Originally published on May 14, 2024.


The weight-loss drugs marketed under brand names like Ozempic and Wegovy can seem like a miracle cure, the answer to the rising rates of obesity.

These new GLP-1 drugs (for glucagon-like peptide-1 receptor agonists) do help people lose weight. Originally developed to treat type 2 diabetes, they also appear to help the heart.

The drugs are delivered by weekly injections and work by delaying gastric emptying to make people feel full longer. The downside is the drugs are expensive, and users have to continue to take them for life to sustain their weight loss.

The cost of taking semaglutide for five years was over $53,000 per patient, compared to just under $20,000 for ESG bariatric surgery.

That is why, contrary to the glowing reports in popular media, healthcare experts are not totally enthusiastic about the new drugs' broad potential to curb obesity. The problem is cost.

“GLP-1s changed the landscape,” Muhammad Haseeb, the lead author of a study that looked at the long-term cost of the new anti-obesity medication semaglutide compared to a form of bariatric surgery, told the Harvard Gazette. “[Semaglutide] is effective, no question about it. But at more than quadruple the price of previous drugs, it comes at a very high cost.”

To get a picture of how the cost and effectiveness of the new weight-loss drugs stack up against gastric surgery, the team compared the price and effectiveness of semaglutide with endoscopic sleeve gastroplasty (ESG), an incisionless form of noninvasive gastric surgery for obesity.

“The purpose of the study [was] to give the whole picture, over the longer term,” Haseeb explained, and it revealed the cost of the GLP-1 drugs was far higher than bariatric surgery over time. The cost of taking semaglutide for five years was over $53,000 per patient, compared to just under $20,000 for ESG bariatric surgery.

Not only was surgery less expensive in the long run, it resulted in greater weight loss. On average, endoscopic sleeve gastroplasty patients lost 18 percent of their body weight over five years, and their BMIs dropped from 37 to 31.7. Patients taking semaglutide lost an average of 15 to 16 percent of their body weight over five years and had an ending BMI of 33.

Semaglutide was the most cost-effective treatment after one year, but as drug costs continued, gastroplasty's cost-benefit rose.

The researchers used data from the results of separate clinical trials of semaglutide injection and endoscopic sleeve gastroplasty that Haseeb brought together in a single computer model.

Semaglutide was the most cost-effective treatment after one year, but as drug costs continued, gastroplasty's cost-benefit rose. The price of semaglutide would have to drop from $13,618 to $3,591 each year to be as cost-effective after five years — a three-fold decrease.

“If you think about it, this is actually astonishing,” said Haseeb, who began the work while studying for a master's degree in clinical investigation at Harvard Medical School. He is currently a fellow at University of Pittsburgh Medical Center.

It's not that the new medications are being overused, said another author of the study, Jagpreet Chhatwal, associate professor of radiology at Harvard Medical School and Massachusetts General Hospital. “Rather, their current pricing structure is disproportionate to their value. There are other, more effective weight-loss options like ESG, which …should be considered along with medications. These have been overshadowed by the excitement about the recent GLP-1 weight-loss medications.”

Gastroplasty surgery is reversible, though it can be a permanent fix. That contrasts with the GLP-1 medications which must continue to be taken even after weight loss has plateaued in order to maintain lower weight.

The study is published in JAMA Network Open.