In the past, when an individual suffering from obesity sought medical intervention to help them lose weight, the only choice available to them was a surgery like gastric sleeve or gastric bypass.
Today, there are much less invasive options available that do not involve incisions or long recovery periods, like GLP-1 weight loss medications such as semaglutide and tirzepatide and endoscopically performed procedures like ESG (endoscopic sleeve gastroplasty).
You may be wondering if these non-surgical options work as well as bariatric surgery, and that is what we are going to talk about today. We are going to look at what these different options are, how they work, and the results they can offer.
Alternate Options for Bariatric Surgery: ESG and GLP-1 Medications
Today there are a few safe and effective solutions that can help you lose weight without having to undergo surgery. Endobariatrics is a fairly new category in bariatric medicine and involves treating conditions that were historically treated with surgery using much less invasive techniques like a procedure called endoscopic sleeve gastroplasty (ESG). Also, a few new prescription weight loss medications (semaglutide and tirzepatide) are now approved by the FDA for weight management and are becoming very popular due to the weight loss results they are able to achieve.
What Is Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic sleeve gastroplasty (ESG) is a non-surgical weight loss procedure offered at Reveal Weight Loss and is performed using a special tool called an endoscope, which goes through your mouth and into your stomach, without having to create any abdominal incisions or leaving any visible scarring. Most people are back to their normal schedule in about three days.
During the procedure, the doctor uses strategically placed stitches to change the shape of your stomach and make it smaller. Your smaller stomach causes you to feel full after eating a small amount of food and slows down how fast your stomach empties, so you stay full longer after meals. This makes it easier for you to eat less, stay satisfied between meals, and lose weight without the use of surgery.
What Are Semaglutide and Tirzepatide?
Semaglutide is a prescription medicine that mimics a natural hormone called glucagon-like peptide-1 (GLP-1) that your body makes and has been used under the name Ozempic for about seven years to help treat type 2 diabetes, but in addition to helping with blood sugar control, it was discovered that many users also lost weight too. These findings prompted additional research into the medication, and eventually it was approved in the summer of 2021 to also be administered in higher doses to be used for weight management under the name Wegovy.
Tirzepatide is a prescription medication that is similar to semaglutide in that it also mimics your body’s naturally produced GLP-1 hormone, but it also mimics a second hormone called GIP (glucose-dependent insulinotropic polypeptide). It was approved by the FDA for the treatment of type 2 diabetes in May 2022 under the name Mounjaro and then approved in higher doses for the treatment of obesity in November 2023. Because tirzepatide contains an additional hormone, it has provided more significant weight loss results to date than semaglutide.
Both these medications are administered through weekly injections and work by copying hormones in your body that are released when you eat to help your metabolism process what you have consumed and turn it into energy. Many people have underlying issues that have caused their metabolism to become sluggish or improperly process these calories, converting them to fat instead of burning them for energy, etc. These medications help streamline these metabolic functions to help your body properly release insulin, reduce your appetite, keep you feeling full longer, and burn calories more efficiently.
How Do the Results of ESG, Tirzepatide, and Semaglutide vs. Bariatric Surgery Compare?
In October 2024, the American Journal of Gastroenterology published the results of a major review that looked at how well different weight loss treatments worked. They looked at bariatric surgery, endoscopic procedures like ESG, and prescription injections like tirzepatide and semaglutide. These results were obtained from 34 different studies and included over 15,000 people. Here are some of the interesting facts they uncovered:
- People who took tirzepatide at the highest dose (15 mg) lost about 21 percent of their total body weight after 72 weeks in clinical trials (SURMOUNT-1). That level of weight loss is close to the amount typically seen with some bariatric surgeries, such as gastric bypass, which often leads to 25–30 percent total body weight loss in a year.
- The review showed very similar results between how much weight people lost with tirzepatide compared to those who had gastric sleeve surgery, which is the most commonly performed bariatric surgery in the United States each year.
