It usually begins the same way. A promise to start fresh on a Monday. A new diet chart saved on the phone. A gym membership that feels like a commitment to a better life. Weight loss - something most of us fall into at some point - comes with its own cycle of hope and frustration. From home remedies and strict routines to trending fitness hacks, people try it all. And now, a new player has entered the scene with unprecedented momentum: weight-loss drugs. With dramatic before-and-after transformations flooding social media, medications like semaglutide and tirzepatide are not just gaining attention, they are reshaping how people think about obesity treatment.
In the United States, this shift is already producing measurable impact. The explosive rise of these drugs is beginning to alter long-established medical pathways, including one of the most effective treatments for severe obesity - bariatric surgery. New research presented at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) found that the number of bariatric procedures dropped below 2 lakh in 2024, marking a decline of more than 20% from the previous year. This is the first such dip since the pandemic year of 2020.
Considering that GLP-1 drugs such as semaglutide and tirzepatide are rapidly entering the Indian market, along with the possibility of cheaper generics, the question becomes increasingly relevant: could India be heading toward a similar shift?
What is bariatric surgery?
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According to the Mayo Clinic, “gastric bypass and other types of weight-loss surgery—also called bariatric or metabolic surgery—involve making changes to your digestive system to help you lose weight.”
These procedures are typically considered when conventional methods such as diet and exercise have not been effective, or when excess weight has led to serious health conditions.
Bariatric surgery works in different ways. Some procedures limit how much food a person can consume by reducing the size of the stomach, while others reduce the body’s ability to absorb fat and calories. In some cases, both mechanisms are combined. While the benefits can be significant, the surgery is not a quick fix. It requires lifelong lifestyle changes, including a strict diet and regular physical activity, to ensure lasting results.
The procedure is generally recommended for individuals with a body mass index (BMI) of 40 or higher, or those with a BMI between 35 and 39.9 who also suffer from obesity-related conditions such as type 2 diabetes, high blood pressure, or severe sleep apnea. In certain cases, even individuals with a BMI of 30 to 34 may qualify if they have serious health complications.
The potential benefits are extensive. Bariatric surgery can reduce the risk of life-threatening conditions including heart disease, stroke, high cholesterol, nonalcoholic fatty liver disease, and even certain cancers. It has also been shown to improve or resolve type 2 diabetes and sleep apnea, significantly enhancing quality of life.
However, as the Mayo Clinic notes, these are major surgical procedures that come with risks. Short-term complications may include excessive bleeding, infection, reactions to anesthesia, blood clots, and breathing problems. In rare cases, it can be fatal. Long-term risks vary depending on the type of surgery but may include bowel obstruction, dumping syndrome - which leads to symptoms like nausea and dizziness - gallstones, hernias, malnutrition, ulcers, and acid reflux. Some patients may even require revision surgeries.
Bariatric surgeries drops over 20% in the US
Researchers from Loyola University in Chicago based their estimates on data from the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP), which compiles outcomes from accredited bariatric centres across the country.
“After years of steady growth, the number of metabolic and bariatric procedures in the U.S. is experiencing a decline amid persistently high obesity rates and a surge in the use of GLP-1 medications,” said lead study author Tyler Cohn, MD. He added that while the study did not establish causation, there is concern that many patients may be opting for non-surgical treatments without fully understanding all available options.
The study also highlights shifts within surgical practices themselves. Sleeve gastrectomy, which had long been the dominant procedure, declined from 64% of all surgeries in 2020 to 58% in 2024. In contrast, gastric bypass procedures increased to 32.82%, their highest share in five years. Revision surgeries - modifications of previous procedures, also rose from around 9% to 11% over the same period.
Other procedures, such as gastric banding and more complex surgeries like biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodeno-ileal bypass (SADI), each accounted for less than 2% of total cases.
Experts believe the growing popularity of GLP-1 drugs is influencing patient choices. “GLP-1s are starting a conversation in doctors’ offices that really wasn’t happening as much as it should have been,” said Richard M. Peterson, MD, President of ASMBS. He emphasised that while the attention around these medications is beneficial in raising awareness, it is crucial for patients to understand all proven treatment options.
Despite the decline, bariatric surgery remains underutilised. According to ASMBS, less than 1% of eligible individuals undergo the procedure each year, even though it is considered one of the most effective long-term treatments for severe obesity. The surgeries not only lead to significant and sustained weight loss but also improve or resolve conditions such as type 2 diabetes, heart disease, and hypertension. Importantly, their safety profile is comparable to commonly performed procedures like gallbladder surgery, appendectomy, and knee replacement.
Will India also see similar trends?
Dr Shashank Shah, Bariatric surgeon at Apollo Spectra Hospital, Pune, emphasised that while weight-loss drugs such as GLP-1 medications are gaining popularity, they may not be a substitute for surgery in all cases. According to him, bariatric surgery continues to remain the most effective and long-term solution, particularly for patients with severe obesity and related conditions like diabetes, sleep apnea, and hypertension.
“The choice depends on the patient’s BMI, overall health, medical complications, and long-term weight management goals,” he said, stressing the importance of personalised medical guidance. He added that patients should consult a bariatric specialist before making any decision, rather than relying on trends or self-medication. “Don’t try to take any weight-loss medication on your own. Make informed decisions about your health with the help of an expert,” he advised.
Dr Shah noted that while weight-loss drugs can support gradual weight reduction, their use must be carefully monitored. “These medications should only be taken on a doctor’s advice. Don’t just take them because others are doing so,” he said.
At the same time, he reiterated the long-term benefits of surgical intervention in appropriate cases. “Bariatric surgery is more effective, safe, and provides sustainable results for patients with severe obesity and diabetes,” he said.
He also pointed out that “the growing shift toward weight-loss drugs may face practical limitations, particularly in the Indian context.” Factors such as high costs, misuse, limited awareness, and unequal access to treatment could restrict their widespread adoption. According to him, “many patients dealing with severe obesity may still require bariatric surgery to achieve lasting results and an improved quality of life.”
Dr P. Praveen Kumar Reddy, Consultant in General Medicine at SRM Prime Hospital, Chennai, said the choice between weight-loss drugs and bariatric surgery should be individualised, based on BMI, associated conditions, and long-term health goals.
He explained that GLP-1 drugs are generally prescribed for individuals with a BMI of 30 or higher, or 27 and above in those with obesity-related conditions such as type 2 diabetes, hypertension, high cholesterol, sleep apnea, or cardiovascular disease. Bariatric surgery, on the other hand, has traditionally been recommended for patients with a BMI of 40 or above, or 35 with serious comorbidities.
“In recent years, obesity and diabetes organisations have advocated lowering these BMI cut-offs to 35 and even 30 in certain cases, which has also led to broader insurance coverage for bariatric procedures,” he said.
Dr Reddy noted that GLP-1 medications can be effective, particularly in the short to medium term. “On GLP-1 drugs, patients can typically lose around 8% to 21% of their total body weight over a period of 6 to 18 months, which is considered a normal and expected response,” he explained.
However, he emphasised that surgical outcomes may be more durable in appropriate cases. “Bariatric surgery is likely to be superior when it comes to sustained and long-term weight loss, especially for patients with severe obesity,” he said.
He added that the two approaches are not necessarily alternatives but can complement each other in a patient’s treatment journey. “Some patients may begin with GLP-1 medications to assess response, while others may opt directly for surgery. In cases where patients do not respond to medication, lose access, or experience side effects, bariatric procedures such as sleeve gastrectomy can offer a more permanent solution,” he said.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
