Despite the GLP-1 craze, bariatric surgery may result in greater weight loss at significantly lower cost, according to a recently published study.
The findings strengthen the case for expanding bariatric programs in outpatient settings.
“Obesity is a heterogeneous disease,” researcher George Eid said in a podcast interview with JAMA Network. “Not everybody responds the same way; not everybody will have the same effect. Some patients will require surgery. You have a subgroup where medication probably will be sufficient, and then you have the other group, where combination therapy is the way to go.”
The study – published in JAMA Surgery – was written by authors from Highmark Health.
Researchers analyzed claims and medical records from 30,458 patients treated between 2018 and 2023. That analysis compared outcomes for individuals with class II and class III obesity who underwent metabolic bariatric surgery, such as gastric bypass or sleeve gastrectomy, against those prescribed GLP-1 receptor agonists.
Surgery patients lost nearly 3 times as much weight as their counterparts on medication, averaging a 28% weight loss compared with 10% for those on GLP-1s, researchers found.
Costs were also about 18% lower over two years, or nearly $12,000 per patient. Bariatric surgery patients had 25% fewer inpatient stays, 38% fewer emergency department visits and lower rates of obesity-related comorbidities, researchers wrote.
“This study provides evidence on the long-term effectiveness and cost-efficiency of bariatric surgery compared to weight management medication for severe obesity,” researcher Tyson Barrett said on the podcast. “Our findings highlight the potential for bariatric surgery to offer a more durable and economically sound solution for this patient population.”
Obesity rates have exceeded 40% of U.S. adults in recent years, with projections expected to climb toward 50% by 2030, researchers wrote. And while GLP-1 medications remain popular, their costs accumulate over time and adherence challenges can limit outcomes.
Future research should focus on tailoring treatment earlier in the care journey, Barrett said.
“What I’m most interested in is understanding if we can better predict who can benefit from what early on,” he said. “Ultimately, we would love to find that treatment as early as possible in an informed, evidence-based way that allows us to really find the most effective, quick, most cost-effective ways of helping these patients recover and ultimately become healthier.”
Outpatient facilities have already shown that with proper patient selection and team experience, bariatric procedures can be performed safely and efficiently in ambulatory surgery centers (ASCs).
While hospitals remain the primary site for bariatric surgery, surgery centers have steadily expanded access, offering same-day discharge, lower costs and a better patient experience.
Dr. Nikhilesh R. Sekhar, medical director of the Bariatric and Specialty Surgery Center of Stamford, part of the New York Bariatric Group, told ASC News last year that his group has successfully performed over 800 of these procedures in ASCs for the last two years.
“We have robust experience and know that [these surgeries are] safe,” Sekhar said. “We have criteria established nationally by the Metabolic and Bariatric Surgery and Quality Improvement Program (MBFAQIP). They have strict requirements for what can be done in the surgery center which we follow. It is all rational, justifiable rules that ensure safety.”
