Bariatric operations & GLP-1s: What to know

The ever-rising popularity of GLP-1 medications is reshaping the landscape of bariatric surgeries — but experts say patients could be overlooking key factors when choosing between the two weight loss treatments.

Interest in GLP-1s surged in late 2022, fueled by TikTok weight loss trends and free celebrity endorsements. By early 2023, surgeons from various specialties began seeing how GLP-1s were affecting their practices.

"Everybody is either on it or asking how to get on it," New York City dermatologist Paul Jarrod Frank, MD, told The New York Times. "We haven't seen a prescription drug with this much cocktail and dinner chatter since Viagra came to the market."

As Ozempic became a household name, the number of bariatric surgeries declined

Throughout 2023 and early 2024, surgeons told Becker's they were performing about 15% fewer bariatric operations. Recently, a new study confirmed this anecdotal evidence and revealed a more dramatic shift: In two years, prescriptions for GLP-1s increased by 132.6%, while bariatric surgery rates fell by 25.6%. 

In July, Norman (Okla.) Regional Health System closed its bariatric program and a weight loss clinic due to declining surgery volumes. 

Over the next decade, Vizient expects inpatient bariatric surgery rates to decrease 15%. Two trends are driving this prediction: More surgeries are shifting to the outpatient space, and more patients are opting for GLP-1s over surgery. 

While both treatments can offer similar body weight reductions, comparing cost-effectiveness is a difficult task. Upfront costs of bariatric surgeries can range from $15,000 to $23,000, whereas the average annual cost of GLP-1s is between $9,360 and $16,200. But it's unclear how long patients should take the medications. For those needing more than two years of medication, for example, surgery could have been more cost-effective. 

Early research is shedding light on these questions, which Tim Schaffner, MD, bariatric surgeon at Bon Secours in Hampton Roads, Va., previously said were the "elephant in the room."

Research led by a Northwestern Medicine team found that bariatric surgery adds two quality-adjusted life years and saves patients about $9,000 per year compared to those taking GLP-1s. Combining surgery and GLP-1s led to more benefits, with average annual savings of $7,200 and five additional quality-adjusted life years.

Joseph Sanchez, MD, the study's lead author, said GLP-1s could reach comparable cost-effectiveness if their prices dropped by about 75%.

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