Semaglutide and Tirzepatide Rise Coincides with 39% Drop in Bariatric Surgery Utilization by Q4 2025
Background
The landscape of obesity treatment has been significantly reshaped by the emergence of highly effective GLP-1R and GIPR co-agonists like semaglutide and tirzepatide. These medications offer substantial weight loss and comorbidity improvement, challenging the traditional role of bariatric surgery as the most effective intervention for severe obesity. Despite their impact, the real-world changes in bariatric surgery utilization and patient characteristics in this evolving paradigm have remained largely unquantified. Understanding these trends is crucial for healthcare planning and ensuring equitable access to care.
Study Design
Researchers queried Epic's nationwide Cosmos database for patients undergoing primary sleeve gastrectomy or gastric bypass between 2018 and 2025. Patient characteristics, including preoperative semaglutide or tirzepatide dispense history, were compared using chi-squared and Wilcoxon rank sum tests. Modified Poisson regression identified factors associated with pre-surgery GLP-1RA use, while multilevel models examined hospital- and state-level variation in pre-surgery GLP-1RA utilization.
Results
Bariatric surgery utilization initially increased after Q3 2018, peaked in Q4 2022, and subsequently decreased by 39% through Q4 2025. Concurrently, the proportion of patients receiving pre-surgery GLP-1RA therapy dramatically increased from 0.2% in Q4 2018 to 35.3% in Q4 2025 (p < 0.001). The demographic profile of bariatric surgery patients also shifted, with the proportion of Hispanic patients rising from 8.1% to 16.8% (p < 0.001).
Key Findings
- Bariatric surgery utilization decreased 39% from Q4 2022 to Q4 2025.
- Pre-surgery
GLP-1RAuse (semaglutide/tirzepatide) increased from 0.2% to 35.3% between Q4 2018 and Q4 2025. - Hispanic patient proportion in bariatric surgery increased from 8.1% to 16.8%.
- Pre-surgery
GLP-1RAuse was associated with White race, private insurance, and type 2 diabetes (RR 2.94). - Upfront surgery was associated with Hispanic ethnicity, Black race, and public/no insurance.
Why It Matters
This study provides critical real-world data on the evolving landscape of obesity management, highlighting a significant shift away from bariatric surgery in favor of GLP-1RA pre-treatment or potentially as a standalone therapy. Clinicians should recognize the increasing role of semaglutide and tirzepatide in the bariatric pathway, influencing patient selection and timing of surgical intervention. The observed disparities, where White, privately insured, older patients with comorbidities were more likely to receive pre-surgery GLP-1RA, while Hispanic and Black patients with public insurance were more likely to undergo upfront surgery, underscore critical health equity concerns. This suggests potential biases in access to newer, often expensive, pharmacotherapies, warranting further investigation and policy adjustments to ensure equitable care.
semaglutide
tirzepatide
bariatric surgery
obesity
glp-1ra
health equity