Bariatric Surgery Demand Declines in the Era of GLP-1 RAs

TOPLINE:

The use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for obesity treatment increased more than twofold between the last half of 2022 and the last half of 2023, whereas the rate of metabolic bariatric surgery dropped by around 25% during the same period, suggesting a notable shift in obesity management strategies.

METHODOLOGY:

• The recent surge in the use of GLP-1 RAs for obesity treatment seems to have coincided with the closure of hospital-based metabolic bariatric surgery programs due to decreased demand; however, empirical data on the relationship between these trends are unavailable.
• This cross-sectional study used 2022 and 2023 medical and pharmaceutical claims data from 17 million adults with commercial or Medicare Advantage insurance who had obesity but not diabetes.
• For each quarter, researchers identified patients with a claim for any formulation of semaglutide or liraglutide and for metabolic bariatric surgery and compared patient characteristics, including age, sex, and comorbidities. Only GLP-1 RA prescriptions with US Food and Drug Administration indications as anti-obesity medications were considered.
• Trends in GLP-1 RA use and metabolic bariatric surgeries per 1000 unique patients were assessed using a linear regression model.

TAKEAWAY:

• During the study period, 81,092 patients were prescribed GLP-1 RAs, 5173 patients underwent metabolic bariatric surgery, and 1,547,174 received neither treatment.
• Patients undergoing metabolic bariatric surgery were more medically complex, with 18.8% having at least four comorbidities vs 8.2% of those who were prescribed GLP-1 RAs and 11.1% of those who received neither treatment (P
• The proportion of patients prescribed GLP-1 RAs for obesity management increased by 132.6% between the last 6 months of 2022 and the last 6 months of 2023 (1.89 vs 4.41 patients per 1000 patients).
• In contrast, the proportion of patients who underwent metabolic bariatric surgery decreased by 25.6% during the same period (0.22 vs 0.16 patients per 1000 patients).

IN PRACTICE:

“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,” the authors wrote.

SOURCE:

This study, led by Kevin Lin, Department of Health Care Policy, Harvard Medical School, Boston, was published online in JAMA Network Open.

LIMITATIONS:

The cross-sectional nature of the study may have limited the ability to establish causality between the increase in the use of GLP-1 RAs and the decline in the rates of metabolic bariatric surgery. Any variation in patient adherence to GLP-1 RAs may have led to confounding errors.

DISCLOSURES:

The authors reported no funding. One author reported receiving grants from the National Center for Advancing Translational Sciences, National Institutes of Health to Harvard Catalyst, Harvard Clinical and Translational Science Center, and financial contributions from Harvard University and its affiliated academic healthcare centers.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.