Where things stand

Marmolejos noted the dramatic rise of GLP-1 medications and the trend's effect on the market. "About 6% of U.S. adults are using GLP-1s today, compared to less than 1% prior to 2019," Marmolejos said.

This surge in GLP-1 usage has created long waitlists at weight management clinics and has directly impacted bariatric surgery volumes, as many eligible patients now prefer pharmacological options.

However, Marmolejos cautioned that it's too early to assess the surge's full impact on national obesity rates. While overall prevalence appears to have plateaued, severe obesity has slightly increased, suggesting that more data is needed to draw definitive conclusions.

The regulatory environment also remains complex. Medicare's refusal to cover GLP-1s for weight loss, despite earlier proposals, reflects legal constraints and political ambivalence.

However, despite declining surgery volumes, bariatric providers remain optimistic. Vogel noted that patient preferences have shifted before — lap-band procedures once made up 35% of surgeries but now account for less than 1%. High discontinuation rates for GLP-1s (around 50% within a year) may eventually drive patients back toward surgical options.

In addition, some providers are experimenting with combination therapies, using GLP-1s post-surgery to maintain weight loss. "They're not necessarily mutually exclusive," Marmolejos said.

Virtual-first providers are also reshaping access to obesity care. Vogel categorized these platforms into three groups: general telemedicine platforms like Hims & Hers, weight-loss focused platforms like Weight Watchers, and multi-condition management providers like Calibrate and Vida.

These disruptors offer convenience and speed but lack comprehensive services, like surgery and cardiometabolic care, that traditional providers can deliver.

What's next?

According to Marmolejos and Vogel, competition is heating up in the anti-obesity drug space, as 157 anti-obesity drugs are currently in clinical trials — seven of which are in phase three. New entrants from companies like Amgen and Boehringer Ingelheim could potentially drive down prices and expand access.

Marmolejos predicted that oral GLP-1s will "take the market by storm," especially among patients hesitant to use injectables. She emphasized the need for providers to help patients navigate the pros and cons of new therapies.

Providers will have to continue adapting to a shifting landscape by cross-training staff, integrating virtual visits, and partnering with primary care.

Marmolejos used the example of Michigan Medicine's weight navigation program, which pairs patients with obesity specialists to create personalized plans, increasing referrals to bariatric services.

Administrative burdens also remain a challenge, especially with inconsistent payer policies. Some providers are restructuring teams or partnering with vendors to streamline prior authorization processes.

The obesity care landscape is rapidly evolving. "Things are going to continue to change — whether it's coverage decisions, consumer preferences, or the competitive landscape," Woods said. As a result, for healthcare professionals, staying flexible and informed isn't just advisable, it's essential.

Advisory Board's weight management-related resources

To help you address the growing use of weight management drugs, Advisory Board offers several resources:

• This expert insight outlines the five biggest questions about weight management drugs and their answers. Similarly, this expert insight addresses what headlines get wrong about weight management drugs and what healthcare leaders should know instead.
• Radio Advisory's Rachel Woods has also covered GLP-1 drugs on the podcast, discussing the potential future of these drugs and how they could help — or hurt — health systems' finances. Other useful resources include this expert insight on the five catalysts that will impact the future of obesity care and this research on four key elements of comprehensive obesity care.
• Our weight management and obesity care resource library can also help leaders understand the current care landscape, manage innovations, and prepare for transformations in care.