How semaglutide and tirzepatide are changing bariatric surgery patterns
A study in Surgical Endoscopy used a nationwide health records database to track how bariatric surgery use and pre-surgery GLP-1 medication use shifted between 2018 and 2025. It found surgery volumes dropped after 2022 while more surgery patients had taken a GLP-1 first, with clear differences by race, insurance, and hospital.
This is a large records-based study, not a trial and not an animal or cell experiment. The researchers looked back at data on real people who had weight-loss surgery to describe patterns over time.
It was published in Surgical Endoscopy. The goal was to understand how the arrival of semaglutide and tirzepatide has changed who gets bariatric surgery and who takes a GLP-1 medication beforehand.
What the researchers studied
The team queried Epic's Cosmos database, a nationwide collection of health records. They pulled patients who had a primary sleeve gastrectomy or gastric bypass between 2018 and 2025. For each patient, they checked whether there was a record of semaglutide or tirzepatide being dispensed before surgery.
They then compared patient characteristics using standard statistical tests, and used regression models to find which factors were independently linked to taking a GLP-1 before surgery. They also examined how much this varied between hospitals and states.
What they reported
Bariatric surgery use rose after the third quarter of 2018 and peaked in the last quarter of 2022. After that it fell by 39% through the end of 2025.
Over the same window, pre-surgery GLP-1 use climbed sharply. Between late 2018 and late 2025, the share of surgery patients who had received a GLP-1 beforehand went from 0.2% to 35.3%. The share of Hispanic surgery patients also rose, from 8.1% to 16.8%.
Certain groups were more likely to have taken a GLP-1 before surgery: patients who were older, White, privately insured, or who had type 2 diabetes, sleep apnea, or metabolic dysfunction-associated steatotic liver disease. Type 2 diabetes carried nearly a threefold higher likelihood. Patients who went straight to surgery were more often Hispanic, Black, and covered by public insurance or uninsured.
The study also found large differences between hospitals. After adjusting for patient characteristics and year, there was a 15-fold gap in pre-surgery GLP-1 use between the highest and lowest hospitals. The authors describe this as driven partly by center-specific factors that are not strictly clinical.
What this does and does not establish
This study describes trends. It shows that surgery volumes changed and that GLP-1 use before surgery grew, and it maps out who was more or less likely to receive each path. That is useful context for understanding the current landscape of obesity care.
It does not test whether a GLP-1 medication works, how well it works, or whether it is better or worse than surgery for any individual. It does not measure weight change, side effects, or long-term outcomes. And because the patterns differ by race and insurance, the findings also point to differences in access, not just clinical decisions.
If you are considering physician-prescribed care
Medications like semaglutide and tirzepatide are one part of a wider set of options for weight and metabolic health, and this study shows how their use is evolving alongside surgery. What is right for you depends on your history and goals, and outcomes vary from person to person.
At Live Vital, these treatments are physician-prescribed and require a medical intake and physician approval. A prescription is never guaranteed. If you want to learn more, you can start at /get-started or book a free consult at /consult. This article is general information, not medical advice.