Abstract / Summary
Traditionally, bariatric surgery has been the primary intervention for obesity management. However, the approval of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in 2014 for weight management marked a change in the trend of obesity management. In this study we aim to analyze the real-world trend in obesity management. A cross-sectional analysis was conducted using the Epic Cosmos database. Outcomes included the incidence of GLP-1 RA prescriptions and bariatric procedures per 1000 people, stratified by sex and age between 2016 and 2025. Out of 68,063,801 patients with BMI ≥ 30 kg/m 2 , aged ≥ 18 years, and had no diabetes, GLP-1 RA prescription has been increasing, especially among those aged 45–65, with women demonstrating higher prescription rates. Simultaneously, surgical rates have declined across the majority of demographics after peaking towards the end of the COVID-19 pandemic in 2022. From 2016 to 2025, GLP-1 RA prescription rates increased substantially, while bariatric surgery rates showed a modest overall decline, with variation across age and sex subgroups. These concurrent aggregate trends do not establish a causal relationship or indicate that pharmacologic treatment replaced surgery at the individual-patient level. Patient-level longitudinal studies are needed to evaluate the relationship between these treatment patterns and their clinical safety and effectiveness.