Metabolic and Bariatric Surgery Utilization in the Era of Glucagon-Like Peptide-1 Receptor Agonists among Adolescents versus Adults

• Even with the growing popularity of newer weight loss medications like semaglutide (Ozempic/Wegovy), the number of teenagers undergoing weight loss surgery continued to rise — increasing by about 15% from 2021 to 2023. This suggests that surgery remains an important and trusted treatment option for teens with severe obesity.
• Among adults, the trend was different: weight loss surgery numbers actually declined from 2022 to 2023, likely because more adults are choosing GLP-1 medications instead. For teenagers, surgery and medications appear to serve complementary roles rather than one replacing the other.
• For the first time, Hispanic and Black teenagers represented the highest share of adolescents receiving weight loss surgery — a meaningful shift suggesting access to surgical care is improving for communities most affected by severe obesity.
• Sleeve gastrectomy remained by far the most common procedure for teens, used in more than 86% of cases each year. Nearly 40% of adolescents did not have surgery until their BMI reached approximately 50 — highlighting the importance of earlier evaluation and intervention when medically appropriate.
• The best approach to treating severe obesity in teenagers will likely combine multiple tools — including weight loss surgery, GLP-1 medications, and strong lifestyle support — tailored to each patient's individual needs.
• This study was published in The Journal of Pediatrics and analyzed data from nearly 4,500 adolescent surgeries at accredited U.S. centers — one of the most comprehensive looks at teen weight loss surgery trends in the GLP-1 era.

Why This Study Was Needed

GLP-1 receptor agonists such as semaglutide changed obesity care almost overnight. In late 2022 the FDA approved semaglutide for adolescents 12 and older after the STEP TEENS trial showed meaningful weight loss, and in early 2023 the 2023 AAP clinical practice guideline recommended that teens with obesity be offered both medication and, when they qualify, surgery. Many experts predicted that bariatric surgery would decline as patients turned to injections. This study checked whether that actually happened, and whether teens and adults followed the same path.

How the Study Was Done

Researchers analyzed the national MBSAQIP registry of accredited bariatric centers for 2021, 2022 and 2023, the first three years of widespread GLP-1 use for weight management. They compared the number of operations in adolescents (13–19 years) and adults (20 and older), overall and by race and ethnicity, and described how the teens who chose surgery changed over time.

What the Study Found

Teens and adults moved in opposite directions

• Adolescent surgery rose every year: 1,376 operations in 2021, 1,490 in 2022 and 1,581 in 2023.
• Adult surgery rose from 209,829 in 2021 to 229,159 in 2022, then fell to 216,323 in 2023 (P for trend = .003).

Growth was driven by Hispanic and Black adolescents

• Operations among Hispanic teens grew from 398 to 511 to 586, and among non-Hispanic Black teens from 266 to 296 to 316.
• By 2023, Hispanic adolescents made up 37.1% of teens having surgery, up from 28.9%; non-Hispanic White teens fell from 39.5% to 33.2%.
• Among adults, surgery increased in Hispanic and Black patients but declined in non-Hispanic White patients.

Who the teens were

• Most had a BMI above 40, and close to 40% had a peak BMI above 50.
• Sleeve gastrectomy accounted for more than 86% of adolescent operations each year.
• Sleep apnea before surgery rose from 18.5% to 23.1%, while reflux fell from 11.7% to 8.9%.

What This Means for Teens and Families

GLP-1 medications and surgery are not competitors; they are tools for different situations, and many patients will use both over time (see GLP-1 medications and surgery compared). For teenagers with the most severe obesity, often a BMI over 50, families and pediatricians are increasingly choosing surgery even with medication widely available. That fits what we know: surgery produces larger and more durable weight loss, while medications usually need to be taken indefinitely. A medical weight loss program remains an excellent option for many teens, and for some it is the bridge to surgery.

Clinical Pearls

• Adolescent bariatric surgery kept growing through 2023 despite the arrival of GLP-1 medications for teens.
• Adult surgery volume fell in 2023, a pattern widely attributed to GLP-1 uptake.
• Hispanic and Black adolescents accounted for most of the growth, narrowing the access gap documented in our 2022 Annals of Surgery utilization study.
• The typical teen having surgery has a BMI above 40; many exceed 50.

Strengths and Limitations

This is a large, national, recent dataset that captures the first three years of the GLP-1 era. It is a cross-sectional analysis: it shows trends but cannot tell us why individual families chose surgery, how many teens tried medication first, or how patients did afterward. Operations outside MBSAQIP-accredited centers are not included.

Expert Commentary

When semaglutide was approved for teenagers, I was asked whether adolescent bariatric surgery would disappear. This study gives the answer: it did not. For the teen with a BMI of 50 and sleep apnea, medication alone rarely gets them to a healthy weight, and families understand that.

I welcome GLP-1 medications. I prescribe them, and they have a real place before and after surgery. But this paper, together with our 10- to 18-year follow-up of adolescent patients, makes the case that surgery remains the most powerful and durable treatment we have for the most severe obesity in young people.

— Dr. Nestor de la Cruz-Muñoz

Related Research

• 2023 JAMA Pediatrics research letter
• 2022 Annals of Surgery utilization study
• 10- to 18-year follow-up of adolescent patients