Glucagon-like peptide-1 (GLP-1) agonists are rapidly gaining popularity as an effective way to lose weight, so much so that bariatric surgery is at risk of becoming a thing of the past.
A study spearheaded by Thomas Tsai, assistant professor at the Harvard T.H. Chan School of Public Health, revealed a 25.6% decrease in the number of bariatric surgery patients in the latter half of 2023 compared to the latter half of 2022. Meanwhile, the number of GLP-1 users spiked to 132.6% in the same timeframe. (1)
Tsai, a bariatric surgeon himself, told reporters that he noticed an uptick in the number of patients cancelling their surgeries. Other practitioners have also reported a similar trend, especially among patients who have started their GLP-1 treatments. (2)
Although it’s unclear whether the trend is momentary or permanent, some experts believe it’s the beginning of bariatric surgery’s decline. Apart from its key role in shedding pounds, GLP-1 has shown promise in managing obesity-related conditions such as heart disease and type-2 diabetes. Certain GLP-1 treatments have been FDA-approved to treat the latter.
Rise of Weight Loss Injection Clinics
Since approving the first GLP-1 medication—Byetta—for treating type-2 diabetes in 2005, the FDA has recognized ten brand names. Other meds for treating type-2 diabetes include Bydureon, Mounjaro, Ozempic, Rybelsus, Trulicity, and Victoza. Meanwhile, FDA-approved GLP-1 medications for weight loss include Saxenda, Wegovy, and Zepbound. (3)
In recent weeks, the FDA has approved a generic version of Victoza in hopes of addressing the ongoing GLP-1 shortage. Novo Nordisk, the drug’s manufacturer, has been struggling to meet demand for Saxenda and Victoza injectables since 2023. (4)
However, this flourishing industry has also seen a rise in GLP-1 poisoning. A study led by The Abigail Wexner Institute at Nationwide Children’s Hospital in Ohio tallied 5,713 cases reported to poison centers across the nation from 2017 to 2022. Female victims comprise over 70% of these cases, most of which involve therapeutic errors. (5)
Therapeutic errors include taking the wrong dose or substance, or taking the right drug and dose but in the wrong manner.
In light of such a risk, local clinics in Newark and across New Jersey are presented with an opportunity to deliver weight loss injections safely. Some are even bariatric surgery clinics that use the procedure alongside GLP-1 meds and weight loss programs, which are believed to deliver optimal effects.
One Highland Park resident interviewed by PIX11 New York told the news outlet that her doctor-supervised Wegovy treatment helped calm the “food noise” in her head. She no longer had to worry about what to eat for breakfast, lunch, or dinner, something that years of trying out multiple diets, she said, failed to achieve. (6)
High Cost Barrier
For all their undeniable effects, however, GLP-1 meds remain out of reach for a majority of the obese and diabetics in the U.S. due to their hefty price tag.
BBC coverage on a congressional committee hearing last September reported that Novo Nordisk charges over USD$1,000 for Ozempic and Wegovy in the U.S. By comparison, the manufacturer charges only less than USD$100 for the same drugs in Germany.
Ozempic shot
The hearing grew heated enough for Sen. Bernie Sanders to accuse Novo Nordisk CEO Lars Jørgensen of treating the U.S. as a “cash cow” for his products. Despite repeated attempts from other senators for the latter to explicitly commit to lowering prices, the BBC report stated that he instead only made statements like being “in support of” better access. (7)
Several months before the hearing, Sanders bought print space in a Danish newspaper to publish his open letter urging the company to lower its GLP-1 weight loss drug prices in the U.S. Novo Nordisk’s headquarters is located in Copenhagen.
According to a Fortune report, the company had lowered the price of Ozempic by 34% to USD$130 a month—two weeks before Sanders’ open letter. Wegovy stayed at USD$365 a month, far less than what the company charges for U.S. patients. (8)
All the while, the U.S. is playing catchup. Despite the imminent transition on January 20, the Biden administration put forward proposals last November to expand Medicare and Medicaid coverage to include anti-obesity medications. The White House estimates that these plans would help reduce the cost of the medications by up to 95%. (9)
However, all isn’t certain with the succeeding Trump administration. Trump’s top pick for Secretary of Health and Human Services, Robert Kennedy, Jr., has expressed criticism for such medications. Instead, he argued in favor of spending the money for forwarding weight loss medication legislation to providing healthy food. (10)
Weight Loss Surgery Still Favored
Amid the GLP-1 surge, many recent studies and medical opinions still support bariatric surgery and its benefits.
