GLP-1s Are Not the End of Bariatric Surgery — They Are Reinventing Obesity Care
The rise of GLP-1 medications is one of the most consequential changes in obesity care in decades. Not surprisingly, bariatric surgery is feeling the impact. As patients gain access to powerful medications such as semaglutide and tirzepatide, fewer are immediately choosing an operation. The trend is real, but the conclusion that GLP-1s will simply replace bariatric surgery misses the larger story.
Recent data show the magnitude of the disruption. U.S. metabolic and bariatric procedures fell from about 230,000 in 2022 to roughly 177,000 in 2024, a decline of about 23% in two years. Meanwhile, GLP-1 prescribing has risen dramatically. In one large analysis of patients with severe obesity, prescriptions increased from fewer than 5,000 in 2018 to more than 1.4 million in 2025.
Yet the most important number may be the one that receives the least attention: despite the extraordinary growth of GLP-1 therapy, the majority of Americans with severe obesity still receive neither anti-obesity medication nor bariatric surgery. In a large 2026 analysis, roughly 90% to 95% received neither treatment. The central challenge, therefore, is not a competition between a drug and an operation. It is that obesity remains profoundly undertreated.
A much larger opportunity
More than 40% of American adults have obesity, and nearly 10% have severe obesity, according to CDC data. We have powerful new medications and highly effective operations, yet we are still reaching only a fraction of the people who could benefit. GLP-1s should therefore be viewed not simply as a threat to surgical volume but as an opportunity to bring millions more people into effective obesity care.
That changes the strategic question for health systems. The question is no longer, “How do we protect bariatric surgery volume?” It is, “How do we help people achieve and sustain metabolic health throughout their lives?”
From competing treatments to a continuum of care
The future model will increasingly integrate medication and surgery rather than force patients to choose between them. For many patients, a GLP-1 will be the logical first therapeutic step. Some will achieve substantial and durable weight loss and never need an operation. Others will not lose enough weight, will experience adverse effects, will lose access to medication or will regain weight after stopping it.
For those patients, bariatric surgery remains an extraordinarily powerful treatment. And the relationship works in the other direction as well: patients who regain weight years after surgery may benefit from GLP-1 therapy rather than another operation. For selected patients with extreme obesity, medication before surgery may help them enter the operating room at a lower weight and potentially lower risk.
The emerging model is therefore not GLP-1 versus surgery. It is GLP-1 when appropriate, surgery when appropriate, and GLP-1 again when needed. These are complementary tools for managing a chronic disease across a lifetime.
But treatment cannot be the whole model
There is an even more important opportunity. If our future model begins with medication and surgery, we are still beginning too late. The best protection against obesity is to help people maintain a healthy weight and metabolic health throughout life.
We already know many of the behaviors that drive well-being: regular physical activity, healthy eating, restorative sleep, stress reduction and strong social connection. These behaviors influence far more than weight. They shape cardiovascular health, diabetes risk, mental health, physical function, resilience and longevity. We also increasingly understand the science of forming and sustaining habits.
Technology can help turn that knowledge into daily practice. Wearables, digital coaching, personalized feedback, nudges and AI-enabled support can help people translate the desire to be healthy into small actions repeated until they become habits. The opportunity is not to lecture people about what they should do. It is to create environments and supports that make healthy choices easier to begin, easier to repeat and easier to sustain.
Well-being and healthy habits → GLP-1 when appropriate → surgery when appropriate → GLP-1 when needed → lifelong well-being
Importantly, well-being surrounds every step. Healthy behaviors should not be a hurdle patients must clear before they “earn” medication or surgery, and medication or surgery should never be viewed as a substitute for healthy living. They are complementary strategies. Sometimes losing weight with medication or surgery may itself make movement, sleep and healthy eating easier, creating a virtuous cycle in which treatment helps make well-being more attainable.
Move upstream, before obesity develops
Healthcare has historically entered the story too late. We wait until someone develops obesity, diabetes, hypertension, sleep apnea or cardiovascular disease and then ask which treatment to provide. Imagine instead a system designed to preserve health before disease takes hold.
That means thinking across a lifetime: helping children and families establish healthy patterns; helping adults preserve muscle, fitness and metabolic health; recognizing unhealthy weight gain early; and providing progressively more intensive support when someone begins moving off a healthy trajectory. Rather than telling someone once a year to exercise, eat better and sleep more, technology may allow us to support healthy behavior every day.
The most ambitious goal is therefore not simply to help people lose weight. It is to help people avoid needing to lose it in the first place — and when obesity does develop, to offer increasingly effective tools without stigma and without delay.
Bariatric surgery becomes metabolic health, and metabolic health becomes well-being
For health systems, this suggests an evolution beyond the traditional bariatric surgery program. A program built primarily around surgical volume will face headwinds. A comprehensive metabolic health and well-being program could have an enormous opportunity for growth.
The front door should increasingly be health rather than surgery. Patients could enter through an assessment of weight, nutrition, physical activity, sleep, stress, social connection, behavioral health and metabolic risk. They could receive habit support, nutrition and exercise interventions, technology-enabled coaching, GLP-1 therapy when appropriate, and surgery when it offers the greatest value.
Success would no longer be measured primarily by how many operations we perform or prescriptions we write. We would ask whether people are maintaining a healthy weight, moving regularly, eating well, sleeping well, managing stress and staying socially connected. We would measure metabolic health, cardiovascular risk, strength, function, quality of life and, ultimately, healthy years of life.
GLP-1 medications may reduce bariatric surgery volumes in the short term. But they have also opened a door to something much larger: millions of people are newly engaged in conversations about obesity, metabolic health and well-being. The health systems that thrive will not defend surgery from GLP-1s. They will embrace medication, surgery, healthy habits and technology as parts of one integrated strategy centered on the patient.
The future of bariatric surgery may be less about surgery and more about helping people flourish. The real opportunity is to move upstream: from treating obesity after it develops to building the habits, relationships, treatments and environments that help people remain healthy throughout their lives.
Peter Pronovost, MD, PhD, FCCM, Chief Quality and Clinical Transformation Officer, and President of the Healthcare Transformation Institute, University Hospitals Cleveland
Betul Hatipoglu, MD, Chief of Endocrinology, Medical Director of the Diabetes & Metabolic Care Center, and the Mary B. Lee Chair in Adult Endocrinology, University Hospitals Cleveland
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
