Trends for metabolic and bariatric surgery are still wobbly as GLP-1 utilization continues to grow. This much is quite clear from a new research letter in JAMA Surgery. What is less clear is any consensus on where the trends will go as health systems and people living with obesity confront the reality of obesity as a complex and chronic disease – one which will be a key factor in population health for some time to come.
An Unsolved Problem
The authors of this letter, in dense academic parlance, point to the problem we have yet to solve:
“Developing evidence-based, patient-centered, multimodal pathways that integrate pharmacological and surgical approaches is essential because MBS remains the most effective and durable treatment for severe obesity, and reduced use may delay definitive care for advanced metabolic disease.”
In plain English, we need to get over simplistic either/or thinking about surgery and medicines for obesity. To get this disease under control requires long-term care, using every tool we can muster.
Trends Through 2025
This latest publication gives is the most current view of trends in GLP-1 and metabolic surgery we have.
Stefanie Rohde and colleagues used national electronic health record data from the Epic Cosmos database. They researchers conducted a retrospective cross-sectional analysis of adults eligible for metabolic and bariatric surgery (BMI ≥40 or ≥35 with comorbidities) from 2018 to 2025. Prescriptions for GLP-1–based drugs – especially semaglutide and tirzepatide – rose sharply, reaching 24% of eligible patients by 2025. Meanwhile, metabolic and bariatric surgery peaked in 2022 and then fell by 46% through 2025.
Declines occurred across diabetes and BMI categories, though least among those with the highest BMI. In short, as effective medicines spread rapidly, use of surgery among eligible patients dropped substantially.
Confronting Reality
The reality that health systems and persons living with obesity must confront is this: dealing with obesity is more like a marathon than a sprint. Losing weight does not solve the problem. Pretending otherwise simply invites the problem to return and do more damage to a person’s health.
We had to get over this kind of thinking in much the same way. We can remember when people would have surgery for cancer and hear afterward, “we got it all.” But just as that was untrue, it is untrue to think that losing weight is the answer to the metabolic disease of obesity.
In reality, we have good tools now. This does not have to be hard. But everyone needs to take the long view and plan on making good use of every tool we have, starting when the symptoms of this chronic disease first appear. Those who confront it will live longer, healthier lives. Denial will serve no one well.
Click here for the research letter in JAMA Surgery, here and here for more about it. For further perspective, click here.
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