Metabolic Bariatric Surgery Outperforms GLP-1s in Weight Loss With Lower Long-Term Costs

Metabolic bariatric surgery was linked to more weight loss at a lower cost compared with glucagon-like peptide-1 receptor agonists (GLP-1) among individuals with class 1 and 3 obesities, according to findings published by investigators in JAMA Surgery.

Currently, metabolic bariatric surgery is considered the last option for treating individuals with obesity, but study authors noted that more research is needed to determine whether its place in the treatment order should be reconsidered.^1,2

Obesity Occurrence and Treatment

Obesity has increased globally, affecting an estimated 1 billion individuals in 2022. The chronic disease is linked to serious health risks and poor outcomes in severe cases, specifically among individuals with a body mass index (BMI) greater than 35.

Obesity is categorized into classes based on BMI: class 1 is 30 to less than 35, class 2 is 35 to less than 40, and class 3 is 40 or greater. The severity of obesity is graded by the cases, with higher classes being linked with increased health risks, such as heart disease, type 2 diabetes, high blood pressure, and sleep apnea, emphasizing the need for effective treatment, as sustained weight loss reduces mortality, related conditions, and cancer risk.¹

Previous research has suggested that metabolic bariatric surgery is the most effective treatment option for individuals with obesity, leading to durable 25% to 30% weight loss with low complication rates. Recently, GLP-1s such as semaglutide (Ozempic, Wegovy; Novo Nordisk) and tirzepatide (Mounjaro; Eli Lilly and Company) have demonstrated 18% to 25% weight loss, though their benefits require ongoing use to prevent weight regain.

While both metabolic bariatric surgery and GLP-1s are effective for weight loss and glycemic control, they come with high costs. Annually, obesity costs exceed $260 billion in the US, with metabolic bariatric surgery adding to that expense with significant upfront expenditures, while GLP-1s require continuous payments for ongoing treatment.¹

Weight Loss and Cost Barriers With Obesity Treatment

To evaluate and compare long-term costs, health care utilization, and clinical outcomes of metabolic bariatric surgery and GLP-1 treatment, researchers conducted a retrospective cohort study using data of patients who underwent obesity treatment between 2018 and 2023 that were retrieved from a health claims database and electronic health records. Patients were included in the study if they had an obesity diagnosis in their claims history and had at least 6 months of health plan enrollment before treatment, with a minimum of 1 year of follow-up data.

The GLP-1 cohort included patients that were treated with semaglutide (45%), tirzepatide (11%), dulaglutide (Trulicity; Eli Lilly and Company) (25%), and exenatide (Byetta, Bydureon; Amylin, AstraZeneca) (1%). The metabolic bariatric surgery cohort included patients who underwent sleeve gastrectomy or gastric bypass. Patients were excluded from the study if they received both treatments or lacked an obesity diagnosis during the baseline period or at the index date. A total of 30,458 patients were included in the analysis, with 14,101 that underwent metabolic bariatric surgery and 16,357 that were treated with GLP-1s for at least a year.¹

Over 2 years, the results demonstrated that the mean total costs were higher for GLP-1s, at $63,483 compared with metabolic bariatric surgery at $51,794, largely due to ongoing pharmacy expenses. In weight loss comparisons, patients treated with metabolic bariatric surgery achieved significantly greater reductions (28.3%) than those treated with GLP-1s (10.3%).¹

The findings suggest that metabolic bariatric surgery was linked with more weight loss and lower ongoing costs compared with GLP-1s in class 1 and class 3 obesity. However, the study authors noted that further research is needed to assess if metabolic bariatric surgery should still be considered as a last resort in treating obesity.¹

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. Obesity treatment with bariatric surgery vs GLP-1 receptor agonists. EurekAlert! News release. September 17, 2025. Accessed October 2, 2025. https://www.eurekalert.org/news-releases/1098414