Bariatric Surgery Rates Fall as GLP-1s Gain Popularity

Prescriptions for semaglutide and tirzepatide increased dramatically, while metabolic and bariatric surgery rates declined.

Published on Mar. 5, 2026

Got story updates? Submit your updates here. ›

A study analyzing data from 31,684,807 patients eligible for metabolic and bariatric surgery in the US found that the use of GLP-1 receptor agonists like semaglutide and tirzepatide increased dramatically from 2018 to 2025, while rates of metabolic and bariatric surgeries declined substantially beginning in 2023. The decline was more pronounced for sleeve gastrectomy than for Roux-en-Y gastric bypass.

Why it matters

The increasing use of GLP-1s and declining rates of bariatric surgery highlight the complex decision-making process for treating severe obesity, as these medications can approach the weight-loss and glycemic effects of surgery. Developing integrated treatment pathways that combine pharmacological and surgical approaches is essential, as bariatric surgery remains the most effective and durable treatment for severe obesity.

The details

The study analyzed data from 31,684,807 patients eligible for metabolic and bariatric surgery in the US across all quarters from 2017 through 2025. Patients younger than 18, those with prior bariatric surgery, gastrointestinal cancer, or pregnancy were excluded. The use of GLP-1s was defined as the proportion of patients with active semaglutide or tirzepatide prescriptions, while the use of bariatric surgery was defined as the proportion of patients who underwent a primary weight-loss surgery. The prevalence of GLP-1 prescriptions increased from 0.22% in Q4 2018 to 24.17% in Q3 2025, a more than 100-fold increase. Bariatric surgery use peaked at 0.17% in Q4 2022 and declined to 0.09% in Q3 2025, a 46.4% decrease over 3 years. The decline was more pronounced for sleeve gastrectomy (50.1% decrease) than for Roux-en-Y gastric bypass (44.3% decrease).

  • The study analyzed data from 2017 through 2025.
  • GLP-1 prescriptions increased from 0.22% in Q4 2018 to 24.17% in Q3 2025.
  • Bariatric surgery use peaked at 0.17% in Q4 2022 and declined to 0.09% in Q3 2025.

The players

Stefanie C. Rohde, MD

The lead author of the study, from the Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.

Got photos? Submit your photos here. ›

What they’re saying

“Earlier access to GLP-1s in patients with diabetes and the observed decline in metabolic and bariatric surgery use irrespective of diabetes status, highlight complex decision-making regarding treatment. Developing evidence-based, patient-centered, multimodal pathways that integrate pharmacological and surgical approaches is essential because metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity.”

— Stefanie C. Rohde, MD (JAMA Surgery)

The takeaway

The increasing use of GLP-1 medications and declining rates of bariatric surgery highlight the need for integrated treatment approaches that combine pharmacological and surgical options to effectively manage severe obesity, as bariatric surgery remains the most effective long-term treatment.