As weight loss drugs soar in popularity, fewer are getting bariatric surgeries

More Americans are turning to increasingly popular weight loss drugs, but fewer are choosing surgery to address obesity, researchers have found.

A new study finds a dramatic uptick in the number of people turning to GLP-1 drugs, which are designed for diabetes but have also gained wide appeal for helping people lose weight.

In the last six months of 2023, the number of patients prescribed GLP-1 drugs rose 132.6%, compared to the last six months of 2022, according to findings published Oct. 25 in JAMA Network Open.

At the same time, bariatric surgeries dropped 25.6% over the same time period, researchers found.

Researchers from Brigham and Women’s Hospital collaborated with researchers at Harvard T.H. Chan School of Public Health and the Brown School of Public Health on the study.

Scientists examined 17 million claims from adult patients with medical and pharmaceutical coverage through commercial and Medicare Advantage insurance. Researchers said they only looked at patients with obesity who did not have diabetes.

Thomas C. Tsai, MD, MPH, a metabolic bariatric surgeon in the surgery department at Brigham and Women’s Hospital, pointed to the significance of the study.

"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," Tsai, the senior author of the study, said in a statement.

The authors note that while GLP-1 drugs are showing that they can aid patients with diabetes and help some patients lose weight, patients are prone to gaining weight again if they stop taking the drugs. And some of the side effects of those drugs cause some patients to give up on the medications.

“Although GLP-1 RAs are effective for the treatment of obesity and related comorbid conditions, such as diabetes, the high cost and high rates of gastrointestinal adverse effects can lead to treatment cessation and subsequent weight regain,” the authors wrote.

Weight loss drugs have become difficult to find for some patients, as manufacturers are struggling to keep up with the demand.

The high cost of GLP-1 drugs - more than $1,000 - keep them out of reach of many Americans. FDA Commissioner Robert Califf denounced drug companies for the persistent high prices during a conversation last week at the HLTH conference.

“The profit margin, especially in the U.S., is outrageous,” Califf said. “They should be ashamed of themselves for what they’re charging Americans.”

The authors suggested that policymakers and clinicians should consider the costs and benefits of weight loss drugs and surgical options.

Tsai said bariatric surgery “remains the most effective and durable treatment for obesity.” He said patients should have greater access to both weight loss drugs and surgical options.

“National efforts should focus on improving access to obesity treatment—whether pharmacologic or surgical—to ensure patients can receive optimal care,” Tsai said in a statement.

Bariatric surgeries could actually be less expensive for patients in the long run than relying on GLP-1 drugs over the course of a lifetime, according to a separate study.

Researchers presented findings comparing the cost at the American College of Surgeons Clinical Congress 2024 in San Francisco. The estimated cost of bariatric surgery ranges from $17,400 to $22,850, while the annual cost of GLP-1 medications range from $9,360 to $16,200. Since patients may need to remain on those medications for an indefinite period, the drug cost would surpass the surgery in a few years, unless there’s a significant drop in prices.

“Undergoing bariatric surgery is more cost effective in the long run than maintaining these medications for the remainder of an individual’s life,” Joseph Sanchez, MD, a general surgery resident at Northwestern Medicine, Chicago and the lead author of that study, said in a statement.

The Norman Regional Health System in Oklahoma announced this summer that it is closing its Journey Clinic, which offered surgical and medical options for weight loss. The health system pointed to a decline in surgeries, and cited the rising popularity of Ozempic and other weight loss drugs, The Oklahoman reported.

Intuitive Surgical, which manufactures da Vinci surgical robots, said in October 2023 that it was seeing a drop in bariatric surgeries, in part due to the growing popularity of weight loss drugs, Reuters reported. But in January, the company said it was seeing a rebound in surgical procedures.

A KPMG survey of American consumer trends found a significant appetite for GLP-1 drugs such as Ozempic and Wegovy, with more than half saying the medications could be important to their health.

Ash Shehata, national healthcare sector leader for KPMG, told Chief Healthcare Executive® in a May 2024 interview with Chief Healthcare Executive® that the consumer demand for the medication remains strong.

“People will likely, in these kinds of numbers, still reach into their pocketbook and use the drugs if their provider gives a prescription,” Shehata said.