Weight Loss Treatment Variability and Cost-Effectiveness: David Rometo, MD

Bariatric surgery is more cost-effective and better at helping patients lose and maintain weight than glucagon-like peptide-1 receptor agonists (GLP-1 RA). They are even proven to be efficacious with a low rate of recurrence; however, they are still considered the last line of treatment for patients with obesity or overweight.^1-3

David Rometo, MD, clinical associate professor of medicine at UPMC Division of Endocrinology and Metabolism in Pittsburgh, PA, said that bariatric surgery is substantially underutilized in an interview with The American Journal of Managed Care^®. Only 0.5% to 1.0% of eligible patients receive bariatric surgery, and underusage has been associated with a lack of education on safety and efficacy and limited access due to socioeconomic factors, such as lack of insurance coverage.¹ However, Rometo believes the increasing popularity of GLP-1 RAs may also increase the number of people who receive bariatric surgery. As more people are consulting their physicians and requesting GLP-1 RAs, the frequent visits and consults increase patients’ exposure to other weight loss options proposed by their primary care physician.

“Because more people will be going to their doctor, starting on medicines, and then they don't tolerate the medicine. They only got to 15% weight loss, but they wanted 25%, or they still have sleep apnea, so they need to lose more weight to get rid of it,” Rometo said. “It's going to increase the number of people in that appropriate medicalization of obesity with comorbidities, and have more people getting surgery.”

Bariatric surgery also costs less considering the long-term usage of GLP-1 RAs required to maintain weight loss. The total costs for 2 years for GLP-1 RAs are $63,483.00 ($946.50) and $51,794.04 ($1376.70) for metabolic bariatric surgery (MBS), resulting in mean cost savings of $11,689 with MBS (P < .00).²

However, usual-care weight loss for patients with obesity and comorbidities like knee osteoarthritis—which includes physical therapy, pain management, and lifestyle changes—was shown to be more cost-effective than both bariatric surgery and GLP-1 RA usage.

Rometo, assessed whether more extreme weight loss programs, like aggressive dieting, although medical supervision is required, may be beneficial to patients who need to lose a significant amount of weight for surgery at the UPMC Pop Health Institute for Value-Based Medicine® event, during his presentation on obesity medicine clinics and comprehensive lifestyle programs.

“If you don't have access to tirzepatide, you have a very low chance of getting 18% weight loss ever,” Rometo said. “Being in a program that achieves a major weight that is required for something else is the other category where we say, ‘This is appropriate.'”

While GLP-1 RAs have captured significant attention in the obesity treatment landscape, bariatric surgery remains the most effective long-term solution for sustained weight loss and improvement of obesity-related comorbidities. Its cost-effectiveness, durability, and ability to achieve higher weight loss targets make it a critical tool that should not be overlooked. Yet, barriers such as limited awareness, misconceptions about safety, and access challenges continue to hinder its broader use. As conversations around obesity management grow—spurred by the popularity of GLP-1 RAs—patients may increasingly be introduced to bariatric surgery as a viable and often superior option. Ensuring equitable access, education, and comprehensive care models will be essential to expand its reach and help more patients achieve durable weight loss and improved quality of life.

References
1. McCrear S. Bariatric surgery reduces metabolic comorbidities in patients with obesity. AJMC. September 9, 2025. Accessed September 29, 2025. https://www.ajmc.com/view/bariatric-surgery-reduces-metabolic-comorbidities-in-patients-with-obesity
2. McCrear S. Bariatric surgery potentially superior to GLP-1 RA treatment for obesity. AJMC. September 17, 2025. Accessed September 29, 2025. https://www.ajmc.com/view/bariatric-surgery-potentially-superior-to-glp-1ra-treatment-for-obesity
3. McCrear S. Tirzepatide more cost-effective than semaglutide for obesity and knee osteoarthritis. AJMC. September 15, 2025. Accessed September 29, 2025. https://www.ajmc.com/view/tirzepatide-more-cost-effective-than-semaglutide-for-obesity-and-knee-osteoarthritis