Rise in GLP-1 treatment for bariatric surgery-eligible patients

According to researcher from Ohio State University Wexner Medical Center in Columbus, prescription for patients who were eligible for metabolic and bariatric surgery (MBS) for glucagon-like peptide-1 receptor agonist (GLP-1 RA) increased from 2018 to 2025, while MBS use decreased beginning in 2023.

“To our knowledge, this is the first study to provide evidence that trends in MBS use have not yet stabilised through quarter 3 of 2025,” the researchers noted. “Stratification by procedure type and BMI category suggests that recent shifts in MBS use may be more pronounced in certain patient subgroups (eg, those seeking sleeve gastrectomy or with lower BMIs).”

The researchers conducted a retrospective, cross-sectional analysis to examine trends in the use of GLP-1 and MBS from 2018 to 2025. Across all years and quarters, the MBS-eligible cohort included 31,684,807 unique patients. The median age was 55 years (IQR, 41-66 years), 60.0% were female, 30.0% had type 2 diabetes, and the median BMI was 40.7 (IQR, 37.4-44.8).

Among MBS-eligible patients, prescription prevalence rates increased rapidly from 0.22% in quarter 4 of 2018 to 24.17% in quarter 3 of 2025. Apart from the pandemic-related decrease in the second quarter of 2020, use of MBS steadily increased to a peak of 0.17% in the fourth quarter of 2022 and subsequently declined to 0.11% in the fourth quarter of 2024 and to 0.09% in the third quarter of 2025, representing a 46.4% decrease in overall MBS use in eligible patients over three years. This decline was more pronounced for sleeve gastrectomy (50.1%) than Roux-en-Y gastric bypass (44.3%). Similar declines in MBS use were observed since 2022 when stratified by diabetes status. When stratified by BMI, use of MBS declined least in patients with a BMI of 55 or greater (decreased by 35.0% vs by 40.7%-49.8% for lower BMI categories).

"Developing evidence-based, patient-centred, multimodal pathways that integrate pharmacological and surgical approaches is essential because MBS remains the most effective and durable treatment for severe obesity, and reduced use may delay definitive care for advanced metabolic disease," the authors noted.

The findings were reported in the paper, 'Trends in Metabolic and Bariatric Surgery Use During the GLP-1 Receptor Agonist Era’, published in JAMA Surgery. To access the researcher letter, please click here