PeptideJournal
News12 min read

The GLP-1 Effect on Bariatric Surgery Rates

In 2022, bariatric surgery programs across the United States hit record volumes — 280,000 procedures, the culmination of a decade of steady growth. Two years later, national data showed a 38% decline. The University of Pennsylvania Health System went from 850 annual surgeries to around 400.

In 2022, bariatric surgery programs across the United States hit record volumes — 280,000 procedures, the culmination of a decade of steady growth. Two years later, national data showed a 38% decline. The University of Pennsylvania Health System went from 850 annual surgeries to around 400. Independence Blue Cross saw its bariatric surgery claims cut in half. A hospital in Oklahoma shut down its entire bariatric program.

The cause was not a medical breakthrough that made surgery unnecessary. It was a pharmaceutical one: GLP-1 receptor agonists like Wegovy and Zepbound had arrived, and millions of patients who might have considered surgery were choosing injections instead. But the head-to-head data tells a more complicated story than the headlines suggest — one where surgery still wins on raw weight loss, drugs win on accessibility, and the real future probably lies in using both.

Table of Contents

The Numbers: Tracking the Decline

The trajectory is stark. Bariatric surgery volumes in the United States grew steadily from 158,000 procedures in 2011 to 280,000 in 2022, according to the American Society for Metabolic and Bariatric Surgery (ASMBS). For many surgical programs, 2022 was a record year — boosted partly by pent-up demand from the COVID-19 pandemic, when elective surgeries had been paused.

Then the GLP-1 wave hit.

A Mass General Brigham study analyzing health insurance data from over 17 million Americans found that between 2022 and 2023, GLP-1 prescriptions for obesity more than doubled while bariatric surgery rates dropped significantly. By September 2024, national data from Strata Decision Technology showed a 38% decline in bariatric surgeries from the beginning of the year.

The decline was not distributed evenly. Some programs lost half their volume in two years. Others held steady or grew. The patients driving the biggest drop were a specific subgroup: those who had previously undergone bariatric surgery, regained weight, and would have returned for revision procedures. These patients were now turning to GLP-1 agonists instead.

Hospital Programs Closing

The financial consequences were immediate. The bariatric surgery department at Norman Regional Hospital in Oklahoma shut down in summer 2024, citing declining profitability after anti-obesity medication introduction. Staff were laid off, procedures canceled, patients left without continuity of care.

Tower Health's Reading Hospital in Pennsylvania closed its bariatric program. At the University of Pennsylvania Health System's three Philadelphia hospitals, annual bariatric surgeries fell from a peak of 850 to around 400. When Penn Presbyterian's bariatric surgeon retired, the hospital didn't replace him.

At the American College of Surgeons Clinical Congress in 2025, bariatric surgeons discussed how to sustain their specialty in what they now formally called "the GLP-1 era."

Head-to-Head: Surgery vs. GLP-1 Agonists

The comparison between surgery and GLP-1 drugs is one of the most important questions in obesity medicine. Multiple studies in 2024 and 2025 have provided direct head-to-head data.

The NYU Langone / ASMBS Study (2025)

The most-cited comparison came from NYU Langone Health and the ASMBS. In this real-world analysis, sleeve gastrectomy and gastric bypass were associated with approximately five times more weight loss than weekly GLP-1 injections at two years:

  • Surgery patients: 58 pounds average loss (24% of total weight)
  • GLP-1 patients: 12 pounds average loss (4.7% of total weight)

Even patients who maintained continuous GLP-1 therapy for a full year lost only about 7% of total weight — still substantially less than surgery.

These real-world numbers differ sharply from clinical trial data, where semaglutide users lost 15-17% of body weight and tirzepatide users lost up to 21%. The gap reflects the difference between closely monitored trial participants and everyday patients dealing with adherence challenges, dose titration issues, insurance interruptions, and side effects.

The JAMA Surgery Cohort (2025)

A JAMA Network Open analysis of 30,458 patients — 14,101 who underwent metabolic bariatric surgery and 16,357 who filled GLP-1 prescriptions for at least one year — provided additional data on the comparison. The study confirmed that metabolic bariatric surgery remains the most effective treatment for Class II and III obesity, while acknowledging that GLP-1 receptor agonists have "recently shown promising results."

Network Meta-Analysis

A network meta-analysis published in Obesity synthesized data from randomized controlled trials comparing metabolic/bariatric surgery with GLP-1 receptor agonists. The analysis confirmed surgery's superiority for total weight loss, though it noted that the drugs' risk profile and non-invasive nature made them appropriate for patients who don't qualify for or don't want surgery.

