TOPLINE:

Among patients who were eligible for metabolic and bariatric surgery in a national sample in the US, prescriptions for semaglutide and tirzepatide increased dramatically from 2018 to 2025, whereas rates of metabolic and bariatric surgeries declined substantially beginning in 2023. Sleeve gastrectomy experienced a steeper decline than Roux-en-Y gastric bypass.

METHODOLOGY:

• Since weight-loss and glycemic effects of GLP-1 receptor agonists such as semaglutide and tirzepatide approach those of metabolic and bariatric surgery, surgical use may be changing, yet no studies have reported trends through 2025 using population-level electronic health record data.
• Researchers analyzed data of 31,684,807 patients eligible for metabolic and bariatric surgery (median age, 55 years; 60% women; median BMI, 40.7) in the US across all quarters from 2017 through 2025 to assess trends in metabolic and bariatric surgery use during the GLP‑1 era.
• Patients younger than 18 years, those who underwent a prior metabolic and bariatric surgery, those with gastrointestinal cancer, or pregnant individuals were excluded from the analysis.
• The use of GLP-1s was defined as the proportion of patients with active semaglutide or tirzepatide prescriptions, and the use of metabolic and bariatric surgery was defined as the proportion of patients who underwent a primary weight-loss surgery during the study period.

TAKEAWAY:

• The prevalence of GLP-1 prescriptions increased dramatically from 0.22% in quarter 4 of 2018 to 24.17% in quarter 3 of 2025, representing more than a 100-fold increase over the study period.
• Metabolic and bariatric surgery use peaked at 0.17% in quarter 4 of 2022 and subsequently declined to 0.09% in quarter 3 of 2025, representing an overall decrease of 46.4% over 3 years.
• The decline was more pronounced for sleeve gastrectomy (a decrease of 50.1%) than for Roux-en-Y gastric bypass (a decrease of 44.3%) from quarter 3 of 2022 to quarter 3 of 2025.
• When stratified by BMI category, the use of metabolic and bariatric surgery declined least in patients with BMI ≥ 55 (a decrease of 35.0% vs 40.7%-49.8% for those in lower BMI categories).

IN PRACTICE:

“Earlier access to GLP-1s in patients with diabetes and the observed decline in metabolic and bariatric surgery use irrespective of diabetes status, highlight complex decision-making regarding treatment. Developing evidence-based, patient-centered, multimodal pathways that integrate pharmacological and surgical approaches is essential because metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity,” the authors wrote.

SOURCE:

The study was led by Stefanie C. Rohde, MD, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio. It was published online as a research letter in JAMA Surgery.

LIMITATIONS:

Potential selection bias at participating institutions and missing data inherent to electronic health record analyses were the main limitations of this study. The study evaluated prescriptions rather than dispensed medications. Additionally, insurance plan coverage data were missing. 

DISCLOSURES:

One author disclosed receiving personal fees from Johnson & Johnson.

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