Metabolic Bariatric Surgery Takes a Backseat as GLP-1RA Use Soars, According to New Research

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The rate of metabolic bariatric surgery decreased from 2022 to 2023, whereas the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as antiobesity medications grew more than twofold, according to a new large study of adults with obesity.¹

Findings from the cross-sectional analysis of 17 million privately insured adults with obesity showed that the use of semaglutide or liraglutide increased 132.6% among participants prescribed the GLP-1RA drugs between the last 6 months of 2022 compared to the last 6 months of 2023 (1.89 vs 4.41 patients per 1000 patients).¹

Conversely, researchers reported a 25.6% decrease in the rate of participants undergoing metabolic bariatric surgery during the same period (0.22 vs 0.16 patients per 1000 patients).¹

“Our study provides one of the first national estimates of the decline in utilization of bariatric metabolic surgery among privately insured patients corresponding to the rising use of blockbuster GLP-1 RA drugs,” senior author Thomas C. Tsai, MD, MPH, a metabolic bariatric surgeon at Brigham and Women’s Hospital, said in a Mass General Brigham press release.²

The surge in use of GLP-1RAs as antiobesity medications has been well documented. One study showed that there were 1 million new GLP-1RA users from 2011 to 2023, most of whom had a body mass index of 30 kg/m2 or greater.

“Anecdotally, health systems have closed hospital-based metabolic bariatric surgery programs due to decreased demand, but empirical data on the association of increased prescribing of GLP-1 RAs with use of metabolic bariatric surgery is unavailable, to our knowledge,” Tsai and colleagues wrote in JAMA Network Open.¹

In the current study, investigators used deidentified claims from 17 million unique privately insured adults between 2022 and 2023. The final analysis only included people with obesity and without diabetes, and only GLP-1RA prescriptions with FDA indications as antiobesity medications (ie, semaglutide and liraglutide).¹

Researchers compared the characteristics (ie, age, sex, comorbidities) of participants who were prescribed GLP-1 RAs, those who underwent metabolic bariatric surgery, and those who received neither treatment. They then assessed trends in use of GLP-1RAs and metabolic bariatric surgeries per 1000 unique patients without diabetes and with obesity using a generalized linear regression model, according to the study.¹

“Due to seasonal variations in metabolic bariatric surgery use, we compared the slope of change during quarter 3 to 4 between 2022 and 2023,” noted Tsai and colleagues.¹

During the study period, a total of 81 092 adults received GLP-1RAs, 5173 patients underwent metabolic bariatric surgery, and 1 547 174 received neither treatment. Individuals who underwent metabolic bariatric surgery more often had medically complex (18.8%) procedures—defined as having 4 or more comorbidities—compared with those prescribed GLP-1RAs (8.2%) or those with no treatment (11.1%).¹

Researchers noted that although GLP-1RAs are effective for the treatment of obesity and related comorbid conditions (such as diabetes), the high cost and high rates of gastrointestinal adverse effects may prompt treatment cessation and subsequent weight regain.¹

“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, who is also an assistant professor of surgery at Harvard Medical School, said in the press release.² “With the national decline in utilization of metabolic bariatric surgery and potential closure of bariatric surgery programs, there is a concern that access to comprehensive multidisciplinary treatment of obesity involving pharmacologic, endoscopic, or surgical interventions may become more limited.”

Tsai and coauthors added in the study that there is still a large addressable population for obesity treatment, “with less than 6% of our study population receiving GLP-1RAs or surgery.”¹

They continued: “Policymakers and clinicians should continue to closely monitor trade-offs between pharmacologic and surgical management of obesity to ensure optimal access to effective obesity treatment.”¹

The researchers noted some study limitations, including the analysis’ cross-sectional design and possible confounding from variations in patient adherence to GLP-1RAs.¹

References:

1. Lin K, Mehrotra A, Tsai TC. Metabolic bariatric surgery in the era of GLP-1 receptor agonists for obesity management. JAMA Netw Open. Published October 25, 2024. doi:10.1001/jamanetworkopen.2024.41380
2. Study finds bariatric surgery declined with rise in GLP-1 drugs to treat obesity. News release. Mass General Brigham. October 25, 2024. Accessed November 1, 2024. https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/study-finds-bariatric-surgery-declined-with-rise-in-glp-1-drugs