GLP-1s and their impact on bariatric surgery

Bakst highlighted the growing attention on GLP-1 medications like Wegovy and Zepbound, noting their significant demand among consumers. However, she cautioned against viewing these drugs as a standalone solution.

"GLP-1s are really powerful drugs, but they can't operate in a silo, and they're not the silver bullet for the obesity epidemic," Bakst said.

A key concern among healthcare providers is whether the rise of GLP-1s will diminish the demand for bariatric surgery. Bakst shared contrasting experiences from different health systems: one reported a decline in bariatric surgery volumes, while another saw an increase, necessitating the hiring of additional bariatric surgeons. This dichotomy suggests that the relationship between GLP-1s and bariatric surgery is complex and varies by context.

Bakst also argued that the focus should not be on competition between GLP-1s and bariatric surgery but on how these treatments can complement each other within a comprehensive obesity care program. According to Bakst, providers need to "think more broadly about ways that you can make these two approaches to weight management complement one another."

How to design a comprehensive weight management program

According to Grimes, traditional obesity care often involves a fragmented approach, where patients are funneled through various specialists without a cohesive plan. This can lead to inefficiencies and missed opportunities for optimal care.

Raasch noted that successful programs share common elements, such as lifestyle and behavioral support, pharmacotherapy, surgical interventions, and services for comorbid conditions. Centralization is crucial, as it brings together these diverse services to create a seamless patient experience. "They take into account a complete picture of the patient's health," Raasch noted. "That might include a range of social support or economic support, things that really take into account the complete picture of a patient's health journey."

However, implementing comprehensive weight management programs is not without challenges. Bakst pointed out the financial and clinical uncertainties, particularly regarding insurance coverage and long-term outcomes.

"It's hard to put a lot of money and resources into a program that you're not sure what the ROI is," she said. Grimes added that the slow clinical ROI for obesity care can deter investment, as it takes time to see significant health improvements.

"For obesity specifically, it's a disease state that takes a long time to see if the services and the care that's going in is actually making a difference," Grimes said. "So provider organizations aren't seeing a very quick immediate return on investment in terms of care, investment being the outcomes for their patients. So it creates a cycle where then if they don't have the outcomes to back up the care that they're providing, then it's even harder to justify reimbursement when negotiating with payers."

Despite these hurdles, the potential benefits are substantial. For patients, comprehensive programs offer a more holistic and accessible approach to weight management. For clinicians, these programs provide a structured pathway to refer patients, alleviating the burden of navigating obesity care alone. Bakst noted that "44% of providers don't know how to approach obesity as a topic with their patients," which underscores the need for integrated support systems.

From a health system perspective, comprehensive programs can enhance patient retention and improve overall care quality. Raasch shared an example of a health system that consolidated 50 fragmented weight management programs into three centralized departments, significantly improving efficiency and patient outcomes.

To unlock the value of comprehensive weight management programs, the experts offered several recommendations, including:

1. Scale what works: Build on existing obesity services and expand into related areas, leveraging current capabilities.
2. Ease access to care: Ensure that patients have access to a centralized, navigable network of obesity care services.
3. Start small: Health systems should not feel overwhelmed by the scope of comprehensive programs. Instead, they should focus on understanding their specific patient population and gradually expand their services.

GLP-1s are a valuable tool in obesity treatment. They are most effective when integrated into a broader, more comprehensive care strategy. By adopting a holistic approach, healthcare providers can better address the multifaceted nature of obesity and improve outcomes for their patients.

"The question shouldn't be what are GLP-1s going to do to my surgical volumes," Burns said, "but how can I harness the attention from GLP-1s and structure my obesity care services to work together?"

Obesity is a complex healthcare issue that is often addressed with fragmented care delivery, but a growing amount of evidence supports the use of comprehensive care models to more effectively address obesity. Learn about the core characteristics of comprehensive obesity care and explore the standard and advanced approaches of programs at leading health systems.