Weight Loss Drugs vs. Bariatric Surgery: Obesity Treatment and Employee Health

Obesity is an expensive and complex health challenge for today's employers. This condition can create numerous chronic problems — increasing employee medical and pharmacy costs while lowering productivity.

Weight loss drugs, specifically GLP-1 receptor agonists (GLP-1s), have become increasingly popular for obesity treatment. Meanwhile, bariatric surgeries for obesity have fallen off, decreasing 25.6% in 2023.¹

New Highmark Health research compares GLP-1 drugs with bariatric surgery

Researchers from Highmark Health and Allegheny Health Network compared the effectiveness of GLP-1 drugs versus bariatric surgery. The research study analyzed the health insurance data of more than 30,400 people with Class II or Class III obesity.² Researchers also had access to clinical data for 1,548 people.

Class II obesity is defined as a BMI (body mass index) of 35 to 40. Class III indicates morbid obesity with a BMI of 40 or higher. Study participants were an average of 50 years old, with 66% percent identifying as female.

About 14,000 people in the study had bariatric surgery for weight loss. Bariatric surgeries included sleeve gastrectomy and gastric bypass. All others used a GLP-1 drug — either dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, or tirzepatide.

Health care utilization and cost differences

All study participants had medical coverage via a commercial or Medicare Highmark health plan. Researchers studied participant data for two years to compare the treatment options. The study focused on three critical outcomes:

• Weight loss
• Ongoing health care costs
• Health care utilization including ER visits and hospital stays

Bariatric surgery delivers 18% greater weight loss

People who had bariatric surgery lost an average of 28% of their total body weight, while people taking GLP-1 drugs lost an average of 10%. Data also shows that:

• 99% of surgical patients achieved at least 5% sustained weight loss versus 72% of those taking GLP-1 drugs.            
• 96% of surgical patients reached 10% sustained weight loss, versus 46% in the GLP-1 group.

Sustained weight loss of 10% or more can improve chronic conditions such as diabetes, heart disease, sleep apnea, and joint pain. Eliminating or lowering incidence of chronic disease also helps control long-term health care costs — for companies and individuals.

Long-term costs $11K lower with bariatric surgery

Researchers took a deep dive into cost implications when analyzing study data. Bariatric surgery had higher initial costs, but lower total costs. Findings show:

• $63,483 two-year total for GLP-1 drugs
• $51,794 two-year total for bariatric surgery
• $11,689 average savings per person that underwent surgery

The primary cost difference was pharmacy spending for GLP-1 drugs. People taking these medications require ongoing monthly refills to maintain weight loss. Employers managing rising drug costs can see those impacts to their bottom line.

Lower overall health care utilization for bariatric surgery

Researchers also discovered that bariatric surgery patients needed fewer health care services when compared to GLP-1 users. Comparative data showed:

• 38% fewer emergency room visits
• 27% fewer outpatient visits
• 25% fewer inpatient hospital stays

Lower utilization again translates into lower total medical costs and insurance claims. Bariatric surgery can result in better outcomes — and fewer health care visits — for people seeking obesity treatment.

Implications for employer health benefits plans

Data suggests bariatric surgery can offer better long-term results and lower costs for employees with severe obesity.

Employers can support each employee's individual weight loss journey by ensuring health benefits design focuses on long-term value and outcomes. Providing access to evidence-based obesity treatment providers and care navigation services is key.

There are opportunities to align your benefits plan against measures of affordability and overall better employee health. Talk to your benefits consultant or Highmark account manager about employee wellness programs for obesity and related conditions.

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