The rapid adoption of GLP-1 medications for weight loss has triggered a significant shift in obesity treatment approaches, with bariatric surgeries declining by 25.6% as prescriptions for these medications more than doubled between 2022 and 2023, according to new research from Harvard Medical School.
A team led by Dr. Thomas Tsai, assistant professor of surgery at Harvard Medical School, analyzed medical records of over 17 million Americans with private insurance or Medicare Advantage who were obese but non-diabetic. Their findings revealed that while GLP-1 medication prescriptions surged by 132.6% during the study period, the number of patients undergoing metabolic bariatric surgery decreased substantially.
"Anecdotally, health systems have closed hospital-based metabolic bariatric surgery programs due to decreased demand," the researchers noted in their study published in JAMA Network Open on October 25, 2024.
GLP-1 Medications Driving Obesity Rate Decline
In a related development, U.S. obesity rates have fallen for the first time in a decade, coinciding with the increasing popularity of GLP-1 medications. Research led by Benjamin Rader, assistant professor of anesthesia at Harvard Medical School, found that the national obesity rate decreased from 46.2% in 2021 to 45.6% in 2023.
The study, which analyzed data from nearly 17 million adults and included 48 million BMI measurements, revealed that average adult BMI in the United States declined to 30.21 in 2023 after steadily rising from 29.65 in 2013 to 30.24 in 2022.
"The most notable decrease [in obesity] was in the South, which had the highest observed dispensing rate for GLP-1 medications," Rader's team reported in JAMA Health Forum on December 13, 2024.
Mechanism and Effectiveness of GLP-1 Medications
GLP-1 medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) work by mimicking a hormone in the intestine that helps create a feeling of fullness, leading to reduced food intake and significant weight loss for many patients.
Since the FDA approved Wegovy in mid-2021 as the first GLP-1 medication specifically for weight loss, sales of these drugs have soared. Their effectiveness in helping patients lose weight without surgery has made them an attractive alternative to bariatric procedures, which were previously one of the main options for significant weight reduction in obese individuals.
Challenges and Future Outlook
Despite their growing popularity, GLP-1 medications face several challenges that may influence their long-term impact on obesity treatment patterns. Tsai and colleagues pointed out that "high cost and high rates of gastrointestinal adverse effects can lead to treatment cessation and subsequent weight regain."
Supply constraints have also been a significant issue, with demand often outstripping manufacturing capacity. "It's possible that the number of weight-loss surgery patients may rise again if ongoing national shortages of GLP-1s continue," the researchers suggested.
Healthcare experts emphasize the importance of monitoring these trends to ensure optimal access to effective obesity treatments. "Policymakers and clinicians should continue to closely monitor trade-offs between pharmacologic and surgical management of obesity," Tsai's team recommended.
Demographic Patterns in Obesity Reduction
The decline in obesity rates showed interesting demographic patterns. Rader's research found that reductions were steepest in the South and among older adults aged 66 to 75. Women also experienced more significant decreases in obesity rates compared to men.
While researchers caution against definitively attributing the obesity rate decline solely to GLP-1 medications—noting that pandemic effects may have played a role, particularly in the South where COVID-19 was more often fatal for obese individuals—the correlation is noteworthy.
"While obesity remains a considerable public health concern, the observed reductions in obesity prevalence suggest an encouraging reversal from long-standing prior increases," Rader and his team concluded.
As the landscape of obesity treatment continues to evolve, healthcare providers and patients now have more options to consider, with both pharmacological and surgical approaches offering different benefits and limitations. The ongoing monitoring of these trends will be crucial for developing effective strategies to address the obesity epidemic in the United States.
