A recent study has looked into a large group of privately insured individuals with obesity and discovered that the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management more than doubled from 2022 to 2023.
This study, conducted by researchers at Brigham and Women’s Hospital, a key member of the Mass General Brigham healthcare system, in partnership with scholars from Harvard T.H. Chan School of Public Health and the Brown School of Public Health, analyzed data from a significant population of privately insured patients dealing with obesity. The findings revealed that the adoption of GLP-1 RAs for anti-obesity treatment surged, increasing more than twofold from 2022 to 2023. In contrast, the same timeframe saw a 25.6% decrease in the number of patients opting for metabolic bariatric surgery to address obesity. The research has been published in JAMA Network Open.
“Our research offers one of the first national insights into the decline in the use of bariatric metabolic surgery among privately insured patients, which correlates with the rising preference for popular GLP-1 RA medications,” stated senior author Thomas C. Tsai, MD, MPH, who is a metabolic bariatric surgeon at Brigham and Women’s Hospital.
Analyzing a national database of medical insurance claims from over 17 million privately insured adults, the researchers focused on individuals diagnosed with obesity without diabetes during 2022-2023. They noted a significant rise in the percentage of patients receiving GLP-1 RAs, with an increase of 132.6% in use between the last halves of 2022 and 2023 (from 1.89 to 4.41 patients per 1,000 patients). Concurrently, there was a 25.6% drop in the number of patients undergoing bariatric metabolic surgery (from 0.22 to 0.16 patients per 1,000 patients).
Among the patients with obesity, a staggering 94.7% did not receive any treatment during the study period, while 5.0% were treated with GLP-1 RAs and only 0.3% had surgery. The study found that compared to those who were prescribed GLP-1 RAs, patients who opted for surgery presented with more complex medical issues.
“Currently, metabolic bariatric surgery remains the most effective and lasting method to treat obesity. National initiatives should aim at enhancing access to obesity treatments, whether through medications or surgery, to ensure patients receive the best possible care,” explained Tsai, who is also an assistant professor of Surgery at Harvard Medical School and an assistant professor in Health Policy and Management at Harvard T.H. Chan School of Public Health.
Tsai also pointed out that, despite their effectiveness in addressing obesity and related conditions like diabetes, the use of GLP-1 RAs has been hindered by their high costs, limited availability, and gastrointestinal side effects that may lead to patients stopping treatment and regaining weight.
“As individuals with obesity increasingly shift towards GLP-1 medications rather than surgical options, it’s crucial to conduct further studies to understand how this change from surgical to drug treatments for obesity affects long-term patient results,” added Tsai. “With the ongoing decline in bariatric surgery procedures and potential closures of surgery programs, there’s a real concern that access to comprehensive, multidisciplinary treatment for obesity—which includes medication, endoscopic, or surgical approaches—may become less accessible.”
“These findings also present an opportunity to broaden the adoption of surgical and pharmacological treatments for obesity and associated health issues,” commented co-author Ateev Mehrotra, MD, MPH, chair of the Department of Health Services, Policy and Practice at Brown University’s School of Public Health. “Both metabolic bariatric surgery and GLP-1 RAs are effective treatments for those with obesity, yet fewer than 6% of the patients in our study received either form of treatment.”
In light of these findings, the authors urge healthcare providers and policymakers to keep a close watch on access to effective obesity treatments amidst the rapidly changing treatment landscape. Additionally, more research is necessary to weigh the benefits and drawbacks of choosing surgical interventions versus the increasingly favored GLP-1 RAs for obesity treatment.
