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Are GLP-1 Receptor Agonists Eliminating the Need for Bariatric Surgery?
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Key Takeaways
- GLP-1 receptor agonists have significantly increased in use, correlating with a decline in metabolic bariatric surgeries for obesity management.
- Obesity affects 75% of Americans over 25, costing the U.S. healthcare system nearly $173 billion annually.
Metabolic bariatric surgery rates has decreased in response to increased use of glucagon-like peptide-1 (GLP-1) receptor agonists.
The use of glucagon-like peptide-1 (GLP-1) receptor agonists rose significantly since their market rollout, demonstrating meaningful successes in treating obesity and type 2 diabetes (T2D). Data published in JAMA Network Open suggests that the increased use of GLP-1s is associated with reduced rates of metabolic bariatric surgery.1
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Obesity is a significant public health burden, affecting approximately 75% of Americans over the age of 25 years and costing the United States health care system almost $173 billion a year. Individuals with obesity are at higher risk of experiencing various conditions such as cardiovascular disease, T2D, and some types of cancers. Rates of obesity continue to climb in response to decreased access to healthy foods and increased production of ultra processed foods, as well as existing policies that fail to effectively address overweight and obesity.2,3
“It’s going to require a lot more attention and a lot more investment than we are currently giving the problem,” Sarah C. Armstrong, MD, professor of pediatrics and population health sciences at Duke University, said in a New York Times article. “Obesity comes from genetic, physiological, and environmental interactions. It’s not the fault of any 1 individual who has the disease.”4
Treatment of patients with obesity varies and can include combinations of lifestyle modifications, medications, or surgery. Surgical interventions are recommended when patients fail to achieve favorable weight-loss despite implementation of diet, exercise, or use of pharmaceutical agents. However, trends in obesity care and metabolic bariatric surgery are changing with the rise of GLP-1s, which have been touted as a “miracle drug.”5,6
In a cross-sectional study, researchers assessed national trends and patient characteristics associated with treatment of obesity with GLP-1s or surgery. Based on the data, they suggest that the decline in metabolic bariatric surgery correlates with increased use of GLP-1s.1
The study included data from patients with obesity who were prescribed either GLP-1s (n=81,092; 9.6% ages 18 to 35 years) or who underwent metabolic bariatric surgery (n=5137; 17.5% ages 18 to 35 years; P < .001). The authors included only GLP-1 RA prescriptions with FDA indications for treating obesity.1
According to their findings, there was a 132.6% increase in patients prescribed GLP-1 receptor agonists and a 25.6% decrease in metabolic bariatric surgery rates between the last 6 months of 2022 compared with the last 6 months of 2023 (1.89 vs 4.41 patients per 1000 patients).1
The findings highlight a significant shift in obesity care as use of GLP-1s continue to rise, offering patients more efficacious pharmaceutical agents that may greatly reduce, if not eliminate, the need for metabolic bariatric surgery. However, challenges such as market shortages, costs, and patient access impact the availability of this therapy. The authors suggest that policymakers and health care professionals continue to monitor pharmacologic and surgical management of obesity to ensure patients have access to effective obesity treatment.1
