GLP-1 drugs present an uncertain opportunity for healthcare and the nation

Bariatric surgery volume has taken a hit, but some experts speculate a rebound is possible.

The wave of weight-loss drugs being prescribed to patients across the country may be behind a new era in obesity treatment. The drugs not only could be an appropriate treatment for millions of Americans but also could disrupt the industry’s existing bariatric surgery efforts and have other far-reaching consequences.

The soaring demand for GLP-1 drugs, shorthand for glucagon-like peptide-1 receptor agonists, may be shifting attitudes about what it means to be overweight, experts say.

“These (drugs) are a game-changer in medicine,” said Marc Bessler, MD, chair of surgery at Lenox Hill Hospital, part of the Northwell Health system in New York. Because GLP-1 treatments are drug-based, obesity is coming to be seen as the disease that it is, he said.

“Before we had anything effective other than surgery, people saw it as a failing,” he said. “When there’s a medication to treat something, it usually means it’s a disorder or disease, and I think people are starting to see it as such,” Bessler said.

The early impact of GLP-1 drugs for weight loss has hit the surgery suite hard. The number of bariatric surgeries fell 8.7% in the last six months of 2023 compared with the same period in 2022 while the number of patients prescribed GLP-1 drugs rose 105.7% in the same time frame, according to a study in JAMA.^a

Those trends give reason to believe GLP-1 drug costs will fall and insurance coverage will rise. Even so, the speed and scope of the drugs’ influence on healthcare remains a huge unknown.

Meanwhile, tempering demand for these medications is the fact that they are not effective for many of the people who take them. A recent study of a clinical trial of 483 adults found that nearly 18% did not respond to the drugs.^b

And some of those who do lose weight with the drugs give them up because of side effects or not wanting to take the drugs indefinitely to maintain weight loss.

Thus, GLP-1 drugs present both an opportunity and a challenge for health systems — and their leaders should actively consider how they will respond.

“This is an environment that’s not going to be going away anytime soon,” said Nicole Faucher, president of Clearway Health, a Boston Medical Center subsidiary that supports specialty pharmacies. “So [systems] need to take an active participation or they will, I think, lose some patients to other systems or outside entities.”

The workforce challenges

The first task in responding to the impact of GLP drugs is training, organizing and aligning the workforce to accommodate the major disruption coming their way, given the demographics of patients and their weight. More than 42% of U.S. adults over age 20 meet the criteria for obesity, according to the Centers for Disease Control and Prevention. To meet that demand requires new staffing approaches.

“It can’t be just simply [patients] keep showing up at primary care offices,” Faucher said. “We know it’s almost impossible to get appointments sometimes,” she said.

To meet this demand, some health systems have created weight-management clinics that have medical oversight from the health system but are staffed by mid-level providers or pharmacists.

“That’s one of the models that we find works very successfully,” Faucher said.

Emily Fitt, a consultant with Sg2, a Vizient company, regards the weight-management clinic concept as promising, but she thinks such clinics should target the highest-acuity patients.

“When we are talking about millions upon millions of Americans [who] could technically qualify for these medications, a weight-management clinic is not going to be scalable,” she said. “So how do we engage or revamp our primary care workforce to include more obesity training for primary care physicians to really manage this population?”

A drug by any other name …

Semaglutide, one of the top-selling drugs in the United States in 2024, is marketed as Wegovy for weight management, as Rybelsus in an oral formulation for managing Type 2 diabetes and as Ozempic for treating Type 2 diabetes, reducing cardiovascular risk in patients with Type 2 diabetes and reducing the risk of kidney disease worsening in adults with Type 2 diabetes and chronic kidney disease.

More than half of all U.S. adults — nearly 137 million individuals — met the criteria for one of the uses for semaglutide approved by the FDA, according to an analysis published in JAMA Cardiology.a Two other drugs, liraglutude and tirzepatide, are approved for weight loss under the respective brand names of Saxenda and Zepbound.

a. Shi, I., et al., “Semaglutide eligibility across all current indications for US adults,” JAMA Cardiology, Nov. 18, 2024

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