The rise in GLP-1 anti-obesity drug use parallels a decline in bariatric surgery

Researchers at Mass General Brigham and associates found that the use of GLP-1 drugs to treat obesity more than doubled from 2022 to 2023, while the number of surgical procedures fell by a quarter.

Key insights

• Researchers from Mass General Brigham and associates assessed national trends in the number of patients with obesity who were prescribed GLP-1 medications and the number who underwent metabolic bariatric surgery.
• Researchers documented a 132.6% increase in patients prescribed GLP-1 drugs and a 25.6% decrease in patients who underwent bariatric surgery between 2022 and 2023.
• Only 6% of patients with obesity in the study population received either GLP-1 drugs or surgery, suggesting that many more patients could be treated.

A new study by researchers at Brigham and Women's Hospital, a founding member of the Mass General Brigham health system, in collaboration with researchers at the Harvard TH Chan School of Public Health and the Brown School of Public Health examined a large sample of privately insured patients with obesity and found found that the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as anti-obesity drugs more than doubled from 2022 to 2023. During the same period, there was a 25.6% decrease in patients undergoing metabolic bariatric surgery to treat obesity. The study is published in JAMA network opened.

Our study provides one of the first national estimates of the decline in bariatric metabolic surgery utilization among privately insured patients that has accompanied the increasing use of blockbuster GLP-1 RA drugs.”

Thomas C. Tsai, MD, MPH, senior author, metabolic bariatric surgeon, Department of Surgery at Brigham and Women's Hospital

Using a nationwide sample of health insurance claims data from over 17 million privately insured adults, researchers identified patients diagnosed with obesity without diabetes in 2022-2023. The study found a large increase in the proportion of patients receiving GLP-1 RAs during the study period, with GLP-1 RA use increasing by 132 from the last six months of 2022 to the last six months of 2023 .6% increased (from 1.89 to 4.41). patients per 1,000 patients). Meanwhile, there was a 25.6% decrease in utilization of bariatric metabolic surgery during the same period (from 0.22 to 0.16 patients per 1,000 patients).

Of the sample of patients with obesity, 94.7% received no form of treatment during the study period (while 5.0% received GLP-1 RAs and 0.3% received surgery). Compared to patients prescribed GLP-1 RAs, patients who underwent surgery tended to be medically more complex.

“Currently, metabolic bariatric surgery remains the most effective and long-lasting treatment for obesity. “National efforts should focus on improving access to obesity treatment – ​​be it pharmacological or surgical – to ensure patients can receive optimal care,” said Tsai, who is also an assistant professor of surgery at Harvard Medical School and Assistant Professor of Health Policy and Management at the Harvard TH Chan School of Public Health.

Tsai notes that while GLP-1 RAs can effectively treat obesity and related diseases (such as diabetes), these drugs are limited by high cost, limited availability, and gastrointestinal side effects that can lead to treatment discontinuation and subsequent weight gain .

“As patients with obesity increasingly rely on GLP-1 rather than surgery, further research is needed to evaluate the impact of this shift from surgical to pharmacological treatment of obesity on long-term patient outcomes,” Tsai said. “Given the nationwide decline in utilization of metabolic bariatric surgery and the potential closure of bariatric surgery programs, there is concern that access to comprehensive multidisciplinary obesity treatment that includes pharmacologic, endoscopic or surgical interventions may become more limited.”

“These results also highlight the opportunity to further expand the use of surgical and pharmacological treatments for obesity and related comorbidities,” said co-author Ateev Mehrotra, MD, MPH, chair of the Department of Health Services, Policy and Practice at Brown University School of Public Health. “Metabolic bariatric surgery and GLP-1 RAs are both effective interventions for patients with obesity, yet fewer than 6% of patients in our study received either treatment.”

Given these findings, the authors encourage clinicians and policymakers to continue to monitor access to effective obesity treatment amid a rapidly evolving landscape of treatment options. Additionally, further research is needed to understand the trade-offs between the use of surgical procedures and the increasingly popular GLP-1 RAs for the treatment of obesity.