Medicare fee‑for‑service bariatric surgery rates fell from 47.1 to 16.6 per 100,000 between 2014 and 2024

Primary bariatric surgery among fee-for-service Medicare beneficiaries fell from 47.1 operations per 100,000 people in 2014 to 16.6 per 100,000 in 2024, a 64.8% drop, according to a research letter published online September 9, 2026, in JAMA Surgery.

The authors, Ryan Howard, Ahmad Hider, Jesse Chandler, and Justin B. Dimick, examined public Medicare data across that decade. They used an interrupted time series, a method that looks for changes in the slope or level of a trend at chosen dates, with breakpoints in 2020 and 2022.

Rates were already falling before the pandemic, then fell faster after 2022

Before COVID-19, primary surgery rates were already declining by about 3.2% per year. In 2020, rates dropped abruptly. After 2022, the decline steepened to about 23.1% per year.

That later acceleration lines up in calendar time with much wider use of GLP-1 medicines for obesity. The letter is careful on what that timing can and cannot prove. Coincidence in time is not the same as proof that medicines replaced operations for the same patients.

Fee-for-service Medicare is the traditional Medicare program that pays hospitals and doctors for each service. Many older adults and people with disabilities rely on it, and obesity-related disease is common in that group. A large public payer's surgery rate is one signal of whether operative care remains reachable.

The letter cannot prove that GLP-1 drugs caused the drop

Howard and colleagues note that other studies have linked falling surgery volumes to GLP-1 uptake. Their Medicare series adds a longer view: the decline started years before the surge in those medicines, then sped up after 2022.

Several other explanations remain open. Eligibility rules and comorbidity mixes can change. Patients can move from fee-for-service Medicare into Medicare Advantage plans, which this dataset does not fully capture. Successful medical treatment may keep some people off the operating schedule. Referral pathways can stall for reasons that have nothing to do with a prescription fill.

The post-2022 slope estimate rests on only three annual data points. That is a thin base for a long-term prediction, and the authors treat it as a signal to watch rather than a settled forecast.

What the numbers do not tell a patient deciding about surgery

These are population rates, not results from a trial that assigned people to surgery or medicine. They do not say whether any one reader would lose more weight, face more risk, or live longer with an operation, a GLP-1 drug, both, or neither.

They also do not measure quality of care at individual hospitals. A falling national rate can reflect fewer referrals, longer waits, tighter coverage, patient preference for medicines, or a mix of all of those.

For clinicians and programs, the practical takeaway in the letter is to treat shrinking operative volume as a reason to check access, not as proof that every patient who might once have had surgery has found an equally good alternative. Looking at who is referred, who completes evaluation, and who leaves the pathway still matters while obesity medicines expand.