ASMBS 2026
As GLP-1 use surges, bariatric surgery volume drops
Clinical takeaway: Patients weighing obesity treatment may benefit from a fuller discussion of surgical options alongside GLP-1 therapy, given surgery's durability and effect on obesity-related conditions.
After years of steady growth, metabolic and bariatric surgery volume in the U.S. has reversed course. This analysis examined how procedure counts and case mix have shifted during the period of rapid GLP-1 uptake.
The total number of procedures fell below 200,000 in 2024, the first time since 2020, a drop of more than 20% from the prior year. The case mix also shifted with sleeve gastrectomy, long the dominant operation, declining to 58% in 2024 from 64% of procedures in 2020. Gastric bypass rose to 33% from 28%, its highest share in five years. Conversions, which include revisions or modifications of prior surgery, climbed to 11% from 9%. Gastric banding and other procedures each accounted for less than 2% of cases.
The findings suggest patients may increasingly view GLP-1 medications as a substitute for surgery rather than one option among several, even though surgery remains the most durable treatment for severe obesity and consistently improves type 2 diabetes, hypertension, and cardiovascular risk. The drop comes against a backdrop of high unmet need. Less than 1% of patients eligible for bariatric surgery undergo it in any given year.
The analysis drew on the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, covering 2020 through 2024 outcomes from all accredited bariatric centers.
The shift in case mix itself is worth watching. The relative rise in gastric bypass and conversions could reflect referral of more complex patients, weight regain after GLP-1 discontinuation, or evolving surgeon and patient preferences.
"GLP-1s are starting a conversation in doctors' offices that really wasn't happening as much as it should have been," said Richard Peterson, MD, MPH, FASMBS, president of ASMBS and professor of surgery at UT Health San Antonio. "The high demand for these drugs and greater attention on the dangers of obesity has created an unprecedented opportunity to educate and engage patients on all proven treatments, not just medications, which is essential to effectively treating this chronic disease."
Source: Ferguson R. ASMBS 2026 Annual Scientific Meeting Abstract 4730. Examining trends in the decline of bariatric surgery — an MBSAQIP analysis