Bariatric Surgery Declines as Obesity Meds Rise: JAMA Study
The landscape of obesity treatment is shifting, with a notable decline in bariatric surgery procedures coinciding with a surge in prescriptions for newer weight loss medications. Data published in JAMA Surgery reveal a 46.4% decrease in bariatric surgeries between the third quarter of 2022 and the third quarter of 2025, as more adults are prescribed medications like semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound). This trend signals a broadening approach to managing obesity, though significant gaps in access to effective treatment remain.
Expanding Treatment Options and Shifting Approaches
The study, led by Stefanie Rohde, MD, and colleagues at Ohio State University Wexner Medical Center, analyzed data from the Epic Cosmos electronic health record database, encompassing over 31 million adults eligible for bariatric surgery. Researchers defined eligibility based on a Body Mass Index (BMI) of 40 kg/m2 or higher without obesity-related comorbidities, or a BMI of 35 kg/m2 or higher with such comorbidities. The analysis revealed that in the third quarter of 2025, 24.17% of eligible adults received a prescription for semaglutide or tirzepatide, while only 0.09% underwent bariatric surgery.
“Obesity treatment options are expanding,” Dr. Rohde told Healio. “While bariatric surgery utilization has declined since its 2022 peak, prescriptions for GLP-1 medications have increased dramatically among people who qualify for surgery. This proves encouraging that more patients are seeking treatment for obesity as a chronic disease — but the reality is that most eligible patients still receive neither medication nor surgery, so the biggest opportunity ahead is improving access to effective care.”
Understanding the Medications Driving the Shift
Semaglutide and tirzepatide are glucagon-like peptide-1 (GLP-1) receptor agonists. These medications work by mimicking the effects of GLP-1, a natural hormone that regulates appetite and blood sugar levels. They promote feelings of fullness, sluggish down gastric emptying, and ultimately lead to weight loss. Semaglutide is available under the brand names Ozempic (for type 2 diabetes) and Wegovy (specifically for weight loss), while tirzepatide is marketed as Mounjaro (for type 2 diabetes) and Zepbound (for weight loss).
A Closer Look at the Numbers
The data demonstrate a clear trend: prescriptions for these medications rose from 0.22% in the fourth quarter of 2018 to a peak of 24.17% in the third quarter of 2025. Bariatric surgery rates, conversely, peaked at 0.17% in the fourth quarter of 2022, then declined to 0.11% in the fourth quarter of 2024 and 0.09% in the third quarter of 2025. Specifically, sleeve gastrectomy procedures decreased by 50.1% and Roux-en-Y gastric bypass procedures decreased by 44.3% during the period from the third quarter of 2022 to the third quarter of 2025.
Beyond Competition: A Chronic Disease Approach
Patrick Sweigert, MD, FACS, DABOM, assistant professor and surgeon at Ohio State University Wexner Medical Center, emphasizes that the shift isn’t necessarily about competition between treatments. “The most important context is that obesity is now widely recognized as a chronic, relapsing disease, and that changes how we approach treatment,” Sweigert explained to Healio. “Just like other chronic conditions, patients may benefit from different therapies at different stages — including medications, surgery or both. The real story here isn’t competition between treatments, but the opportunity to finally address a massive population of patients who have historically gone untreated.”
Significant Access Gaps Remain
Despite the increase in medication prescriptions, a substantial proportion of eligible individuals still aren’t receiving any treatment for obesity. The study found that 75.8% of the study group were not receiving either pharmacotherapy or surgical intervention in the third quarter of 2025. This highlights ongoing challenges related to access, affordability, and awareness.
Dr. Rohde points to the need to address these barriers. “It is encouraging how many more patients are receiving treatment than ever before. However, there are still access concerns,” she said. “many patients have never sought or received highly effective treatment for obesity given that of stigma or prior lack of options. Hopefully, the widespread uptake of these medications across society is changing that stigma.”
The Path Forward: Guidelines and Further Research
The researchers advocate for the development of evidence-based, patient-centered guidelines to inform treatment strategies for obesity. They likewise emphasize the need for continued monitoring of trends in both obesity medication prescriptions and bariatric surgery procedures. Further research is crucial to understand the long-term effects of these medications, optimal treatment sequencing, and the potential for combination therapies.
The evolving treatment landscape for obesity offers novel hope for individuals struggling with this chronic condition. However, addressing access barriers and fostering a comprehensive, patient-centered approach will be essential to maximizing the benefits of these advancements.
Stefanie Rohde, MD, can be reached at [email protected]; Bluesky @stefanie-rohde; X @stefrohde.
Patrick Sweigert, MD, FACS, DABOM, can be reached at [email protected] or X @psweigert.