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I looked at my new consultation list last Monday. Five years ago, this day was reserved for new patients to the practice. Patients who had never had any treatments in the past for their struggles with obesity. Patients who had never had any exposure to evidence-based therapy. Last week, just like all the Mondays this year, there were just a smattering of patients that would fall into this category. Now, most of the new consultations were for weight recurrence, either after previous surgery or after failed medical weight loss therapy. I am not special, no bariatric practice is immune to the wave of GLP-1 usage among our patient population. Anew Gallup poll demonstrates that 11% of U.S. adults are currently on a GLP-1 for weight loss, up from just 3% in 2024. Fifteen percent report having tried one at some point. Obesity has ticked down to 36.4% from its 2022 peak of 39.9%, and awareness of these drugs is now at 91% of the public. Good news, on the surface, for population health.
The numbers worth sitting with are further down the report. Brand-name drugs like Ozempic and Zepbound still account for 68% of current use, but compounded or custom-mixed versions have grown to 19%, and a third of those compounded users switched over from a brand name, mostly to save money (66% cited cost or insurance as the reason). Effectiveness ratings between the two are close: 77% of compounded users call the drug effective or extremely effective, versus 74% for brand-name. That's close enough that patients have little incentive to go back once they've made the switch to an unregulated, custom-mixed product with no FDA oversight on dosing or purity.
That has direct implications for your consultations. Many of my patients now arrive having already tried a GLP-1, sometimes a compounded version obtained through a med spa or telehealth site with minimal screening, before anyone evaluated them for surgical candidacy. Gallup also flags that patients 65 and older report meaningfully weaker GLP-1 effectiveness, a group often steered toward the drug as a first option when surgery may be the better long-term fit given comorbidity burden and durability of results.
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There's a second wrinkle for practices staring over the cliff. Type 2 diabetes prevalence has flattened at 13.5% after 15 years of steady increases, tracking the obesity decline with a lag. That's a population-health win, but it doesn't tell us what happens to the patients who stop their GLP-1, whether from cost, side effects, or supply issues, and regain. Surgery's outcome data on durability at 5 and 10 years still has no real GLP-1 equivalent to compare against, since the drugs haven't been in mainstream use long enough to generate it. Practices are also increasingly fielding a different kind of consult: post-bariatric patients with weight regain asking about a GLP-1 as an adjunct, not a replacement.
Worth building into new-patient intake, given all of this: not just "have you tried a GLP-1," but which version, from where, for how long, whether they stopped, and what happened to their weight after they did. That last question is where a lot of the real referral opportunity is hiding.