The rapid rise of GLP-1 medications, coupled with declining rates of bariatric surgery, is causing a notable shift in obesity care. Rather than shuttering, however, bariatric surgery practices are choosing to reshape and expand their offerings. 

Private practices and hospital-based bariatric centers alike are broadening their offerings to include not only surgery but also GLP-1 therapies and other medical treatments, along with psychological support, nutrition services, and, in some cases, body contouring procedures to address post-weight loss concerns.

The goal, those involved said, is to create a one-stop center for obesity care, reflecting a growing, research-driven understanding that optimal management does not pit surgical against medical treatments but often requires both to address a lifelong chronic disease.

“Bariatric surgery isn’t dead,” said Kevin Huguet, MD, MPH, a bariatric surgeon in St. Petersburg, Florida, and founder and medical director of the MIIS Weight Loss Institute as well as director of the Metabolic and Bariatric Surgery Center at St. Anthony’s Hospital.

At his private practice center, both surgical and medical options are available. “Choosing one tool or an isolated intervention is not where we are anymore,” he told Medscape Medical News. 

Bariatric Surgery Rates Decline

For years, the number of patients eligible for bariatric surgery has far exceeded the number who actually undergo the procedure. In an oft-quoted figure, less than 1% of those eligible receive surgery, often due to insurance barriers or a preference to try medical therapy first.

In a recently published research letter in JAMA Surgery, investigators found a 46% decline in bariatric surgeries among eligible patients between 2022 and 2025. 

“We used Epic Cosmos, a nationally representative dataset, to identify those eligible for bariatric surgery,” said co-author Patrick Sweigert, MD, assistant professor of surgery at The Ohio State University Wexner Medical Center, Columbus.

Prescriptions for semaglutide and tirzepatide rose sharply from 2018 to 2025, while bariatric surgery rates began to decline in 2023. The proportion of eligible patients undergoing surgery peaked at 0.17% in late 2022, dropping to 0.09% in the third quarter of 2025.

Data from the American Society for Metabolic and Bariatric Surgery (ASMBS) also show a decline, from 279,967 in 2022 to 270,089 in 2023. 

“Bariatric care is not dead — it’s just dramatically changing,” Sweigert said. Surgery remains part of the treatment armamentarium, alongside medical and other treatments.

“The question is, how do we employ both approaches so we are meeting every individual patient’s need,” said co-author Stefanie C. Rohde, MD, a general surgery resident at The Ohio State University Wexner Medical Center.

Bariatric Surgery’s Role Is Evolving

A recent review highlights the shift in bariatric surgery from a BMI-centric approach to one focused on metabolic disease severity. 

Conditions once considered contraindications, such as end-stage organ failure, are now being reconsidered. Surgery is also increasingly used as a “bridge” to other major procedures by reducing obesity-related perioperative risk. 

The authors concluded that bariatric surgery “has transitioned from being viewed as a last-resort intervention to an effective, evidence-based therapeutic modality for obesity and its related medical conditions.”

In the last five years, more programs have addressed this changing environment by integrating medical and surgical options, said Richard Peterson, MD, MPH, president of the ASMBS and professor and division chief of general and minimally invasive surgery at UT Health San Antonio. 

Although comprehensive programs remain relatively uncommon, ASMBS is developing a “blueprint” to help centers adopt this model.

Hospital-Based Programs Lead Integration 

In 2023, Baton Rouge General opened the Louisiana Center for Bariatrics, offering both surgical and medical weight loss options.

Drake Bellanger, MD, a staff obesity medicine specialist, transitioned from performing bariatric surgery to focusing on other treatment options in 2021. Even as early as 2014, he began incorporating anti-obesity medications such as phentermine, topiramate, and later GLP-1s.

At the new center, surgeons, obesity medicine specialists, and dietitians trained in weight loss and preparing patients for weight loss surgery collaborate closely, with referrals flowing in both directions. Additional services include behavioral counseling. 

“It’s becoming more the norm,” Bellanger told Medscape Medical News, describing the shift toward a “less siloed” approach.

Providence Swedish Weight Loss Services in Seattle has operated for two decades but transitioned to a fully integrated program about 5-6 years ago, said Anirban Gupta, MD, the center’s medical director. 

Previously surgeon-led, the center had already incorporated pharmacotherapy and lifestyle support. It has since expanded to include obesity medicine physicians, dietitians, and psychologists, Gupta told Medscape Medical News.

While some programs have seen declining volume, Gupta said theirs has grown, which he attributes to its comprehensive approach.

As the popularity of GLP-1s has grown, stigma has been reduced and obesity care has been normalized. As a result, more patients seek help. About 80% of new patients see a medical weight loss physician first, he said, although patients can choose their entry point.

Private Practice-Based Bariatric Centers

Some physicians have left hospital employment to establish private practices, opening bariatric centers offering comprehensive options.

“We see medications and surgery as working synergistically,” said Huguet of the MIIS Weight Loss Institute in St. Petersburg, Florida. His center now offers surgical and medical treatments, wellness services, body contouring, and hormone replacement.

“There is still a demand for bariatric surgery,” Huguet said, noting that some patients cannot tolerate medications or do not achieve desired results.

“Patients love it,” he added. “Everything is housed in one place.” He sees his center as “a safe space” to get the information and help they need.

Elizabeth “Betsy” Dovec, MD, left hospital practice after nearly a decade and founded a comprehensive private bariatric surgery practice, BodyByBariatrics.com, in 2023. In 2025, she opened the Surgical Institute of Central Florida, a 15,000 square foot building in Winter Garden, Florida.

In addition to surgery, the center includes a med spa, cosmetic services, dietitian support, exercise coaching, and behavioral therapy.

She told Medscape Medical News that she views her model as the future and predicts continued challenges for hospital-based programs due to cost and access barriers. 

“Bariatric hospital programs are going to continue to close their doors at a frightening rate,” she said. 

For Gupta, the key to success is in offering patients a variety of options. 

“I think if you’re not expanding, and you’re not paying attention, you risk running into trouble,” he said. 

The Ohio State University College of Medicine funded the study on bariatric surgery rates. Peterson reports consulting relationships with Intuitive Surgical, Medtronic, Teleflex/Standard Bariatrics, and Optum. Dovec, Bellanger, Huguet, and Gupta report no relevant disclosures.