The Clinical Trial vs. Real-World Gap

Understanding this gap is important. In the STEP trials, semaglutide 2.4 mg produced average weight loss of 15-17%. In the SURMOUNT trials, tirzepatide at highest doses produced up to 22.5% weight loss. These numbers led to enormous public excitement and the widespread perception that "Ozempic works as well as surgery."

The real-world data tells a different story. As the ASMBS study showed, typical GLP-1 patients lose far less than trial participants. The reasons include lower adherence rates, dose reductions due to side effects, insurance coverage gaps, and the gap between motivated trial volunteers and the general patient population. For a detailed comparison of these drugs, see our semaglutide vs. tirzepatide guide.

Which Patients Benefit from Each Approach

The surgery-vs-drugs framing obscures a more useful question: which approach works best for which patients?

When Surgery Is the Better Option

Class III obesity (BMI > 40) or Class II with comorbidities: Surgery delivers the greatest benefit for patients at the highest BMI levels. The weight loss magnitude — 25-35% of total body weight with gastric bypass — exceeds what any current medication achieves, and the metabolic benefits (diabetes remission, cardiovascular risk reduction) are well-documented over 10+ year follow-up periods.

Patients who need rapid, definitive metabolic improvement: For patients with severe type 2 diabetes, surgery can produce diabetes remission within days — before significant weight loss occurs — through changes in gut hormone signaling and nutrient routing.

Patients who have failed medications: For those who've tried GLP-1 agonists and not achieved adequate weight loss, surgery remains the escalation option with the highest probability of success.

When GLP-1 Drugs Are the Better Option

Moderate obesity (BMI 27-35): Patients in this range may achieve clinically meaningful weight loss with GLP-1 agonists without the risks and irreversibility of surgery.

Patients unwilling or unable to undergo surgery: Many patients refuse surgery due to fear, cultural factors, or practical barriers. GLP-1 agonists provide an effective alternative with a fundamentally different risk profile.

Patients with contraindications to surgery: Some patients have surgical risks that make bariatric procedures inadvisable. GLP-1 agonists offer a pharmacological path that avoids these risks.

Post-surgical weight regain: Patients who've had bariatric surgery and regained weight are increasingly successful candidates for GLP-1 therapy, which addresses one of the key drivers of the surgical volume decline.

The Complementary Use Case

The most sophisticated view — and the one gaining traction among obesity medicine specialists — is that surgery and GLP-1 drugs are not competitors but complementary tools in a chronic disease management toolkit.

The Cancer Treatment Model

At the 2025 ACS Clinical Congress, bariatric surgeons advocated for what they called a "cancer model" of obesity treatment — multimodal care involving surgery preceded and/or followed by medication. In oncology, surgery, chemotherapy, radiation, and immunotherapy are routinely combined based on the individual patient's needs. Obesity medicine is moving toward the same paradigm.

Pre-Surgical GLP-1 Use

GLP-1 agonists before surgery can reduce liver volume and visceral fat, making the procedure technically easier and potentially safer. Some surgeons are now prescribing pre-operative GLP-1 courses as standard practice.

Post-Surgical GLP-1 Use

For patients who experience weight regain after surgery — estimated at 20-30% of patients at 5 years — GLP-1 agonists can help maintain or extend surgical weight loss. This combination approach may produce the best long-term outcomes of either treatment alone.

Safety Considerations for Combined Use

One important caution: GLP-1 agonists slow gastric emptying, which creates anesthesia safety concerns. A study found that residual gastric contents are 16.5 times more likely in patients using semaglutide who also have digestive symptoms. This has led some institutions to require GLP-1 discontinuation before surgery and to modify pre-operative fasting protocols.

Long-Term Outcomes: The Data We Have and Don't Have

Surgery: Decades of Follow-Up

Bariatric surgery has the advantage of long-term outcome data. Studies with 10-20 year follow-up show sustained weight loss, durable diabetes remission, reduced cardiovascular events, and in some studies, reduced all-cause mortality. The Swedish Obese Subjects (SOS) study, with over 20 years of data, remains the landmark reference.

GLP-1 Drugs: The Weight Regain Problem

The biggest concern with GLP-1 agonists is durability. Stopping these medications leads to significant weight regain, according to a large-scale analysis of 11 global studies. The STEP 1 extension data showed that patients who discontinued semaglutide regained approximately two-thirds of their lost weight within a year.

