Despite the rise of the new anti-obesity drugs known as GLP-1s, rumors surrounding the death of metabolic and bariatric surgery have been greatly exaggerated. While the number of bariatric procedures were down about 3.5% in 2023 and likely dropped further in 2024, surgery now appears to be rebounding as many GLP-1 patients turn to one-time minimally invasive surgical procedures, including sleeve gastrectomy and gastric bypass, for even more robust and durable results.
"GLP-1 medications are effective but once patients stop taking the weekly injections, the weight and the associated health problems soon return," said Ann M. Rogers, MD, MD, FACS, FASMBS, President, American Society for Metabolic and Bariatric Surgery (ASMBS), which is kicking off its three-day annual scientific meeting in the nation's capital on June 17th (June 15-17). "This is why we're seeing and hearing more and more about patients revisiting bariatric surgery or considering it for the first time. Medications will never replace surgery nor can we operate our way out of the obesity epidemic. The solution is comprehensive obesity care which considers all options or some combination to help patients safely and effectively achieve their goals."
A recent study found that most patients with overweight or obesity discontinued GLP-1 therapy within one year (53.6%), a number that grows to 72.2% by two years. Meanwhile, studies show patients may lose as much as 60% of excess weight within six months of surgery and 77% in as early as 12 months. On average, five years after surgery, patients maintain 50% of their excess weight loss.
"Traditionally, diet and exercise has been on one side of the treatment spectrum and metabolic and bariatric surgery on the other with drug treatment somewhere in between. However, given its high safety and effectiveness, metabolic and bariatric surgery and the new anti-obesity medications need earlier consideration and not be viewed as treatments of last resort only to be used when everything else has failed. The old way of trying everything short of drugs and surgery are over," said Richard M. Peterson, MD, MPH, FACS, FASMBS, President-elect, ASMBS.
Highlighted Studies at the ASMBS Annual Meeting:
- Real-world comparative effectiveness study of GLP-1s and bariatric surgery -- NYU Langone Health
- Retrospective analysis compares mental health burden after GLP-1 treatment vs. bariatric surgery -- Tulane
- Prospective study on changes in self-esteem after bariatric surgery -- Geisinger Medical Center
- Retrospective study on complication rate disparities after bariatric surgery -- Yale School of Medicine
- BMI and Complications -- How BMI may affect complication rates after bariatric surgery -- Prisma Health
According to the U.S. Centers for Disease Control and Prevention (CDC), the prevalence of obesity and severe obesity is 40.3% and 9.4%, respectively. Studies show the disease may weaken or impair the body's immune system, cause chronic inflammation and increase the risk of many other diseases and conditions including, cardiovascular disease, stroke, type 2 diabetes, and certain cancers. The most common approach to treating obesity, which the American Medical Association designated a disease more than a decade ago, has been traditional diet and exercise alone, the least effective method of weight loss for most people with obesity.
In 2023, over 270,000 people had weight-loss surgery, a mere fraction of the more than 22 million people in the U.S. with severe obesity, and as popular as the anti-obesity drugs seem to be, only about 12% of Americans say they have ever taken one, including 6% who say they are currently taking the weekly injections.
About Metabolic and Bariatric Surgery
Metabolic, bariatric, or weight-loss surgery such as gastric bypass and sleeve gastrectomy has been shown to be the most effective and long-lasting treatment for severe obesity. The operations improve or resolve diseases including type 2 diabetes, heart disease and high blood pressure and leads to significant and durable weight loss. Its safety profile is comparable to some of the safest and most commonly performed surgeries in the U.S. including gallbladder surgery, appendectomy and knee replacement.
About ASMBS
