Study details

For the study, researchers compared the effectiveness and cost of semaglutide, the main ingredient in weight-loss drugs like Wegovy and Ozempic, and ESG as treatments for obesity within the American healthcare system.

The researchers simulated three groups of middle-aged patients with obesity who either received semaglutide, ESG, or no treatment at all, and looked at weight changes and healthcare costs over the course of five years.

Based on previous research, the study authors expected that people who did not undergo any treatment would be expected to gain weight during the five-year period.

Meanwhile, those who took semaglutide were expected to lose weight and keep it off provided they continued taking their medication. However, it was expected that around 20% of people would stop taking the medication because of side effects, meaning they would regain their weight.

Patients who underwent ESG were expected to lose weight, but would also risk experiencing adverse events, including surgery-related side effects like bleeding, infection, and stomach tears that could require another procedure. The researchers also assumed that some patients who didn't lose enough weight following ESG would need to have the surgery again or switch to another treatment like medication or a different surgery altogether.

The researchers also estimated the costs to the U.S. healthcare system for each group of patients, accounting for the effectiveness of the procedures, complications from treatment, and other factors.

It was assumed that patients receiving no treatment would cost the healthcare system nothing. However, Chris Thompson, an author of the study and a professor at Harvard Medical School, noted this was a conservative estimate, as "people that have ongoing obesity are going to definitely have increased healthcare expenditures in a variety of ways," like needing insulin because they have diabetes or having complications from heart disease.

"But the problem with [the complications of obesity], it's a little more subjective," Thompson added. "So it's harder to get the actual numbers on the healthcare costs for those."

The researchers also accounted for the initial costs associated with ESG or a repeat ESG, adverse events related to ESG, and the monthly cost of semaglutide.

In total, over a five-year period, the researchers found that semaglutide would cost $33,583 more per patient on average than ESG, and that patients would lose more weight after undergoing ESG. They also found that quality of life was slightly higher in patients who underwent ESG compared to those who took semaglutide.

The researchers also estimated that in order for the two treatments to be equally cost-effective, the price of semaglutide would have to drop from its current $13,618 per year to $3,591 per year.

Discussion

According to Neil Floch from Yale University and director of bariatric surgery at Greenwich Hospital, weight-loss interventions fall along a spectrum, going from non-invasive options to more surgically invasive options.

These can range from lifestyle interventions like diet changes or increasing physical activity, to gastric bypass surgery, which requires invasive surgery, Floch said.

"The Roux-en-Y gastric bypass is considered the 'gold standard' for weight loss, leading to the most weight lost," said Kirsten Frederiksen, chair of the Obesity Medicine Association's Bariatric Medical-Surgical Committee. "But is it always covered by insurance? No. Do patients always want it? No. So we need these other options."

Thompson said he believes there's value in determining the cost-effectiveness of other medical devices and procedures similar to what was done in the study.

"We have a responsibility to estimate the economic impact of these devices or procedures to the healthcare system," he said. "Is it going to reduce overall costs or increase them?"

Frederiksen said she agrees but added that there are challenges to accurately assessing costs. She also noted that the researchers didn't consider every factor that could affect costs.

"They found that about a third of patients who had ESG needed to be on an anti-obesity medication — in addition to having had the procedure — in order to keep the weight off," Frederiksen said. "So would that increase the cost? It could potentially by a lot."

While a cost-benefit analysis can be useful to estimate the impact of certain treatments on the healthcare system, when it comes to deciding which weight-loss treatments to use, it's more about individualizing care, said Spencer Nadolsky, an obesity and lipid specialist and medical director at Weight Watchers.

"All options should be discussed with patients, and there should be a shared doctor-patient decision-making process to decide which therapy is best for them at that time," Nadolski said.

"[Doctors] should also discuss the risks and benefits [of all treatments] with patients based on their individual needs," Nadolsky added. "Patients ultimately have autonomy on what they want to do. While GLP-1s are expensive, we still see patients wanting to pursue them."

Advisory Board's weight-related resources

According to CDC data, more than 70% of U.S. adults ages 20 and older are either overweight or obese. Obesity is also prevalent  among children, with rates growing between 17.7% and 21.5% over the last decade.

As obesity rates continue to rise, so will healthcare costs. Currently, obesity costs the U.S. healthcare system $173 billion every year.  

To help address the growing weight-related issues in healthcare, Advisory Board offers several resources on different topics, including:

GLP-1 drugs

Interest in new weight-loss drugs, including Novo Nordisk's Wegovy and Eli Lilly's recently approved Zepbound, has surged this year, leading to record sales — as well as supply shortages as manufacturers struggle to keep up with demand.

Advisory Board's Chloe Bakst and Rachael Peroutky  recently shared their insights on how GLP-1 shortages might impact healthcare and what leaders can do in the meantime.

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 the expert insights  "5 catalysts that will impact the future of weight management drugs,"  and  "What the headlines get wrong about weight management medications."

Bariatric surgery

In 2022, the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders updated guidelines for weight-loss surgery, expanding eligibility for more people.

Under the new guidelines, anyone with a BMI over 35, regardless of their health status, is eligible for weight loss surgery. People with a BMI over 30, which is the official definition of obesity, are also eligible if they haven't been able to achieve substantial or long-term weight loss.

This expert insight outlines three barriers to bariatric surgery and how to overcome them. For patients considering bariatric surgery, this resource offers three factors they should keep in mind while they decide.

Meanwhile, this decision guide offers resources to help you build a successful weight management program that effectively attracts new patients struggling with obesity. It also guides patients through their care journey and keeps them engaged in the long term.

Healthcare's approach to obesity

Recently, healthcare organizations have made an effort to move away from using BMI to determine obesity and assess health. In June, the American Medical Association voted to adopt a new policy that moves away from using BMI alone when assessing whether a patient is at a healthy weight.

Some physicians are also looking beyond BMI and people's weight as they assess their health and recommend treatments. Instead of focusing on weight loss to treat health issues, some providers are now taking a "weight-neutral" approach that avoids intentional weight loss.

In a recent Radio Advisory episode, Rachel Woods and Advisory Board experts Darby Sullivan and Chloe Bakst discussed healthcare's current approach to obesity and whether it's helping or harming patients.

Similarly, this expert insight covers three missteps in our current approach to obesity, outlining five potential ways providers can address these issues. (Marshall, CBS Boston, 4/16; Radcliffe, Healthline, 4/15)