Metabolic Surgery: Up, Down, or Sideways?
“Our results provide a national contemporaneous estimate of the decline in metabolic bariatric surgery associated with the era of GLP-1 RAs.” Writing in JAMA Network Open last week, Kevin Lin, Ateev Mehrotra, and Thomas Tsai say rates of metabolic surgery dropped 26% in 2023 as use of GLP-1 medicines for obesity more than doubled. Nonetheless, we have good reasons for uncertainty about future trends. Will metabolic surgery go up, down, or sideways as obesity care gains wider acceptance?
Embracing Chronic Care for a Chronic Disease
To discern where the future of metabolic surgery lies might well be impossible at the moment. For one thing, the whole world is in the early stages of totally rethinking how we view obesity. It is not easy. In the past, the simplistic view has been that bad food and bad behavior explain most or all of the problem.
But now, the science of obesity tells us this is a complex chronic disease, driven by biology in an environment that triggers the disease in more people than ever before. Nonetheless, deep-seated beliefs are slow to change. Most people still think about obesity treatment in acute terms only. Lose weight and we’re done. All fixed.
Through that lens, surgery ought to fix it. Or taking an obesity medicine for weight loss. That would be fine if obesity were just an acute condition, but it clearly is not. Surgery requires follow-up care. Obesity medicines stop working when people stop taking them.
These are obvious truths that many people implicitly deny. Change takes time, but it is coming.
The Case for Growth
So we believe there is a strong case for growth in obesity care and that includes surgical care. For one thing, surgery can be a very cost-effective approach to obesity care. Data newly published in the Journal of the American College of Surgeons makes this point. Marcus Cunningham and colleagues conclude:
“The results of this analysis demonstrate that bariatric surgery is associated with higher rate of diabetes remission and fewer long-term expenditures when compared with medical therapy in patients with obesity. Additionally, ICER values of these procedures were determined to be cost-effective.”
Reflecting on the implications of all the changes bringing progress for obesity care, Tsai tells us:
“Right now there’s just a high degree of uncertainty for what this all means in terms of bariatric surgery volume in the long term. But for patients, with all the different treatment options that now exist, this truly is a golden age. The challenge for the next few years is making sure patients are able to access them.”
Given more people seeking and getting effective care for obesity, the long-term prospects are bright. Obesity care, including metabolic surgery, is unlikely to go down or sideways. Unmet health needs favor the case for growth.
Click here for the JAMA Network Open paper and here for the paper in JACS. For further perspective, click here and here.
Circus Sideshow, painting by Georges Seurat / WikiArt
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October 28, 2024