TOPLINE

Bariatric surgery volume among adults increased by roughly 4% a year from 2015 to 2022, then dropped by more than 11% annually in 2023 and 2024 — a reversal not seen among adolescents, whose procedure counts showed no significant change over those same 2 years.

METHODOLOGY

• Obesity remains a major driver of illness, death, and healthcare spending in the US, and although bariatric surgery is one of the most effective treatments available, new weight-loss drugs such as GLP-1 receptor agonists have rapidly reshaped how physicians and patients approach obesity care.
• Researchers drew on nearly 2 million patient records from 959 accredited centers in a national registry that tracks bariatric surgery outcomes to examine how these shifts have affected the actual number of surgeries performed nationwide over the past decade.
• They grouped patients into two age bands — adolescents (10-18 years) and adults (≥ 19 years) — covering 5931 adolescents and 1,964,090 adults; sleeve gastrectomy was the most commonly performed procedure overall.
• Annual surgery volumes for adults and adolescents were tracked separately using statistical models to test whether trends shifted after 2022, enabling the comparison of surgery volumes before and after that point. The analysis also examined whether patterns varied by race, ethnicity, and procedure type and assessed trends in preoperative BMI, adjusting for age, sex, and race.

TAKEAWAY

• The mean preoperative BMI was 46.5 in adults and 49.1 in adolescents; the mean 30-day postoperative BMI was 42.3 and 44.4, respectively.
• Among adults, surgery volume rose steadily from 167,430 procedures in 2015 to a peak of 229,826 in 2022 before significantly declining to 176,915 by 2024; however, adolescent volume rose from 259 procedures in 2016 to 936 in 2023 and fell slightly to 820 in 2024, with no significant change in trends after 2022.
• Race- and ethnicity-stratified analyses revealed that post-2022, surgery volume significantly declined among non-Hispanic White, non-Hispanic Black, and other/unknown race adults, whereas it increased among Hispanic and Latino adults; among adolescents, volume held steady for non-Hispanic White individuals and rose across the other groups, although these differences were not statistically significant.
• Procedure-specific trends also diverged by age group: Among adults, both sleeve gastrectomy and gastric bypass rose before 2022 (by about 5% and 7% per year, respectively) before declining afterward — sleeve procedures fell especially sharply, by roughly 16% a year; among adolescents, sleeve procedures kept rising both before and after 2022 (by about 14% and 8% per year, respectively), whereas bypass procedures shifted from a decline to a nonsignificant increase of about 32% a year.

IN PRACTICE

"The factors contributing to the decline are likely multi­factorial. This period coincided with the expanding avail­ability and use of GLP-1-based and dual-incretin therapies, which have broadened the range of effective obesity treat­ments. Other potential contributors include changes in insurance coverage and prior-authorization require­ments, hospital and surgical capacity, workforce and refer­ral patterns, economic conditions and out-of-pocket costs, patient preferences, residual effects of the COVID-19 pan­demic, and changes in MBSAQIP [Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program] participation," the authors wrote.

SOURCE

The study was led by Sarah Messiah, the University of Texas Southwestern Medical Center in Dallas. It was published online in Obesity Surgery.

LIMITATIONS

The registry only captured surgeries from participating accredited centers, not every bariatric procedure performed nationwide. It did not track medication use, insurance coverage, or referral patterns. The registry's list of participating centers shifted over the decade, but the data did not identify individual hospitals or their case volumes.

DISCLOSURES

The study did not report specific funding sources. The authors reported no relevant conflicts of interest.

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