US Bariatric Surgery Volumes Climbed for a Decade, Then Fell Two Years Running

For roughly a decade, the number of metabolic and bariatric operations performed in the United States climbed almost without interruption. Then it turned. Adult procedure volume, as recorded by the field’s national quality registry, reached 229,826 in 2022, slipped to 216,968 in 2023, and fell to 176,915 in 2024 — a two-year drop of about 23% from the peak.

That is the central finding of a repeated cross-sectional analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), published in Obesity Surgery. The study covers 1,970,021 patients who had an operation between 2015 and 2024, making it the most complete recent accounting of how much bariatric surgery the country is actually doing.

A registry, not a survey

MBSAQIP collects standardized data from accredited centers and issues Participant Use Data Files — a near-census of US bariatric practice rather than a sample. The authors pooled those files for a decade, split patients into adolescents (ages 10 to 18) and adults (19 and older), and modelled annual volumes with segmented negative binomial regression, placing a prespecified change point at 2022. That design lets them estimate separate trends for the run-up and the two years after.

The population was dominated by adults: 1,964,090 of the 1,970,021 patients. Sleeve gastrectomy accounted for 61.8% of all procedures, Roux-en-Y gastric bypass for 27.7%. Those two operations are, in effect, the field.

What rose, and what fell

The trajectory differs sharply by age group.

Among adults, utilization rose significantly from 2015 to 2020 (p < 0.0001), then declined significantly across 2022 to 2024 (p < 0.001). Adolescents followed a gentler arc: volume rose significantly from 2015 to 2020 (p = 0.021), climbed to 936 procedures in 2023, and eased to 820 in 2024 — a change the model did not find statistically significant (p = 0.98). Teen bariatric surgery remains rare, and its recent movement is, in statistical terms, flat.

The dip is a fact; the cause is not in the data

The registry counts operations. It does not record why a patient or a surgeon chose one path over another, so the study cannot say what drove the adult decline. The authors are explicit on this point, writing that the “emerging pattern warrants continued surveillance” and framing the question as one about surgical access, treatment selection, and the delivery of obesity care — not about demand alone.

The timing overlaps with the arrival of highly effective incretin therapies, and that is where a second, separate paper is useful. A narrative review in Surgery for Obesity and Related Diseases argues that glucagon-like peptide-1 (GLP-1) drugs and surgery should be understood as complements rather than competitors. Its authors note that GLP-1-based therapies produce roughly 15% to 21% total body weight loss in randomized trials but require sustained administration to hold that effect, while bariatric surgery typically achieves 25% to 35% total body weight loss with durable metabolic benefits. Emerging evidence, they write, supports using these agents before and after surgery as adjuncts — with unresolved questions about timing, patient selection, duration, and cost.

That argument is a narrative review, a lower tier of evidence than a randomized trial or a systematic review: it synthesizes existing literature and reflects its authors’ clinical judgment. It is best read as a framework for interpreting the volume data, not as proof that medication substituted for surgery.

Where access fits in

The society’s own yearly tallies tell a compatible story. ASMBS estimates that total bariatric procedures — a broader measure that includes endoscopic and revisional work — reached 279,967 in 2022 before settling to 270,089 in 2023, with sleeve gastrectomy at 157,254 and gastric bypass at 63,132 that year. Those figures are estimates drawn from several data sources, and they lag the registry by a year, but the direction matches.

Combine the two and the practical stakes come into focus. If fewer operations are being done, the question is whether patients who meet criteria are being offered surgery, whether referrals are shifting, and whether accredited centers are absorbing the change evenly. The paper does not answer those questions. It measures the size of the shift that makes them worth asking.

What the data can and cannot say

This is observational, registry-based evidence. Propensity methods and regression adjust for what is measured; they cannot rule out unmeasured differences, and the study makes no claim of causation. It also cannot speak to outcomes after surgery — only to how often surgery happened.

For outcomes, the field relies on a different instrument. The LABS study, a multi-centre prospective cohort funded by NIDDK, followed thousands of patients after bariatric surgery and remains the largest long-term observational account of safety and weight outcomes. A volume registry and a longitudinal cohort answer different questions: one counts operations, the other follows the people who had them. Both are needed to see a field clearly.

For now, the decade of MBSAQIP data adds a clean, well-measured fact to the record: US adult bariatric surgery reversed course in 2023 and 2024. Whether that is a durable turn, a reallocation toward medication, or a temporary correction is a question only the next few years of surveillance can settle.

This article reports published research and registry analyses. It is not medical advice. NIDDK Labs Archive is an independent informational resource and is not affiliated with the NIH, NIDDK, or the LABS research group; references to LABS describe that NIDDK-funded study, not this site’s own work.