Bariatric Surgery Declines 46% as GLP-1 Obesity Drug Prescriptions Surge to 24% of Eligible Adults

Bariatric surgery uptake has decreased since the fourth quarter of 2022, coinciding with a rise in prescriptions of semaglutide and tirzepatide for adults with obesity. In the third quarter of 2025, 24.17% of adults with a BMI of 40 kg/m2 or higher without an obesity-related comorbidity or those with a BMI of 35 kg/m2 or higher with an obesity-related comorbidity received a prescription for semaglutide or tirzepatide, whereas 0.09% of the study population underwent bariatric surgery during that same period.

Data collected from the Epic Cosmos electronic health record database identified 31,684,807 adults eligible for bariatric surgery using patient vitals and diagnostic codes (median age, 55 years; 60% women). Bariatric surgery procedures and prescriptions for semaglutide and tirzepatide were collected from the first quarter of 2017 through the third quarter of 2025.

Prescriptions of semaglutide and tirzepatide increased from 0.22% in the fourth quarter of 2018 to a peak of 24.17% in the third quarter of 2025. The percentage of adults undergoing bariatric surgery peaked at 0.17% in the fourth quarter of 2022 before falling to 0.11% in the fourth quarter of 2024 and 0.09% in the third quarter of 2025.

From the third quarter of 2022 to the third quarter of 2025, bariatric surgery procedures declined by 46.4%. During that period, there was a 50.1% decrease in sleeve gastrectomy and a 44.3% reduction in Roux-en-Y gastric bypass procedures.

Even with the increase in obesity medication prescriptions, 75.8% of the study group was not receiving any sort of pharmacotherapy or surgical treatment in the third quarter of 2025.

These drugs contain semaglutide and tirzepatide, which are GLP-1 receptor agonists that reduce sugar levels and appetite. Semaglutide and tirzepatide increase feelings of satiety or fullness, improves insulin sensitivity, and aids weight loss by reducing hunger and regulating appetite.

Semaglutide can achieve around 16 per cent weight loss, and tirzepatide can go over 20 per cent, especially when combined with diet and exercise. Older medications, like Orlistat, could only reduce about 5 per cent of body weight over several months.

The expiry of the semaglutide patent in India on March 20, 2026, marks an inflection point for the healthcare system. Generic versions of this medication will be introduced at significantly lower costs. Currently priced between R8,000-R11,000 these drugs are expected to become more affordable in the coming months as semaglutide will go off-patent, allowing generics to enter the market and widen access.

According to a report by Business Standard, sales of GLP‑1 weight‑loss therapies in India jumped about 115 per cent in 2025 compared with the previous year as new drugs such as Mounjaro and semaglutide variants gained traction.

Side effects, such as nausea, vomiting, bloating, and acidity are common. Patients with histories of pancreatitis, high triglycerides, thyroid cancer risk may face serious complications. The ready availability of these drugs in pharmacies has heightened the risk of misuse, with many being sold over-the-counter in violation of regulations.

Globally, there are now more than 20 crore humans taking GLP-1 medications. About 21 crore Indian men and 23 crore Indian women are obese in 2025, comprising a third of India's population according to the National Family Health Survey (NFHS-5, 2019-21).