Bariatric surgery outpaces GLP-1s in weight loss, cost savings

Editor's Note

Bariatric surgery delivers greater weight loss and lower long-term costs than GLP-1 medications, Ambulatory Surgery Center News September 18 reports. A new JAMA Surgery study of more than 30,000 patients found that surgical patients lost nearly three times as much weight as those on medication while generating meaningful savings for payers and providers.

The research, conducted by Highmark Health and based on claims and medical records from 2018 to 2023, compared outcomes for patients with class II and III obesity. Individuals who underwent metabolic bariatric procedures such as gastric bypass or sleeve gastrectomy lost an average of 28% of body weight, compared with 10% among patients prescribed GLP-1 receptor agonists.

Cost differences were also significant. Over 2 years, expenses for surgery patients were about 18% lower, nearly $12,000 less per patient, than those on GLP-1s. These patients also experienced fewer inpatient stays, fewer emergency department visits, and lower rates of obesity-related comorbidities. Researchers noted the data highlight bariatric surgery’s durability and economic value, especially as obesity rates surpass 40% of US adults and are projected to approach 50% by 2030.

Although GLP-1s remain popular, the article details their costs accumulate over time and adherence challenges may limit their effectiveness. Study authors emphasized the need for more precise tailoring of treatment earlier in the care journey to identify which patients will benefit most from surgery, medication, or a combination of both.

The article also notes ambulatory surgery centers (ASCs) are increasingly performing bariatric procedures, supported by national safety criteria and program requirements. With proper patient selection and experienced teams, ASCs have demonstrated that these operations can be performed safely on an outpatient basis. One bariatric group has already reported more than 800 successful cases in ASC settings over the past 2 years, reinforcing the potential for wider adoption.

As the popularity of GLP-1s continues, the study provides strong evidence that surgery remains a more effective and cost-efficient treatment option for many patients with severe obesity, with growing momentum for outpatient expansion.