As GLP-1 Drug Use Tripled, Bariatric Surgery Rates Fell Sharply After 2023

Something shifted in the weight-loss surgery landscape around 2023. Bariatric procedure rates, which had been climbing steadily for years, began to fall - and the timing lines up precisely with the rapid adoption of GLP-1 receptor agonists like semaglutide and tirzepatide. A study in JAMA Surgery uses a national patient sample to quantify just how sharp that shift has been and to ask whether it is happening evenly across patients who might benefit from surgery.

The answer is that it is not. The decline in metabolic and bariatric surgery appears concentrated in specific subgroups - patients seeking sleeve gastrectomy rather than gastric bypass, and patients with lower body mass index among those still meeting eligibility criteria. That pattern raises a medical question worth taking seriously: are some patients who would benefit from surgery now choosing medications instead, and will that choice serve them as well in the long run?

The numbers behind the trend

The study drew on a national sample of patients eligible for metabolic and bariatric surgery and tracked prescription and procedure rates from 2018 through 2025. Semaglutide and tirzepatide prescriptions increased dramatically across the study period. Bariatric surgery rates, which had been stable or rising, declined substantially beginning in 2023 - roughly when tirzepatide (Mounjaro, later Zepbound) began reaching patients at scale and when semaglutide (Wegovy) became widely prescribed for weight management rather than just diabetes.

The decline was not uniform. Sleeve gastrectomy, which had overtaken gastric bypass as the most common bariatric procedure in the US, showed a more pronounced drop than bypass procedures. And within the eligible population, patients with lower BMI categories saw steeper declines in surgery use than those with higher BMI - suggesting that the patients with the most room for medical management may be drifting toward medications first.

What the data cannot tell us

This is a trend analysis, not an outcomes study. It documents what is happening - surgery down, GLP-1 prescriptions up - but it cannot tell us whether patients switching from surgery to medications are making the right call for their individual situations. That question will require longer follow-up data that do not yet exist at scale.

GLP-1 receptor agonists produce meaningful weight loss - typically 15 to 20 percent of body weight for semaglutide, and approaching 25 percent in some tirzepatide trials. For some patients, that is sufficient to achieve their health goals. For others - particularly those with severe obesity or obesity-related comorbidities that respond better to the metabolic changes surgery induces - medications may be a less effective option that is being chosen partly for convenience, cost, or the appeal of avoiding a major procedure.

Sleeve gastrectomy's particular prominence in the decline is worth noting. It is the simpler surgical option, less invasive than bypass and with fewer long-term nutritional consequences. It was already the procedure chosen by patients with lower severity or those more hesitant about surgery's permanence. That those patients are now most likely to choose GLP-1 drugs instead is plausible - but whether they will achieve equivalent long-term metabolic benefits is not established.

A reshaping of obesity medicine

The GLP-1 era has reshuffled obesity treatment faster than perhaps any pharmacological development since the class was first approved. The speed of the shift - from niche diabetes drug to mainstream weight management tool in roughly five years - has outpaced the ability of clinical guidelines to keep up with evidence on how to match patients to treatments.

Bariatric surgery remains more effective than any currently available medication for severe obesity, particularly for achieving remission of type 2 diabetes and for patients who need sustained very large weight losses. The question raised by this study is whether the availability of medications that are good - but perhaps not quite as good, for certain patients - is quietly diverting some of those patients away from a more appropriate treatment.

The corresponding author is Stefanie C. Rohde, MD, at Ohio State University Medical Center (stefanie.rohde@osumc.edu). The study was published in JAMA Surgery.