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Cited by 88Bariatric Surgery and OutcomesPharmacology and Obesity TreatmentObesity, Physical Activity, Diet

Obesity Treatment With Bariatric Surgery vs GLP-1 Receptor Agonists

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Barrett, Tyson S., Hafermann, Juliane O., Richards, Shannon, LeJeune, Keith, Eid, George M.·2025·JAMA Surgery
DOI 10.1001/jamasurg.2025.3590PMC PMC12444648
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Abstract

Importance: Obesity is a chronic condition with negative consequences for patients, the health care system, and society. The most effective treatment of class II and III obesity is metabolic bariatric surgery (MBS), which is usually considered a last resort. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have recently shown promising results. Objective: To compare weight loss and ongoing costs associated with MBS and GLP-1 RAs in the US. Design, Setting, and Participants: This cohort study used data from the Highmark Health insurance claims database and the Allegheny Health Network electronic medical record in the US. Participants were patients with class II or III obesity treated with either MBS or GLP-1 RAs who were enrolled in Highmark insurance for at least 6 months prior to index treatment and had follow-up data available for at least 12 months. Using propensity score weighting, the populations were adjusted for differences in baseline spending, health care utilization, age, sex, comorbidities, and smoking status. Data were analyzed from July 2024 to July 2025. Exposures: MBS (sleeve gastrectomy or gastric bypass) vs GLP-1 RAs (dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, or tirzepatide). Main Outcomes and Measures: The main outcomes were total weight loss and monthly ongoing costs (pharmacy, medical, and surgery costs) at baseline and over 2 years after index treatment. Mean adjusted costs were calculated using a linear mixed-effects model. Results: Analyses included 30 458 patients (mean [SD] age, 50 [11] years; 20 118 [66.1%] female), with 14 101 undergoing MBS (mean [SD] follow-up, 34 [16] months) and 16 357 receiving GLP-1 RAs (mean [SD] follow-up, 32 [17] months). After propensity score weighting, baseline characteristics were comparable. The mean (SE) total costs over 2 years were $63 483 ($1563) for GLP-1 RAs and $51 794 ($1724) for MBS ( P < .001). The main driver of this difference was higher sustained pharmacy costs in the GLP-1 RA group throughout year 2 of follow-up. Comparing weight loss data of 257 patients using GLP-1 RAs and 1291 patients who underwent MBS, total weight loss was greater for the MBS group (mean [SE], 28.3% [0.3%]) than the GLP-1 RA group (mean [SE], 10.3% [0.5%]) ( P < .001). Conclusions and Relevance: These findings suggest that MBS was associated with more weight loss at lower ongoing costs compared with GLP-1 RAs in class II and III obesity. Further study is needed to determine if MBS should still be considered the last resort in treating obesity.

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Crossref · 10.1001/jamasurg.2025.3590

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  • In a landscape where long-term stability costs between USD 12,000 and 16,000 annually, metabolic health effectively becomes a subscription-based service.

    “In a landscape where long-term stability costs between USD 12,000 and 16,000 annually (Barrett et al., 2025; Samuels et al., 2025), metabolic health effectively becomes a subscription-based service.”

    From IS OBESITY PHARMACOTHERAPY A LIFETIME COMMITMENT? A STRUCTURED REVIEW OF WEIGHT REGAIN AND STRATEGIES FOLLOWING INCRETIN CESSATION (2026) · cites this paper as Barrett et al., 2025

    The Discussion says durable weight loss with GLP-1 receptor agonists may require long-term treatment that accrues costs every month, supporting the recurring-cost premise. But the Results (Costs, Table 1) do not report USD 12,000–16,000 annually as the cost of maintaining metabolic health: the $11,689 figure is a cost difference versus surgery over two years, while reported second-year GLP-1-group costs are $2,448.42 per month. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Systemic factors, including high out-of-pocket costs, limited drug access, and tolerability issues, shape long-term effectiveness at the population level.

    “This trend underscores how systemic factors, including high out-of-pocket costs (ranging from USD 12,000 to 16,000 annually), limited drug access, and tolerability issues, shape long-term effectiveness at the population level (Barrett et al., 2025; Samuels et al., 2025).”

    From IS OBESITY PHARMACOTHERAPY A LIFETIME COMMITMENT? A STRUCTURED REVIEW OF WEIGHT REGAIN AND STRATEGIES FOLLOWING INCRETIN CESSATION (2026) · cites this paper as Barrett et al., 2025

    The Discussion (page unavailable) says GLP-1 treatment accrues ongoing costs and that common gastrointestinal adverse effects caused some patients to discontinue treatment, supporting the cost and tolerability concerns. The Results > Costs report pharmacy and total costs, not out-of-pocket costs of USD 12,000–16,000 annually. The passages do not establish limited drug access or quantify how these factors shape long-term effectiveness at the population level. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The cumulative lifetime costs of incretin-based therapies may eventually exceed those of surgical intervention.

    “While incretin-based therapies are highly effective, their cumulative lifetime costs may eventually exceed those of surgical intervention (Barrett et al., 2025; Brosnihan et al., 2025).”

    From IS OBESITY PHARMACOTHERAPY A LIFETIME COMMITMENT? A STRUCTURED REVIEW OF WEIGHT REGAIN AND STRATEGIES FOLLOWING INCRETIN CESSATION (2026) · cites this paper as Barrett et al., 2025

  • Annual out-of-pocket costs ranging from USD 12,000 to 16,000 are prohibitive for many patients without comprehensive insurance coverage.

    “Annual out-of-pocket costs ranging from USD 12,000 to 16,000 are prohibitive for many patients without comprehensive insurance coverage.”

    From IS OBESITY PHARMACOTHERAPY A LIFETIME COMMITMENT? A STRUCTURED REVIEW OF WEIGHT REGAIN AND STRATEGIES FOLLOWING INCRETIN CESSATION (2026) · cites this paper as Barrett et al., 2025

    The Methods (Outcomes) define costs as combined medical and pharmacy costs, and the Results (Costs) report monthly and two-year totals, not annual patient out-of-pocket expenses. Searches for the USD 12,000–16,000 range, insurance coverage, and affordability found no passage supporting those parts of the claim. Page numbers were not available in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Authors
Barrett, T. S., Hafermann, J. O., Richards, S., LeJeune, K., & Eid, G. M.
Affiliations
  • Highmark Health, Pittsburgh, Pennsylvania
  • Coreva Scientific, Koenigswinter, Germany
  • Allegheny Health Network (US)
Corresponding author
Eid, George M.
ORCID
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2025-11-01
Volume
160
Issue
11
Pages
1232
ISSN
2168-6254 (ISSN-L)
DOI
10.1001/jamasurg.2025.3590
PMC
PMC12444648
OpenAlex
W4414280202
Cited by
87
References
42
Citations by year
2026: 75 · 2025: 12
FWCI
81.85
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JAMA Surgery (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
obesity, bariatric surgery, GLP-1 receptor agonists, weight loss, health care costs, sleeve gastrectomy, gastric bypass, semaglutide, tirzepatide, pharmacy costs, cost comparison, health insurance claims, propensity score weighting, health care utilization
MeSH terms
Glucagon-Like Peptide-2 Receptor, Liraglutide, Exenatide, Glucagon-Like Peptide-1 Receptor Agonists, Adult, Glucagon-Like Peptides, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, Obesity, Obesity, Morbid, Peptides, United States, Weight Loss, Bariatric Surgery

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