New anti-obesity drugs reduces weight-loss surgery numbers

In 2022–2023, the researchers found people diagnosed with obesity without diabetes using a nationwide sample of medical insurance claims data from over 17 million persons with private insurance.

According to a recent study that looked at a sizable sample of obese individuals with private insurance, the use of anti-obesity treatments like Ozempic and Wegovy more than quadrupled between 2022 and 2023. The number of patients receiving metabolic bariatric surgery to manage obesity decreased by 25.6% throughout that time frame.

Researchers from Brigham and Women’s Hospital, the Brown School of Public Health, and the Harvard T.H. Chan School of Public Health collaborated on the study, which was published in JAMA Network Open.

Our study provides one of the first national estimates of the decline in utilization of bariatric metabolic surgery among privately insured patients corresponding to the rising use of blockbuster GLP-1 RA drugs.

Thomas C. Tsai

In 2022–2023, the researchers found people diagnosed with obesity without diabetes using a nationwide sample of medical insurance claims data from over 17 million persons with private insurance. Glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, were used by 132.6 percent more patients during the study period from the last six months of 2022 to the last six months of 2023 (from 1.89 to 4.41 patients per 1,000 patients), according to the study. At the same time, the number of bariatric metabolic surgical procedures decreased by 25.6% (from 0.22 to 0.16 patients per 1,000 patients).

94.7 percent of the obese individuals in the sample did not get any kind of therapy throughout the research period, whereas 0.3 percent had surgery and 5 percent were given GLP-1 RAs. Patients who had surgery tended to have more complicated medical conditions than those who were taking GLP-1 RAs.

For now, metabolic bariatric surgery remains the most effective and durable treatment for obesity. National efforts should focus on improving access to obesity treatment — whether pharmacologic or surgical to ensure patients can receive optimal care,

Thomas C. Tsai

Tsai points out that although GLP-1 RAs are useful in treating obesity and associated diseases (such diabetes), their use has been restricted by their high price, scarcity, and gastrointestinal adverse effects, which can cause patients to stop taking them and subsequently gain weight.

As patients with obesity increasingly rely on GLP-1s instead of surgical intervention, further research is needed to assess the impact of this shift from surgical to pharmacologic treatment of obesity on long-term patient outcomes,

With the national decline in utilization of metabolic bariatric surgery and potential closure of bariatric surgery programs, there is a concern that access to comprehensive multidisciplinary treatment of obesity involving pharmacologic, endoscopic, or surgical interventions may become more limited.

Thomas C. Tsai

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These results also highlight an opportunity to further expand uptake of surgical and pharmacologic treatments for obesity and related comorbidities,

Metabolic bariatric surgery and GLP-1 RAs are both effective interventions for patients with obesity, yet less than 6 percent of patients in our study received either form of treatment.

Ateev Mehrotra

In light of these findings, the authors advise physicians and legislators to keep an eye on access to efficient obesity treatment in the face of a quickly changing treatment environment. Furthermore, further study is required to comprehend the trade-offs between treating obesity with increasingly common GLP-1 RAs and surgical surgery.


Source: The Harvard Gazette

Journal Reference: Lin, Kevin et al. “Metabolic Bariatric Surgery in the Era of GLP-1 Receptor Agonists for Obesity Management.” JAMA network open vol. 7,10 e2441380. 1 Oct. 2024, DOI: 10.1001/jamanetworkopen.2024.41380.


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