A cost-effectiveness study by the American College of Surgeons last October revealed that searching and relying on weight loss surgeons locally not only saves thousands in the long run but also adds more years to a person’s life. Although the average yearly cost is much higher than GLP-1 medications, the surgery can save over USD$9,000 and add one quality-adjusted life year (QALY).
When both bariatric surgery and GLP-1 are employed, the savings reach over USD$7,200 and add over five QALYs. That said, the researchers said these figures can change with the cost of GLP-1 medications. (11)
Another study of over 400 obese and diabetic patients compared the likelihood of chronic kidney disease recurring between bariatric surgery patients and GLP-1 users. It found that the former had a lower risk of kidney disease and failure—respectively, 60% and 44% lower than the latter. (12)
Experts believe bariatric surgery will likely remain the foremost means of intervention for medical weight loss in the following years. However, the science-backed benefits of GLP-1 treatment are also worth considering.
References:
- Lin K, Mehrotra A, Tsai TC. Metabolic Bariatric Surgery in the Era of GLP-1 Receptor Agonists for Obesity Management. JAMA Network Open [Internet]. 2024 Oct 25 [cited 2024 Oct 26];7(10):e2441380. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825349
- Molteni M. In the era of GLP-1 drugs, demand for bariatric surgery plunges [Internet]. STAT. 2024. Available from: https://www.statnews.com/2024/10/25/bariatric-surgery-falls-as-glp-1-demand-rises-wegovy-zepbound/
- Catanese L. GLP-1 diabetes and weight-loss drug side effects: [Internet]. Harvard Health. 2024. Available from: https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more
- Office. FDA Approves First Generic of Once-Daily GLP-1 Injection to Lower Blood Sugar in Patients with Type 2 Diabetes [Internet]. U.S. Food and Drug Administration. 2024. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-once-daily-glp-1-injection-lower-blood-sugar-patients-type-2-diabetes
- Gaw CE, Hays HL, Kemp CA, Sandhya Kistamgari, Spiller HA, Rine NI, et al. Glucagon-Like Peptide-1 Receptor Agonist Cases Reported to United States Poison Centers, 2017–2022. Journal of medical toxicology. 2024 Feb 29; Available from: https://pubmed.ncbi.nlm.nih.gov/38421490/
- Corrado K. Wegovy patient says medicine calmed the “food noise” in her head. PIX11 [Internet]. 2024 Nov 20 [cited 2025 Jan 3]; Available from: https://pix11.com/news/local-news/wegovy-patient-says-medicine-calmed-the-food-noise-in-her-head/
- https://www.facebook.com/bbcnews. Live updates: Ozempic and Wegovy drugmaker treating US as its “cash cow”, Sanders says [Internet]. BBC News. 2024. Available from: https://www.bbc.com/news/live/c04p5916k4xt
- Allen A, News KH. How Denmark got homegrown giant Novo Nordisk to lower Ozempic prices [Internet]. Fortune Well. Fortune; 2024. Available from: https://fortune.com/well/2024/08/07/ozempic-novo-nordisk-lower-prices-denmark/
- House TW. FACT SHEET: Biden-Harris Administration Takes Latest Step to Lower Prescription Drug Costs by Proposing Expanded Coverage of Anti-Obesity Medications for Americans with Medicare and Medicaid | The White House [Internet]. The White House. 2024. Available from: https://www.whitehouse.gov/briefing-room/statements-releases/2024/11/26/fact-sheet-biden-harris-administration-takes-latest-step-to-lower-prescription-drug-costs-by-proposing-expanded-coverage-of-anti-obesity-medications-for-americans-with-medicare-and-medicaid/
- Robert F. Kennedy Jr. Ozempic [Internet]. YouTube. 2024 [cited 2025 Jan 3]. Available from: https://www.youtube.com/watch?v=qX9nQ40mSMY
- Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone [Internet]. ACS. 2024. Available from: https://www.facs.org/media-center/press-releases/2024/bariatric-surgery-is-more-cost-effective-than-newer-weight-loss-drugs-alone/
- Aminian A, Gasoyan H, Zajichek A, Alavi MH, Casacchia NJ, Wilson R, et al. Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease. Annals of Surgery [Internet]. 2024 Jun 11 [cited 2024 Nov 28]; Available from: https://journals.lww.com/annalsofsurgery/fulltext/2024/09000/renoprotective_effects_of_metabolic_surgery_versus.7.aspx