Bariatric Surgery Potentially Superior to GLP-1RA Treatment for Obesity

Researchers have found bariatric surgery to be more cost-effective for treating patients with obesity compared with glucagon-like peptide-1 receptor agonists (GLP-1 RAs), according to new study findings published in JAMA Surgery.¹

Obesity affected an estimated 1 billion people in 2022 and is a known risk factor for many chronic conditions requiring long-term treatment. Patients with class II (body mass index [BMI] ≥ 35) and class III (BMI ≥ 40) obesity are at the highest risk for poor health outcomes. The most effective treatment to date is metabolic bariatric surgery (MBS), of which there are 2 types, sleeve gastrectomy and gastric bypass, and it surpasses other weight loss interventions, like the GLP-1s tirzepatide and semaglutide, in cost-effectiveness and efficiency.² In terms of results, patients can experience a weight loss of approximately 25% to 30% of their total weight, unlike with GLP-1 usage, which requires long-term adherence; patients also often experience weight gain recurrence after discontinuation. However, despite low complications and mortality rate, as well as increased weight loss and cost-effectiveness, bariatric surgery is often considered a last resort after other weight loss interventions have not achieved a patient’s weight loss goals.¹

Bariatric surgery may be better at treating weight loss that GLP-1RAs. | Image Credit @ Vadim-adobestock

The present study used data from the Highmark Health insurance claims database and Allegheny Health Network electronic medical records (EMRs) in the US, which included medical and pharmacy health vare encounters; diagnoses; procedures; and negotiated costs with each claim. Participants had to have Highmark insurance coverage for at least 6 months prior to their treatment and at least 12 months of follow-up data. Patients' total weight loss and monthly ongoing costs (pharmacy, medical, and surgery) were assessed at baseline and over 24 months following initial treatment.

The Most Efficient and Cost-Effective Treatment for Weight loss

The primary study cohort consisted of 30,458 patients, 14,101 who underwent MBS and 16,357 who filled GLP-1 prescriptions for the last year. Their mean age was 50 years, and 20,118 (66.1%) were female patients. The mean follow-up periods were 34 months for MBS and 32 months for GLP-1s.

The mean (SD) adjusted costs included pharmacy and medical costs. During the 6-month baseline period, researchers observed similar monthly costs for MBS and GLP-1s: $1673.29 ($102.59) and $1601.32 ($97.27) (P = .61), respectively. The mean (SE) monthly costs for the GLP-1 group increased significantly from baseline for years 1 and 2 of follow-up, respectively: $2841.83 ($130.29) (P < .001) and $2448.42 ($27.46) (P < .001). The MBS group, however, had higher mean (SE) costs in 1 year after baseline but dramatically lower monthly costs the second year vs baseline: $3161.49 ($143.63) vs $1154.68 ($85.82) (P < .001).

Researchers associated higher costs for the first year of follow-up in the MBS group with immediate short-term costs of surgery. Overall, the total costs for the entire 2-year period were $63,483.00 ($946.50) for GLP-1s and $51,794.04 ($1376.70) for MBS, resulting in mean cost savings of $11,689 with MBS (P < .001).

“The chronic nature of obesity requires long-term (and potentially lifelong) treatment with GLP-1 RAs to achieve durable weight loss, accruing costs every month,” the study authors explained. “In contrast, the monthly expenses are much lower after MBS.”

In regard to weight loss, for the group with a BMI of 40 or higher, weight loss data were only available for a smaller population of patients who underwent MBS (n = 1291) and those who used GLP-1s (n = 27). These cohorts represented 9.2% and 1.6% of the entire study population, respectively. At baseline, the MBS group had a mean BMI of 45.2 compared with 46.1 seen in the GLP-1 group. Those who underwent MBS significantly outperformed the GLP-1 group in terms of weight loss: 98.8% (n = 1275) of the MBS cohort lost at least 5% of their starting body weight, and 96% (n = 1239) lost at least 10%. In comparison, 184 patients (71.6%) reached at least 5% sustained weight loss, and 118 patients (45.9%) reached at least 10% sustained weight loss with GLP-1 RA therapy (P < .001 for both).

“We also observed that MBS was associated with fewer obesity-related comorbidities and reduced health care utilization at follow-up more markedly than GLP-1 RAs,” the study authors wrote. “This suggests that the lifetime costs for comorbidity treatment and health care utilization may also be substantially lower after MBS than with GLP-1 RA treatment.”

The study had several limitations, including varying follow-up times, reliance on claims and EMR data with potential biases, and differences in baseline characteristics between subsamples, which may affect generalizability. Additionally, the purpose of prescriptions was not consistently identifiable, and results may not apply outside the US health care system. Despite efforts to adjust for confounding factors, unmeasured confounders may still have influenced the findings.

“Surgical treatment may offer greater effectiveness at a lower cost than obesity management medication for the durable treatment of obesity,” the study authors concluded. “Further study is needed to determine whether there are patient subgroups that would benefit from an earlier referral to surgery.”

References

1. Barrett TS, Hafermann JO, Richards S, LeJeune K, Eid GM. Obesity treatment with bariatric surgery vs GLP-1 receptor agonists. JAMA Surg. Published online September 17, 2025. doi:10.1001/jamasurg.2025.3590

2. McCrear S. Tirzepatide more cost-effective than semaglutide for obesity and knee osteoarthritis. AJMC^®. September 17, 2025. Accessed September 17, 2025. https://www.ajmc.com/view/tirzepatide-more-cost-effective-than-semaglutide-for-obesity-and-knee-osteoarthritis