US bariatric surgery procedures fall below 200,000 for first time since 2020

The number of metabolic and bariatric surgery procedures in the United States dropped below 200,000 in 2024 for the first time since 2020, a more than 20% decline from the prior year, according to research ‘‘Examining trends in the decline of bariatric surgery – an MBSAQIP analysis (Abstract ID: 4730)’, presented at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery.

Tyler Cohn

“After years of steady growth, the number of metabolic and bariatric procedures in the U.S. is experiencing a decline amid persistently high obesity rates and a surge in the use of GLP-1 medications,” said lead study author, Dr Tyler Cohn, Associate Professor at Loyola University Medical Center. “While we did not study causation, the concern is that many patients are selecting non-surgical therapies for obesity without fully understanding all of their available options. Millions more are living with obesity and are not receiving treatment at all.”

Researchers from Loyola University in Chicago based their 2020-2024 estimates after review of the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP) database, which includes reported outcomes from all MBSAQIP-accredited bariatric centers.

Beyond the overall recent decline, the study found meaningful shifts in the types of operations being performed. Between 2020 and 2024, sleeve gastrectomy, long the dominant procedure, fell from 64% of all surgeries to 58%. Gastric bypass increased from 28.44% to 32.82%, its highest share of procedures in five years. Conversions (revisions or modifications of prior surgeries) rose from about 9% in 2020 to 11% in 2024.

Other bariatric procedures -- including gastric banding, biliopancreatic diversion with duodenal switch (BPD/DS), single anastomosis duodeno-ileal bypass (SADI) and one anastomosis gastric bypass (OAGB) -- each accounted for less than 2% of procedures.

“GLP-1s are starting a conversation in doctors’ offices that really wasn’t happening as much as it should have been,” said Dr Richard M Peterson, President, ASMBS and Professor of Surgery at UT Health San Antonio, who was not involved in the study. “The high demand for these drugs and greater attention on the dangers of obesity has created an unprecedented opportunity to educate and engage patients on all proven treatments, not just medications, which is essential to effectively treating this chronic disease.”