ASMBS meeting data show rising GLP‑1 use, falling operations, and a large treatment gap

Two analyses presented at the 2026 ASMBS annual meeting describe different parts of a changing obesity-treatment picture. One used the Epic Cosmos electronic health record network to track treatment for patients whose records showed severe obesity without diabetes. The other counted U.S. metabolic and bariatric procedures in the MBSAQIP registry.

The Cosmos analysis covered active patient populations that grew from about 9.0 million in 2018 to 19.9 million in 2025. GLP-1 prescriptions increased from 4,592 to 1,421,202 during that period. Recorded bariatric operations rose from 19,792 in 2018 to 42,615 in 2023, then declined to 37,339 in 2024 and 33,429 in 2025.

Despite the growth in medication use, 90% to 95% of people in the Cosmos population received neither treatment in a given year. GLP-1 use increased from 0.03% to 5.3%, while surgery use peaked at 0.24% in 2023 and was about 0.21% in each of the next two years.

The separate MBSAQIP analysis counted 177,297 U.S. procedures in 2024, down from 217,387 in 2023. Sleeve gastrectomy represented 58.35% of the 2024 procedures, compared with about 64% in 2020. Gastric bypass increased from 28.44% to 32.82% of procedures over the same period. Revisions, conversions, and modifications also took a larger share.

UC San Diego researchers pulled Epic Cosmos records on people with severe obesity and no diabetes. GLP-1 prescriptions in that slice rose from 4,592 in 2018 to more than 1.42 million in 2025. Operations rose from just under 20,000 in 2018 to about 42,600 in 2023, then fell to 37,339 in 2024 and 33,429 in 2025. Between 90% and 95% of the active patients in the file received neither treatment.

Lead author Jeffery Reeves said the surgery drop may be concentrated among people with the highest disease burden. A companion MBSAQIP count found U.S. metabolic operations dropped under 200,000 during 2024, the first such dip since 2020, more than 20% below the prior year. Sleeve share fell from about 64% in 2020 to 58% in 2024. Bypass rose from 28.44% to 32.82%.

Conversions rose from about 9% to 11%. ASMBS notes its broader 2023 estimate was more than 270,000 procedures, because that figure includes people with diabetes and other datasets. The society still says fewer than 1% of eligible people have surgery in a given year.

Most patients still received neither treatment

The clearest finding is the size of the treatment gap. Medication use expanded quickly, and surgical use declined after 2023, but most people represented in the Cosmos analysis still had no record of either intervention. The data support broader conversations about the full range of obesity care rather than treating medication and surgery as mutually exclusive choices.

The changing procedure mix also matters for surgical programs. Fewer total operations and a smaller sleeve share do not mean that one procedure has replaced every other option. They show how the national mix shifted within this registry during the years studied.

The meeting package is less a horse race than a coverage gap. Most people with severe obesity in these files were not on a GLP-1 and did not have an operation. For a reader already in care, the mix shift is context: more people start with a pen, some later need an operation, and sleeve is a smaller share of a smaller surgical total.

The datasets cannot prove why surgery declined

These analyses do not prove that GLP-1 use caused the decline in surgery. They are descriptive meeting studies, not randomized comparisons of treatment decisions. Insurance coverage, referral patterns, patient preference, access, stigma, clinical eligibility, and other factors could contribute to the trends.

The two datasets should not be added together. Cosmos used records for a population with severe obesity but without diabetes inside one electronic record network. MBSAQIP used a national surgical registry and counted procedures rather than the same patient population. ASMBS also publishes broader annual estimates built from additional data, which explains why other national totals can differ.

Receiving neither treatment in these records does not establish that a person received no obesity care of any kind. The analysis did not measure every nutrition, behavioral, primary-care, or non-GLP-1 medication intervention. It also did not determine which treatment would have been appropriate for each individual.

It does not prove GLP-1s caused the surgical decline. The two studies use different denominators, so the Cosmos counts should not be added to the MBSAQIP totals. It is not a reason to refuse medication or to rush an operation.