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TOPLINE:

Between 2022 and 2024, prescriptions for GLP-1 receptor agonists increased by about 140%, whereas the use of metabolic bariatric surgery decreased by about 34%, indicating a rapid shift from surgical to pharmacologic management of obesity.

METHODOLOGY:

• The impact of increasing GLP-1 medication use on bariatric surgery rates remains unclear. As many payors are requiring prior authorization for GLP-1 receptor agonists, tracking metabolic bariatric surgery volumes is essential to ensure access to appropriate medical and surgical care for patients with obesity.
• Researchers utilized a comprehensive US longitudinal database to conduct a cross-sectional analysis of 11.7 million unique insurance enrollees with continuous medical and pharmaceutical coverage through commercial, Medicaid, and Medicare Advantage insurance plans from 2022 through 2024.
• Included patients were adults born before 2004 who were not known to be deceased and had at least one diagnosis of obesity, overweight, or diabetes between January 2022 and December 2024; patients who both underwent metabolic bariatric surgery and received GLP-1s during the study period were excluded.
• The GLP-1 receptor agonists analyzed included liraglutide, semaglutide, and tirzepatide. Researchers also compared enrollee characteristics, including age, sex, and Elixhauser comorbidity index, between patients prescribed GLP-1 receptor agonists and those who underwent surgery.

TAKEAWAY:

• During the study period, 9.2% of patients filled GLP‑1 prescriptions and 0.4% underwent metabolic bariatric surgery; patients undergoing surgery were more medically complex than those prescribed GLP‑1 receptor agonists or receiving no treatment.
• Between 2022 and 2023, the use of GLP-1 receptor agonists increased by 71.8%, with a further 39.9% relative increase between 2023 and 2024; overall use increased by 140.4% from 2022 to 2024.
• The utilization of metabolic bariatric surgery declined by 14.4% between 2022 and 2023, with the decline accelerating in 2024 to a further 23.0% year-on-year decrease.
• Outcomes were similar when analyses were limited to patients with class 2 or 3 obesity.

IN PRACTICE:

“Despite the increase in GLP-1s, our study shows that obesity remains undertreated, with only about 9.5% of the relevant population undergoing treatment with GLP-1s or MBS [metabolic bariatric surgery],” the authors wrote. “The initial decline in metabolic bariatric surgery observed in earlier studies has continued into 2024. The effect of these trends on long-term multidisciplinary management of obesity should be monitored to ensure patients can access both optimal pharmacologic and surgical treatment for obesity.”

SOURCE:

This study was led by Robert J. Calzaretta Jr, MIDS, Analysis Group, in Boston and San Francisco. It was published online as a research letter in JAMA Surgery.

LIMITATIONS:

Limitations of this study include its cross-sectional nature and potential confounding from variations in patient adherence to GLP-1 receptor agonists. The exclusion criteria may have underestimated the postsurgery use of GLP-1s by patients for weight maintenance.

DISCLOSURES:

One author reported personal fees from Analysis Group and Johnson & Johnson MedTech and grants from Arnold Ventures and The Commonwealth Fund, all outside the submitted work.

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