A landmark JAMA study analyzing insurance claims data from 4.1 million patients found that GLP-1 receptor agonist use was associated with a 28% reduction in ER visits attributable to obesity-related conditions over a 24-month follow-up period — findings with significant implications for emergency department volume projections.
GLP-1 receptor agonists — the drug class that includes semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) — have reshaped the treatment of obesity and type 2 diabetes since their widespread adoption beginning in 2022. A new JAMA study suggests their impact may extend well beyond the endocrinology clinic, with measurable effects on emergency department utilization that could reshape volume projections for hospitals nationwide.
The study, conducted by researchers at Brigham and Women's Hospital, Stanford University School of Medicine, and the University of Pennsylvania, analyzed insurance claims data from 4.1 million patients enrolled in commercial health plans between January 2022 and December 2025. The study population included all patients who initiated GLP-1 receptor agonist therapy during the study period, matched 1:3 to comparable patients who did not initiate GLP-1 therapy using propensity score matching on age, sex, BMI, comorbidity burden, and baseline healthcare utilization.
The primary outcome was emergency department visits with a primary diagnosis attributable to obesity-related conditions, defined using a validated ICD-10 code algorithm that included heart failure exacerbation, hypertensive crisis, type 2 diabetes complications (hyperglycemic emergencies, hypoglycemia, diabetic ketoacidosis), acute coronary syndrome, atrial fibrillation, and obesity hypoventilation syndrome. Secondary outcomes included all-cause ER visits, hospitalizations, and 30-day readmissions.
Over the 24-month follow-up period, patients who initiated GLP-1 therapy had a 28% lower rate of obesity-related ER visits compared to matched controls (incidence rate ratio 0.72, 95% CI 0.69–0.75, p<0.001). The absolute risk reduction was 3.2 ER visits per 100 patient-years — a clinically meaningful difference given the high baseline ER utilization in this population.
The reduction was most pronounced for heart failure exacerbation visits (−41%), hypertensive crisis visits (−33%), and hyperglycemic emergency visits (−37%). Atrial fibrillation-related visits showed a more modest reduction (−18%), consistent with the known cardiovascular benefits of GLP-1 agents that have been demonstrated in dedicated cardiovascular outcomes trials.
All-cause ER visits were reduced by 14% in the GLP-1 group — a smaller but still statistically significant reduction that suggests benefits extending beyond the targeted obesity-related conditions. The investigators hypothesize that weight loss and metabolic improvement may reduce ER utilization for a broader range of conditions than those captured in the primary outcome definition.
The study's findings have significant implications for emergency department volume projections. Obesity affects approximately 42% of American adults, and obesity-related conditions are among the most common drivers of ER utilization. If GLP-1 therapy continues to expand — current prescribing trends suggest that 15–20% of eligible adults may be on GLP-1 agents by 2030 — the aggregate effect on ER visit volume could be substantial.
The investigators modeled the population-level impact of current GLP-1 prescribing trends and projected a reduction of approximately 2.1 million obesity-related ER visits annually by 2030 if current adoption rates continue. That figure represents approximately 1.5% of total annual ER visit volume — a modest but meaningful reduction in a system that is already operating near capacity.
Emergency medicine leaders caution against over-interpreting the volume implications. The ACEP 2026 Workforce Report projects a 22% increase in total ER visit volume by 2030, driven by population aging, primary care access deterioration, and behavioral health demand growth. A 1.5% reduction from GLP-1 effects would offset only a small fraction of that projected increase.
The study's most important limitation — acknowledged prominently by the investigators — is that its findings apply to a commercially insured population with access to GLP-1 therapy. The patients most likely to benefit from GLP-1 agents in terms of ER utilization reduction are often those least likely to have access to them.
GLP-1 agents remain expensive: monthly costs range from $800 to $1,200 without insurance coverage, and coverage varies significantly by payer. Medicaid coverage of GLP-1 agents for obesity (as opposed to type 2 diabetes) remains inconsistent across states, and Medicare Part D coverage of semaglutide for obesity was only authorized beginning in 2025. The patients who disproportionately use emergency departments for obesity-related conditions — lower-income, uninsured, or Medicaid-insured individuals — are precisely those with the most limited access to GLP-1 therapy.
The investigators call for expanded Medicaid and Medicare coverage of GLP-1 agents for obesity as a healthcare utilization reduction strategy, arguing that the downstream savings in ER visits and hospitalizations may offset a significant portion of the drug costs.
The growing prevalence of GLP-1 therapy in the population has also created new clinical considerations for emergency physicians. GLP-1 agents slow gastric emptying, which has implications for procedural sedation (increased aspiration risk), medication absorption (altered pharmacokinetics for orally administered drugs), and the interpretation of abdominal symptoms (nausea and vomiting are common GLP-1 side effects that can mimic surgical emergencies).
The American Society of Anesthesiologists issued guidance in 2023 recommending extended pre-procedural fasting for patients on GLP-1 agents, and emergency physicians have reported increasing numbers of patients presenting with GLP-1-related gastrointestinal adverse effects including severe nausea, vomiting, and gastroparesis. These presentations represent a new category of GLP-1-related ER visits that partially offsets the reduction in obesity-related visits documented in the JAMA study.
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