This creates a fundamentally different treatment model. Surgery is a one-time intervention (with potential revisions) that produces lasting anatomical changes. GLP-1 therapy is a chronic medication that must be continued indefinitely to maintain effect. The lifetime cost implications of this difference are enormous.

Cardiovascular Outcomes

The SELECT trial established semaglutide's cardiovascular benefit — a 20% reduction in major adverse cardiovascular events in patients with obesity but without diabetes. Bariatric surgery has similar cardiovascular data from observational studies. What we lack is a randomized trial directly comparing long-term cardiovascular outcomes between surgery and GLP-1 drugs. Such a trial would be logistically difficult but enormously valuable.

The Economic Argument

Cost analysis increasingly favors surgery over long-term GLP-1 use.

Researchers from the University of South Florida found that the cost of ongoing GLP-1 drugs like Wegovy surpasses bariatric surgery costs in 9-12 months. A Northwestern University analysis found that bariatric surgery delivered two more healthy years of life and saved approximately $9,000 per year compared to GLP-1 drugs.

At list prices, Wegovy cost roughly $1,300/month before recent discount programs. Annual cost: approximately $15,600. Bariatric surgery costs $20,000-35,000 depending on procedure type and location. By the second year, surgery is the cheaper option — and the gap widens every subsequent year.

Recent pricing changes are shifting this calculus somewhat. The FDA approved oral Wegovy (semaglutide 25 mg tablets) with an expected price of $149/month. Medicare negotiated prices of $245/month for injectable GLP-1 agonists. These lower price points extend the break-even timeline but don't eliminate surgery's long-term cost advantage, since GLP-1 therapy is lifelong.

The Surgical Infrastructure at Risk

Perhaps the most concerning dimension of the GLP-1 surgery shift is capacity erosion. Only about 1% of patients eligible for bariatric surgery actually receive it. If surgical programs close due to declining volumes, that number could drop further.

Many bariatric programs require a minimum case volume to maintain accreditation, keep surgeons' skills sharp, and remain financially viable. Programs that drop below these thresholds may close — and rebuilding surgical capacity is far harder than preserving it.

As one surgeon noted at the ACS congress: "There are a lot of financial headwinds, and where surgical programs may not be able to wait this out long enough, it has the potential to create further imbalance."

Some hospital leaders expect volumes to rebound within 3-5 years as the cost of widespread GLP-1 use proves prohibitive and the weight regain problem becomes more apparent. Others are less optimistic, particularly at smaller institutions without the financial reserves to weather a multi-year downturn.

The Medicare/Medicaid population presents a specific concern. Few studies have compared long-term outcomes of GLP-1 agonists versus surgery in these patients, who represent the largest payer group in the US and face different access barriers than commercially insured populations.

Next-Generation Drugs and the Evolving Calculus

The competitive landscape between surgery and medications is not static. Next-generation drugs promise even greater weight loss, potentially closing the gap with surgery.

Cagrilintide + semaglutide: An amylin analog combined with semaglutide showed 20.4% body weight reduction in a 2025 NEJM study — approaching surgical territory for some patients.

Retatrutide: The triple agonist (GIP/GLP-1/glucagon) produced up to 24.2% weight loss in Phase 2, with Phase 3 results expected in 2025-2026.

Orforglipron: The first oral small-molecule GLP-1 agonist, which could dramatically improve adherence and access by eliminating injections.

Survodutide: A dual GLP-1/glucagon agonist with promising weight loss and NASH data.

Each increment in pharmaceutical weight loss narrows the gap with surgery and potentially shifts more patients toward the medication pathway. If a future drug consistently produces 25-30% weight loss — comparable to sleeve gastrectomy — the calculus changes substantially.

But weight loss magnitude isn't the only variable. Surgery's metabolic effects go beyond weight — gut hormone changes, bile acid alterations, microbiome shifts — and may provide benefits that even high-efficacy drugs can't replicate. The question of whether pharmacological weight loss produces the same metabolic benefits as surgical weight loss, pound for pound, remains open.

FAQ

Are GLP-1 drugs replacing bariatric surgery?

Partially, yes. National bariatric surgery volumes declined 38% in 2024, with some programs closing entirely. However, surgery is not disappearing. It remains the most effective treatment for severe obesity, and many experts predict volumes will stabilize or rebound as the limitations of long-term GLP-1 use — including weight regain after discontinuation and ongoing costs — become more apparent.

How does weight loss compare between surgery and GLP-1 drugs?

