GLP-1 use surges as surgery rates drop for severe obesity

Drawing on electronic health records from nearly 20 million patients with severe obesity, researchers from University of California San Diego find that GLP-1 prescriptions have grown exponentially -- from less than 4,600 prescriptions in 2018 to more than 1.4 million in 2025 -- according to a new real-world analysis presented today at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery (#ASMBS2026).

Bariatric surgery procedures rose much more gradually from just under 20,000 procedures in 2018 to almost 43,000 in 2023, before dropping for the first time in 2024 and 2025 to under 40,000. Meanwhile, the share of people receiving no treatment for obesity remained between 90% to 95%. Only patients with severe obesity and no diabetes were included in the study, which extracted 2018-2025 data from the Epic Cosmos database.

The most unexpected signal is that the decline in surgery may be concentrated among patients with the highest degrees of obesity and disease severity. This raises a question of whether patients who stand to benefit most from surgery may be the ones most likely to forgo it in favor of GLP-1s. It could also mean that for some, the medications may be a bridge to a future surgery. But the bigger picture we must grapple with is the fact that these treatments are only reaching a fraction of the population that could benefit."

Jeffery Reeves, MD, lead study author, assistant professor of surgery and medicine, UC San Diego School of Medicine

In the study, bariatric surgery utilization rates rose gradually from 0.03% in 2018 to 0.24% in 2023 and then dropped to roughly 0.21% in 2024 and 2025, the sharpest decline since the introduction of the new GLP-1 agonists. In contrast, GLP-1 use increased from 0.03% to 5.3% in the span of seven years.

"Undertreatment of obesity in the U.S. is well-known, but seeing the magnitude in this database is striking – tens of millions untreated despite multiple effective therapies," said study co-author Ruth Laverde, MD, UC San Diego School of Medicine.

According to the ASMBS, less than 1% of those eligible for weight-loss surgery currently have it in any given year. More than 270,000 bariatric surgeries were performed in the U.S. in 2023, the latest estimates available. ASMBS procedure estimates are based on broader patient populations and additional datasets than used in this particular study, i.e. patients with both diabetes and severe obesity within a specific electronic health record.

"While it's encouraging to see more patients accessing GLP-1s and concerning that less are opting for surgery, this study exposes an even bigger issue – most people with severe obesity remain untreated," said Richard M. Peterson, MD, FASMBS, MPH, President, ASMBS and Professor of Surgery at UT Health San Antonio in Texas, who was not involved in the study. "Barriers including insurance coverage, access to care, affordability and stigma are likely driving the gap, which can only be closed by exposing patients to the entire continuum of obesity treatment.".