Weight-loss drug boom shakes bariatric surgery in US: Is India next?

Bariatric surgeries have fallen sharply in the US as GLP-1 weight-loss drugs have gained ground. In India, doctors say the shift may arrive more gradually, with medicines and surgery likely to coexist.

In Short

• Surgery volumes in America fell below 2,00,000 for first time since 2020
• Researchers linked the decline to soaring use of semaglutide and tirzepatide
• Indian doctors report patients increasingly ask to try injections before operations

The explosive rise of weight-loss drugs in the US is beginning to reshape obesity treatment in ways few expected. One of the clearest signs is shown in the sharp fall of bariatric surgery for the first time in years.

As GLP-1 drugs such as semaglutide and tirzepatide rapidly enter the Indian market, along with cheaper generics, doctors say India could soon face a similar shift, though perhaps not on the same scale.

New research presented at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) found that the number of metabolic and bariatric surgeries in the US dropped below 2,00,000 in 2024 for the first time since the pandemic year of 2020. That marks a decline of more than 20% from the previous year.

WHAT IS BARIATRIC SURGERY?

Bariatric surgery is a metabolic procedure in which the stomach size or the digestive tract is altered to restrict food intake and nutrient absorption. The surgery usually happens in people with severe obesity when diet and exercise are not enough to reduce excessive fat in the body.

Researchers from Loyola University in Chicago analysed data from the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which tracks outcomes from accredited bariatric centres across the country.

“After years of steady growth, the number of metabolic and bariatric procedures in the US is experiencing a decline amid persistently high obesity rates and a surge in the use of GLP-1 medications,” said lead study author Dr Tyler Cohn.

The findings come at a time when obesity treatment itself is changing rapidly.

For years, bariatric surgery, including sleeve gastrectomy and gastric bypass, was considered one of the most effective long-term treatments for severe obesity and obesity-linked diabetes.

But the arrival of GLP-1 drugs, which can help patients lose 10-20% of their body weight, has dramatically changed patient behaviour.

Doctors say many patients now prefer injections over surgery, especially because they are less invasive and increasingly accessible.

INDIA MAY SEE A SLOWER, MORE LAYERED SHIFT

India may be headed down a similar road.

Ravishankar KS, Consultant, Department of General and GIMAS (Gastrointestinal and Minimal Access Surgery), Kauvery Hospital, Marathahalli, said, “Bariatric surgery is anyway limited in India, not as much as surgeries are conducted in the US.

No doubt, people who still qualify for bariatric surgery will have to undergo it. "But yes, overall the demand will decrease. People already prefer weight-loss drugs, especially because it’s cheaper,” he said.

Dr. Ravishankar added that lifestyle changes after the Covid-19 pandemic have also played a role in delaying the need for surgery.

“Post-Covid we have also seen the trend of people becoming more conscious about taking care of their health and adopting preventive lifestyle changes. So the time to reach when a surgery is required is anyway reduced,” he said.

The US data also showed a shift in the types of bariatric surgeries being performed.

Sleeve gastrectomy, once the dominant procedure, declined from 64% of all surgeries in 2020 to 58% in 2024. Meanwhile, gastric bypass procedures increased to their highest share in five years.

The popularity of GLP-1 drugs has opened up broader conversations around obesity treatment rather than replacing surgery entirely.

“GLP-1s are starting a conversation in doctors’ offices that really wasn’t happening as much as it should have been,” said Dr. Richard Peterson, President of ASMBS.

WHY SURGERY IS UNLIKELY TO DISAPPEAR

In India, surgeons say the impact is more nuanced.

Dr. Venugopal Pareek, Senior Consultant, GI Laparoscopic, Bariatric and Robotic Surgeon at CARE Hospitals, Hyderabad, said there has not yet been a dramatic nationwide fall in bariatric surgeries.

“I wouldn’t say there’s been a clear or consistent drop across India. From what we’re seeing in practice, volumes are fairly stable overall," he said.

But what has changed, he explained, is patient decision-making.

“There’s a bit more hesitation, more exploration of non-surgical options before committing to surgery,” said Dr Pareek. “So it can feel like things have slowed in certain pockets, but I wouldn’t call it a definite decline — more a shift in how people are making decisions.”

The rapid expansion of GLP-1 drugs in India, including lower-cost versions, is already altering how obesity patients enter treatment pathways.

“Patients who earlier would have come straight for surgery are now asking, ‘Can I try an injection first?’” Dr Pareek said.

Still, he cautioned against assuming that drugs will fully replace surgery.

“These medications typically give you 10–15% weight loss, and they often need to be continued long term,” he explained.

Surgery, on the other hand, is still the only option that delivers durable metabolic change, especially in severe obesity or uncontrolled diabetes.

INDIA'S OBESITY TREND VS THE US

India’s obesity burden also differs sharply from that of the United States. Bariatric surgery remains underutilised in India despite rising obesity and diabetes rates, largely because of cost, access, awareness and stigma around surgery.

That is why doctors believe India is unlikely to see a collapse in bariatric procedures anytime soon.

“I’d be cautious about directly applying the US trend to India. The ecosystems are very different,” Dr Pareek said.

In India, we have a massive and still growing obesity burden. Surgery is still underutilised relative to need. And cost dynamics are interesting, GLP-1 drugs, even with generics, are still a recurring expense, whereas surgery is a one-time intervention.

Instead of one treatment replacing the other, experts say obesity care may increasingly move toward a combined model where medicines, lifestyle changes and surgery work together depending on the patient’s condition.

“What I see happening is not replacement, but redistribution,” Dr Pareek said. “More patients will try drugs first. Some will do well and avoid surgery. But a significant number will either not respond enough or won’t sustain the treatment — and they will come back to surgery.”

If anything, doctors say, we’re moving toward a combined model rather than one overtaking the other.

The real shift is that obesity care is becoming more layered, not less surgical.

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