Is Wegovy Shrinking Bariatric Surgery, Too?

 Glucagon-like peptide 1 (GLP-1) receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), were originally approved for type 2 diabetes before their obesity indications. But the evidence that they could help millions of Americans lose weight (and prevent major heart events

opens in a new tab or window for those individuals with cardiovascular disease) has begun to reshape the healthcare landscape in unexpected ways.

One of the most striking shifts has been in the area of bariatric surgery, where once-steady demand for weight-loss procedures has declined significantlyopens in a new tab or window (by as much as 30% at some facilities) as more patients turn to these potent medications to shed pounds. This change is so pronounced that some bariatric surgery programs have closedopens in a new tab or window.

This trend is not just about GLP-1 medications, however.

It represents a broader transformation in how the country and its providers are approaching weight management and the treatment of related conditions. While these drugs may be shrinking surgery volumes, they also are opening the door to new possibilities for reducing the need for other drugs and procedures, a shift that will ultimately, and significantly, influence healthcare utilization and costs.

The Broad Health Benefits of GLP-1 Drugs

For some Instagram influencers, GLP-1 agonists are all about keeping slim to stay stunning for the camera. I won't comment on the desire to shed a few pounds to attract a few hundred followers because that discussion keeps us from focusing on the broad, positive effects GLP-1 agonists could have on Americans' health.

Semaglutide, tirzepatide, and other GLP-1 agonists do not only help people lose weight. Patients who take these drugs have experienced significant improvements in diabetes, blood pressure, and cardiac risks. These improvements are critical because they can reduce the need for additional pharmaceutical interventions and, in some cases, prevent hospitalizations altogether.

The full potential has yet to be quantified, but even though GLP-1 agonists come with big price tags (perhaps too big), they could save the country billions each year in healthcare costs.

For example, weight loss achieved through semaglutide can lead to a reduction in hypertension, which in turn may decrease the need for antihypertensive medications. Improved cardiac function could mean fewer interventions for heart-related issues, and better-managed diabetes can reduce the risk of complications such as neuropathy, retinopathy, and kidney disease, all of which can lead to hospitalizations and other costly interventions.

A Positive Ripple Effect on Healthcare Services -- but Challenges Remain

As GLP-1 drugs continue to gain popularity, we are beginning to see its ripple effect across various sectors of healthcare. Bariatric surgery is just one area where demand is shifting. Hospitals that once relied on a steady stream of bariatric procedures are now facing a new reality where fewer patients are opting for surgery, preferring instead to manage their weight with medication.

This shift is positive because it allows healthcare providers to reallocate resources to other areas of need. While GLP-1 receptor agonists are not a panacea and do come with their own set of side effects, such as gastrointestinal issuesopens in a new tab or window and other risksopens in a new tab or window, they offer a glimpse into how targeted medications can shift the demand for healthcare services.

In the near-term, however, there could be challenges. As noted above, these drugs are costly and that, combined with high demand for them (even for off-label useopens in a new tab or window), have employersopens in a new tab or window (including government employers), insurers, and public officials very worried about how they will pay for them and stay in business.

The Centers for Medicare & Medicaid Services (CMS) already covers the drugs for diabetes and semaglutide's cardiovascular prevention indicationopens in a new tab or window in patients with overweight or obesity, but coverage does not extend to prescriptions exclusively for obesity.

House lawmakers earlier this year considered pushing CMS to cover GLP-1 agonists for weight lossopens in a new tab or window, ultimately passing a narrower version of the legislationopens in a new tab or window that would only cover some patients aging into Medicare; if it became law, however, it could still lead to an abrupt increase in healthcare spending as more and more patients are prescribed the drug.

The idea of adding to the federal deficit at a time when the national debt is increasing is scary, but policymakers should play the long game. Providing GLP-1 receptor agonists to a broader group of Americans could lead to a healthier population that requires fewer medical interventions.

The future of healthcare may very well involve more medications like GLP-1 drugs that not only treat a specific condition but also lead to broader health improvements and, therefore, reduce the need for other interventions. As policymakers consider the costs of covering such drugs, the potential for improving the health of Americans and the sustainability of the healthcare system cannot be overlooked.

https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/112026