Highmark study: Surgery beats drugs like Ozempic for those looking to lose weight

Sep. 17—Weight loss surgery is a cheaper and more effective way than medications like Ozempic for obese patients to shed pounds, according to a Highmark Health study released Wednesday that tracked thousands of people.

Patients with severe obesity lost 28% of their weight on average, compared to just 10% with the GLP-1 class of drugs.

Surgeries were tied to 18% lower costs compared to GLP-1s. The medications cost about $63,000 versus $52,000 for surgeries, including the initial procedure and follow-up care.

The study also found patients who underwent surgery had 25% fewer inpatient hospital stays and 38% fewer trips to the emergency room.

Highmark pulled data from its insurance division, Highmark Health Plan, as well as its Allegheny Health Network hospitals to examine outcomes for more than 30,000 patients treated between 2018 and 2023. Cost and outcomes were tracked for the two years after a patient started treatment.

The study was published in the Journal of the American Medical Association's surgical edition. It comes just one day after the release of a similar study from Cleveland Clinic, which found people with obesity and Type 2 diabetes who choose surgery over medications live longer and face fewer health problems.

Both studies have massive implications for the more than 40% of Americans who live with obesity, a disease linked to higher rates of heart failure, diabetes and more.

Common weight loss surgeries include a gastric bypass, which rearranges the digestive system to promote weight loss, and a sleeve gastrectomy, where surgeons remove about 80% of the stomach, per the Mayo Clinic.

As the study notes, these surgeries are "usually considered a last resort" to treat obesity.

They were put up against GLP-1s, which go by brand names like Ozempic, Wegovy and Mounjaro.

Lasting solution?

GLP-1s were first designed to manage diabetes by improving insulin production. As it turned out, they can also temper appetites and slow digestion, leading to their widespread use as weight loss tools.

Some brands are prescribed off-label for weight loss, while others have specific approval from the federal Food and Drug Administration. Most GLP-1s are injectable, though more pill-based forms could be on the horizon.

From 2019 to 2024, the number of people prescribed GLP-1s shot up by almost 600%, according to health care research nonprofit FAIR Health.

An August report from RAND, another research nonprofit, found nearly 12% of Americans have used GLP-1s to slim down.

Insurers say they're getting crushed trying to keep up.

List prices for these drugs come in around $1,000 a month, and treatment is indefinite.

Research shows most people who stop taking GLP-1s regain lost weight in a matter of months. Surgery, on the other hand, comes with high initial costs, but can be a lasting solution when paired with diet and exercise.

"The question we were really asking ourselves is how much time needs to go by with using the medications before the economics of surgery make sense for the member," Keith Lejeune, senior vice president of research and innovation at Highmark Health, told TribLive.

Though the study published Wednesday, Highmark got the results months ago.

Surgery eligibility

Its insurance arm used the data and recommendations from medical associations to lower the minimum body mass index its members need to qualify for weight loss surgery.

"Our goal is to ensure our medical policies for bariatric surgery are allowing it to be as accessible as these medications," Lejeune said.

The procedures remain available only "when medically appropriate and when more conservative measures for weight reduction are not effective," the policy says.

Bariatric surgery is not without its issues.

Immediate risks include infection, bleeding and leaks in the digestive system. In the long term, patients could develop dumping syndrome, when food passes through the stomach too quickly, as well as ulcers, malnutrition and bowel obstructions.

Not everyone loses weight, either, often because of an inability to make lifestyle changes.

These factors can lead people to wish they never had surgery at all. Last year, researchers at the University of Wisconsin looked at past studies and found up to 20% of people who underwent a weight loss procedure felt regret.

George Eid, chair of Allegheny Health Network's Bariatric and Metabolic Institute, said these surgeries are safer and more effective than ever.

Surgeons no longer need to make big incisions, and most procedures last an hour or less, according to Eid. Patients typically go home the next day. Complications are rare.

"Any intervention is going to have side effects," Eid said. "The advancement in surgery has been amazing to the point that it's one of the safest surgeries."

While GLP-1s remain a good option for people with moderate obesity, Eid said his hope is to lower perceptions of weight loss surgery as a dangerous or dramatic step.

"The only thing I can do is show them data and science," he said.

Jack Troy is a TribLive reporter covering business and health care. A Pittsburgh native, he joined the Trib in January 2024 after graduating from the University of Pittsburgh. He can be reached at jtroy@triblive.com.

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