Surgery Down, Medications Up, But Most Patients Still Get Neither: The Obesity Treatment Gap

It would be reasonable to assume that, in the age of highly effective GLP-1 medications, more people with obesity are being treated than ever before. New data released by a leading professional society tell a more sobering story: even accounting for both surgery and medication together, the overwhelming majority of patients with severe obesity in the United States are still receiving neither.

The numbers

Bariatric surgery volumes fell from a peak of roughly 42,600 procedures in 2023 to about 33,400 in 2025 — the sharpest sustained decline since the introduction of GLP-1 medications. Over the same broader period, GLP-1 prescriptions have grown enormously, from roughly 4,600 in 2018 to about 1.4 million in 2025, a nearly 300-fold increase. Yet when the society's researchers calculated what fraction of the eligible population these numbers actually represent, surgical utilization sat at only about 0.21% of eligible patients in 2024 and 2025, while GLP-1 use — though far higher — still reached only about 5.3% of the studied population. Put together, somewhere between 90% and 95% of people with severe obesity received no formal treatment for it at all.

The finding that concerns me most

Perhaps the most important detail in this analysis is not simply that overall surgical volume dropped, but that the decline appears concentrated among patients with the highest degrees of obesity — precisely the group who, as I discussed in a companion piece on BMI and surgical access, stand to benefit most from surgical treatment and often respond less completely to medication alone at the doses and durations currently available. If the people falling through the cracks are disproportionately those with the greatest disease burden, then simple "surgery versus medication" narratives are missing the point; both pathways, together, still leave the majority of patients with severe obesity untreated by either.

Why medication is not simply "replacing" surgery

I want to be clear with patients: GLP-1 and dual-agonist medications are genuinely transformative, and I prescribe them regularly. But they are not a universal substitute for surgery. Average weight loss with the best current medications, while impressive, generally remains somewhat below what bariatric surgery achieves, particularly in patients with a very high starting BMI. Medications require ongoing use — stopping them is reliably associated with significant weight regain — while surgery produces a durable anatomic change that continues to work even during periods when medication access is interrupted, whether due to cost, supply shortages, or insurance changes, all of which remain very real barriers in the Gulf region as much as anywhere else. The right framing, echoed by the society behind this analysis, is that patients need access to the entire continuum of obesity treatment — lifestyle and behavioral therapy, medication, endoscopic procedures, and surgery — matched to their individual disease severity, preferences, and response, not forced to choose a single "winner" between drugs and surgery.

What is actually driving the treatment gap

The barriers identified are familiar to anyone practicing in this field: inconsistent insurance coverage for both medications and surgery, genuine affordability challenges even where coverage exists, limited specialist and program capacity, and persistent weight-related stigma that keeps some patients from seeking care and, at times, keeps some clinicians from referring them. None of these barriers are solved by a new drug alone, however good it is.

What I tell my patients

If you have obesity-related disease — type 2 diabetes, sleep apnea, fatty liver disease, hypertension, joint disease — and have not yet had a serious conversation with a physician about your full range of treatment options, you are, unfortunately, in the statistical majority, not the minority. That is not a reflection of you; it reflects real gaps in how our health systems currently deliver obesity care. I would encourage you to have that conversation regardless — ask specifically about medication, surgery, and how they might work together in your individual case, rather than assuming one path is closed to you before it has been properly assessed.

Source: American Society for Metabolic and Bariatric Surgery, national data analysis on bariatric surgery volumes and GLP-1 medication use, 2026.