GLP-1 RAs Have Higher Utilization Among Patients With Obesity Than Bariatric Surgery
Key Takeaways:
- In an analysis of US adolescents and young adults with obesity, researchers found that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were more popular as initial intervention than metabolic and bariatric surgery (MBS).
- Utilization of GLP-1 RAs increased between May 2022 and January 2026 from 88.2% to 96.1%, while MBS utilization decreased from 11.6% to 3.7%.
- Varied utilization based on patient characteristics is more likely due to different treatment decision-making rather than access barriers.
As rates of severe obesity continue to rise among US adults and adolescents, effective weight management therapies are critical. The most common treatments for obesity include GLP-1 RAs, MBS, or both.
In order to help inform treatment decision-making and optimization, researchers evaluated the treatment patterns of all 3 therapy options among US adolescents and young adults.
The study used data from Epic Cosmos to observe individuals aged 13 to 25 years who were treated for obesity between May 2022 and January 2026. Patients were categorized into 3 groups based on treatment: GLP-1 RA only, MBS only, and combined GLP-1 RA and MBS.
Obesity Treatment Patterns Among US Adolescents and Young Adults
Among the 204 148 patients included in the study, 94.1% received GLP-1 RAs, 4.4% received MBS, and 1.5% received a combination of both therapies.
Not only were GLP-1 RAs the most common treatment option, but their use also increased significantly from 88.2% to 96.1% during the study period. MBS utilization, on the other hand, decreased from 11.6% to 3.7%.
Among patients who received combination treatments, 72.3% initiated GLP-1 RAs before MBS, further demonstrating the clinical preference for GLP-1 RAs over MBS.
Patient Characteristics for GLP-1 RAs and MBS
Rates of GLP-1 RAs use were higher among adolescent (97.2%), male (95.6%), and Asian (97.3%) patients.
Exclusive use of MBS was more common among young adults than adolescents (5.1% vs 1.7%), females than males (4.9% vs 3.2%), and Hispanic and Black patients than White patients (8.8% and 4.7% vs 2.5%).
Combined treatment utilization was relatively similar between adolescents and young adults as well as male and female patients. It was slightly more common among Hispanic and Black patients than White patients (2.1% vs 1.2%).
Implications for Managed Care
The study’s findings highlight the shift in obesity treatment toward the increased adoption of GLP-1 RAs among adolescents and young adults.
The treatment patterns based on sex and ethnicity may reflect differences in treatment decisions rather than disparities in care.
The authors noted, “These findings underscore the rapid transformation of obesity care for [adolescents and young adults] and highlight the need for evidence-based guidance on treatment sequencing and long-term outcomes.”
Reference
Messiah SE, Ernest DK, Elnakieb Y, et al. GLP-1 receptor agonist and bariatric surgery utilization among adolescents and young adults. JAMA Pediatr. 2026. doi:10.1001/jamapediatrics.2026.2828