In real-world data, surgery produces roughly five times more weight loss than GLP-1 agonists. A 2025 study found surgery patients lost an average of 58 pounds (24% of body weight) versus 12 pounds (4.7%) for GLP-1 patients at two years. Clinical trial data for GLP-1 drugs shows better results (15-22% weight loss) than real-world data, but still less than typical surgical outcomes.

What happens when people stop taking GLP-1 drugs?

Most patients regain a significant portion of lost weight. STEP 1 extension data showed approximately two-thirds of weight loss was regained within one year of stopping semaglutide. This means GLP-1 therapy is effectively a lifelong commitment — unlike surgery, which produces lasting anatomical changes.

Is it safe to take GLP-1 drugs before or after bariatric surgery?

GLP-1 drugs before surgery can reduce liver size and make the procedure easier, though they slow gastric emptying, which requires modified pre-operative fasting protocols. After surgery, GLP-1 drugs can help manage weight regain. However, the combination requires coordination between surgical and medical teams to manage safety considerations, particularly around anesthesia.

Which is more cost-effective long-term?

At list prices, surgery becomes cheaper than continuous GLP-1 therapy within 9-12 months and saves approximately $9,000/year thereafter according to one analysis. Recent price reductions for GLP-1 drugs extend this break-even point but don't eliminate surgery's long-term cost advantage, since medications must be continued indefinitely.

The Bottom Line

The GLP-1 revolution has done something no previous weight-loss drug managed: it has genuinely competed with bariatric surgery for patients. The 38% decline in surgical volumes and the closure of hospital programs are real, consequential changes to the obesity treatment landscape.

But the head-to-head data is clear. Surgery produces substantially greater weight loss — five times more in real-world comparisons. It has decades of long-term outcome data. And it doesn't require lifelong medication adherence.

GLP-1 drugs have genuine advantages too: lower upfront risk, no surgery required, easier access, and a rapidly improving efficacy trajectory as next-generation drugs enter the market.

The smartest approach — and the one most obesity medicine experts are converging toward — is combining both. Pre-surgical GLP-1 use to optimize patients for surgery. Post-surgical GLP-1 use to prevent regain. Surgery for those who need maximum weight loss. Medications for those who need a less invasive option. The "cancer model" of multimodal, individualized treatment planning applied to a chronic metabolic disease.

The real risk isn't that GLP-1 drugs replace surgery. It's that surgical capacity erodes during this transition period, leaving fewer options for the patients who need them most. Preserving that capacity — while integrating pharmaceutical and surgical approaches into a coherent treatment framework — is the challenge the field faces now.

References

  1. American Society for Metabolic and Bariatric Surgery. "Estimate of Bariatric Surgery Numbers, 2011-2023." ASMBS

  2. ASMBS. "Head-to-head Study Shows Bariatric Surgery Superior to GLP-1 Drugs for Weight Loss." January 2026. ASMBS

  3. Arterburn DE, et al. "Metabolic Bariatric Surgery in the Era of GLP-1 Receptor Agonists for Obesity Management." JAMA Network Open. 2024;7(11):e2443502. JAMA

  4. Sabatella L, et al. "Comparative Efficacy of Metabolic/Bariatric Surgery Versus GLP-1 Receptor Agonists: A Network Meta-Analysis of Randomized Controlled Trials." Obesity. 2025. Wiley

  5. Afolabi M, et al. "Obesity Treatment With Bariatric Surgery vs GLP-1 Receptor Agonists." JAMA Surgery. 2025. PubMed

  6. Harvard T.H. Chan School of Public Health. "Rise in obesity drug use linked with decrease in weight-loss surgery." October 2024. Harvard

  7. Mass General Brigham. "Study Finds Bariatric Surgery Declined with Rise in GLP-1 Drugs to Treat Obesity." October 2024. Mass General Brigham

  8. Bannon E. "Bariatric surgery rates plunge as patients turn to GLP-1 drugs." STAT News. October 2024. STAT

  9. American College of Surgeons. "Bariatric Surgeons Consider Sustainability of Bariatric Surgery in GLP-1 Era." ACS Clinical Congress 2025. ACS

  10. American College of Surgeons. "Are Anti-Obesity Medications Changing Bariatric Surgery?" ACS Bulletin. April 2025. ACS

  11. Dhanvijay SC, et al. "Bariatric surgery vs. GLP-1 receptor agonists among primarily Medicare and Medicaid patients with diabetes: a 3-year analysis." Surgery for Obesity and Related Diseases. 2025. PubMed