disease treatment. The first coronary bypass was performed in 1964, statins were discovered in the 1970s, and breakthrough captopril was introduced in 1975. Some were concerned that cardiac surgery would become obsolete.
Obviously, it didn’t. Ultimately, both medical and surgical treatments exist today for heart disease.
The first weight loss surgery was performed in 1953. Gastric bypass was developed in 1966 and revolutionized by the minimally invasive laparoscopic approach in 1994. Treating obesity should involve both medications and surgery — like chemotherapy paired with surgical tumor removal. Medications can accrue long-term costs and adverse events, while surgery offers multiple, more immediate mechanisms to address obesity. Contraindications remain a key consideration in both.
In five years, the bariatric surgery program in health systems will remain essential. Surgery has stood alone for more than 70 years as a treatment for a chronic disease. Obesity treatment welcomes a partnership of medications and innovations as the multi-modal treatment continues to be refined. It is important to keep all of these treatments together in an interdisciplinary team and program that is MBSAQIP accredited. This accreditation ensures a program meets national quality benchmarks and establishes long term follow up. Precision treatment in obesity will improve and should live in a metabolic and bariatric surgery program.
Surgery is essential and is the most effective and durable option for sustained weight loss. It will continue to be lifesaving, superior for specific indications, and crucial for improving medical conditions, reducing disabilities, and enhancing quality of life.
Amir Ghaferi, MD. Bariatric Surgeon with Froedtert & the Medical College of Wisconsin health network and Physician Enterprise President, South Region, Froedtert ThedaCare Health (Milwaukee):
Obesity is arguably the biggest public health crisis in our country. The landscape of weight management has evolved rapidly with the emergence of GLP-1 medications. These medications can be highly effective and may benefit people who are not candidates for bariatric surgery, or even serve as an adjunct to bariatric surgery.
Still, bariatric surgery continues to be the best option for long-term weight management and associated comorbidities. Yet, fewer than 1% of eligible patients in the United States are undergoing bariatric surgery.
Bariatric surgery will continue to be the gold standard for managing severe obesity and its associated conditions. However, even patients who undergo surgery must commit to lifestyle changes and may still require additional treatments such as GLP-1s. Weight management is a team sport with important contributions from dietitians, health psychologists, surgeons, endocrinologists and primary care physicians.
Rather than viewing the landscape as a zero-sum game, we should embrace these new medications as an important element of our broader toolkit for weight management. Hospitals and health systems can significantly improve community health outcomes by investing in comprehensive weight management programs that include all treatment options. Recommending and delivering the appropriate treatments will be critical to solving this public health challenge.
Yasir Khan, DO. Bariatric Surgeon, Chief Medical Officer of Mercy Health Partners Cincinnati and Surgery Department Chair at The Jewish Hospital-Mercy Health (Cincinnati):
As a bariatric surgeon, I have seen firsthand the dramatic impact of GLP-1s — both as a weight loss option for patients and in raising overall awareness of obesity. Almost 50% of the U.S. population is obese (defined as a BMI greater than 30). In our practice, GLP-1s are a first-line treatment for patients with a BMI between 30 and 40 who do not have significant medical comorbidities.
For patients with a BMI over 40, bariatric surgery remains the most durable and cost-effective option, and this is becoming more widely recognized by patients and physicians alike. Bariatric surgery results in an excess body weight loss of about 70% in one year, which is significantly higher than medications. It is also very safe, with average complication rates lower than common operations like gallbladder removal and knee replacement.
GLP-1s and most medications are intended for lifelong use to maintain weight loss. The cost of a laparoscopic or robotic sleeve gastrectomy is about the same as a one-year supply of semaglutide. This fact is starting to be realized by patients who want to lose and maintain more than 50 pounds to achieve a healthy weight and BMI.
As bariatric surgery numbers are starting to increase with patients who have higher BMI, I believe this trend, along with the growing awareness of obesity, will result in a significant increase in bariatric surgery rates in the next five years.
