Introduction The introduction of second-generation GLP-1 receptor agonists such as semaglutide and tirzepatide has transformed obesity treatment. These medications produce substantial weight loss and metabolic improvements, approaching outcomes traditionally achieved with metabolic and bariatric surgery (MBS).
Introduction
The introduction of second-generation GLP-1 receptor agonists such as semaglutide and tirzepatide has transformed obesity treatment. These medications produce substantial weight loss and metabolic improvements, approaching outcomes traditionally achieved with metabolic and bariatric surgery (MBS). With their rapid adoption in clinical practice, questions have emerged regarding whether the increasing use of GLP-1 therapies is influencing the utilisation of bariatric surgery.
Summary
This large population-level study analysed electronic health record data from Epic Cosmos, including over 31 million patients eligible for bariatric surgery between 2017 and 2025. Researchers examined trends in prescriptions of GLP-1 receptor agonists and the rate of bariatric surgery among eligible patients.
Key findings include:
GLP-1 prescription rates increased dramatically, from 0.22% in late 2018 to 24.17% by mid-2025.
Bariatric surgery rates initially increased, peaking in 2022, but declined sharply afterwards.
By 2025, MBS use had fallen by 46.4% compared with 2022 levels.
The decline was more pronounced for sleeve gastrectomy than for Roux-en-Y gastric bypass.
Surgery rates declined across patient groups regardless of diabetes status, though the decline was less pronounced in patients with a BMI ≥55.
Despite the rise in pharmacologic therapy, 75.8% of surgery-eligible patients received neither GLP-1 therapy nor bariatric surgery, suggesting significant undertreatment of severe obesity.
Key Message
The rapid adoption of GLP-1 receptor agonists is associated with a decline in bariatric surgery utilisation, signalling a shift in obesity management. However, because bariatric surgery remains the most durable treatment for severe obesity, future care pathways will likely require integrated pharmacologic and surgical strategies tailored to patient needs.
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