Dip in bariatric surgeries shows emerging ‘medical options first’ approach to weight loss
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Key takeaways:
- GLP-1 receptor agonist prescriptions for obesity treatment grew by 132.6% from 2022 to 2023.
- Clinicians should continue to monitor trade-offs being GLP-1s and surgical treatment, researchers said.
The rate of metabolic bariatric surgery decreased from 2022 to 2023, whereas the use of GLP-1 receptor agonists as anti-obesity medications grew over twofold, a research letter showed.
The increased use of GLP-1 receptor agonists, particularly for the treatment of obesity, has been well documented. One study showed that there were 1 million new GLP-1 receptor agonists users from 2011 to 2023, most of whom had a BMI of 30 kg/m2 or greater.
“Anecdotally, health systems have closed hospital-based metabolic bariatric surgery programs due to decreased demand, but empirical data on the association of increased prescribing of GLP-1 [receptor agonists] with use of metabolic bariatric surgery is unavailable, to our knowledge,” Kevin Lin, BA, from Harvard Medical School, and colleagues wrote in JAMA Network Open.
In the cross-sectional study, Lin and colleagues examined deidentified claims data from 17 million deidentified adults between 2022 and 2023.
The final analysis included only adults with obesity and without diabetes, and only GLP-1 receptor agonist prescriptions with FDA indications as anti-obesity medications.
A total of 81,092 patients received GLP-1 receptor agonists during the study period, whereas 5,173 patients underwent metabolic bariatric surgery.
Patients who underwent metabolic bariatric surgery more often had medically complex (18.8%) procedures — defined as having four or more comorbidities — compared with those prescribed GLP-1 receptor agonists (8.2%) or those with no treatment (11.1%).
Researchers reported a 132.6% increase in patients prescribed GLP-1 receptor agonists between the last 6 months of 2022 and the first 6 months of 2023.
During that period, they also noted a 25.6% decrease in patients undergoing metabolic bariatric surgery.
GLP-1 receptor agonists are effective for treating obesity and diabetes, but “the high cost and high rates of gastrointestinal adverse effects can lead to treatment cessation and subsequent weight regain,” the researchers explained.
“Further data are needed to assess whether trends in metabolic bariatric surgery use will stabilize with ongoing national shortages of GLP-1 receptor agonists,” they wrote.
Lin and colleagues added that there is still a large addressable population for obesity treatment, “with less than 6% of our study population receiving GLP-1 receptor agonists or surgery.”
There were some study limitations, which included the analysis’ cross-sectional design and possible confounding from variations in patient adherence to GLP-1 receptor agonists.
“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 researchers concluded.