Bariatric Surgery Demand Declines in the Era of GLP-1 RAs

The use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for obesity treatment increased more than twofold between the last half of 2022 and the last half of 2023, whereas the rate of metabolic bariatric surgery dropped by around 25% during the same period, suggesting a notable shift in obesity management strategies.

METHODOLOGY:

• The recent surge in the use of GLP-1 RAs for obesity treatment seems to have coincided with the closure of hospital-based metabolic bariatric surgery programs due to decreased demand; however, empirical data on the relationship between these trends are unavailable.
• This cross-sectional study used 2022 and 2023 medical and pharmaceutical claims data from 17 million adults with commercial or Medicare Advantage insurance who had obesity but not diabetes.
• For each quarter, researchers identified patients with a claim for any formulation of semaglutide or liraglutide and for metabolic bariatric surgery and compared patient characteristics, including age, sex, and comorbidities. Only GLP-1 RA prescriptions with US Food and Drug Administration indications as anti-obesity medications were considered.
• Trends in GLP-1 RA use and metabolic bariatric surgeries per 1000 unique patients were assessed using a linear regression model.

TAKEAWAY:

• During the study period, 81,092 patients were prescribed GLP-1 RAs, 5173 patients underwent metabolic bariatric surgery, and 1,547,174 received neither treatment.
• Patients undergoing metabolic bariatric surgery were more medically complex, with 18.8% having at least four comorbidities vs 8.2% of those who were prescribed GLP-1 RAs and 11.1% of those who received neither treatment (P < .001).
• The proportion of patients prescribed GLP-1 RAs for obesity management increased by 132.6% between the last 6 months of 2022 and the last 6 months of 2023 (1.89 vs 4.41 patients per 1000 patients).
• In contrast, the proportion of patients who underwent metabolic bariatric surgery decreased by 25.6% during the same period (0.22 vs 0.16 patients per 1000 patients).

IN PRACTICE:

“Policymakers and clinicians should continue to closely monitor trade-offs between pharmacologic and surgical management of obesity to ensure optimal access to effective obesity treatment,” the authors wrote.

SOURCE:

This study, led by Kevin Lin, Department of Health Care Policy, Harvard Medical School, Boston, was published online in JAMA Network Open.

LIMITATIONS:

The cross-sectional nature of the study may have limited the ability to establish causality between the increase in the use of GLP-1 RAs and the decline in the rates of metabolic bariatric surgery. Any variation in patient adherence to GLP-1 RAs may have led to confounding errors.