- People who had the ESG procedure lost between 15 and 20 percent of their total body weight in twelve months with much lower risks for complications or side effects than undergoing surgery.
- When people used semaglutide along with ESG, the results were extremely similar to those achieved by patients who underwent bariatric surgery, but without the risks and downtime that surgery involves.
ESG vs. Semaglutide
When comparing endoscopic sleeve gastroplasty (ESG) vs. semaglutide, including the long-term weight loss results and the costs involved, ESG appears to be the most logical choice, offering the most benefits at the lowest cost.
Weight Loss Potential
- Semaglutide helped individuals lose an average of almost 15% of their total body weight over 68 weeks in clinical trials.
- Patients who undergo ESG lose an average of between 15 and 20% or more of their total body weight in just 12 months.
Cost
- A five‑year economic analysis published in April 2024 reported that ESG saves over $33,000 per patient compared to the costs associated with using semaglutide. ESG also helped them maintain a healthier weight and a lower BMI after five years (31.7 vs. 33.0).
- Semaglutide costs an average of $13,600 per year, and many patients stop using it within six to twelve months, leading to weight regain. It was determined that undergoing ESG offers more effective weight loss at a much less expensive cost. Also, patients have the ESG procedure just one time, and semaglutide must be used consistently to maintain results. Many individuals regain their lost weight when they stop using the medication, but the restrictive effects of ESG offer permanent help.
Tirzepatide vs. ESG
- The data comparing tirzepatide vs. ESG is limited because this medication is fairly new, but we do know that in clinical trials it offered more potential for weight loss than semaglutide.
Weight Loss Potential
- Tirzepatide helped people lose about 21 percent of their total body weight over 72 weeks in clinical trials, and a longer study showed that with continued use, individuals can maintain a weight loss of around 23 percent for at least three years.
- Data obtained from a study of patients who regained weight after undergoing gastric sleeve surgery were able to lose about 13.2% of their overall weight after about 12 months, which is almost identical to the individuals who underwent a revision using ESG, who lost 13.4% of their total weight after a year. ESG
- Individuals who have the ESG procedure typically lose an average of 15 to 20% of their total body weight in a year, and many people have lost upwards of 50% of their total body weight.
Cost
- Tirzepatide costs around $1,000 to $1,300 per month, which adds up to anywhere from $12,000 to $16,000 per year. Just like with semaglutide, many people stop taking it within the first 6 to 12 months, often due to the high cost or the side effects. When these individuals cease using the medication, most experience weight regain.
- Endoscopic sleeve gastroplasty (ESG) has been reported as more affordable and more effective in the long run according to cost-effectiveness models. These models demonstrate that after about two years, ESG offers greater long-term weight loss and lower costs than continuing to use tirzepatide. ESG is also a one-time procedure, while tirzepatide must be used consistently to maintain your weight loss results.
How Do the Weight Loss Results of ESG vs. Semaglutide Compare?
One smaller study that was conducted compared ESG vs. semaglutide for weight loss. The study was led by Dr. Hoff and tested the weight loss results of ESG alone and ESG together with semaglutide in a carefully controlled, double-blind trial.
Every patient had the ESG procedure with the doctor using the same suturing pattern, and each patient also followed the exact same exercise and diet plan, and was supervised and guided by the same research team. Some participants only had the ESG procedure, and some were also given semaglutide to use during their weight loss journey. The results of what Dr. Hoff discovered can be seen in the chart below.
| ESG with Semaglutide | ESG Only | |
|---|---|---|
| Average Weight Lost (Total Body) | 27% | 20% |
| Average Weight Lost (Excess Body Weight) | 86% | 60% |
There were no serious adverse side effects noted for any participants.
Noteworthy Observation: Gastric sleeve surgery usually provides an average of 20%- 30% total body weight loss and has a much longer recovery time and a higher risk of complications. The combination of ESG and semaglutide offers such similar results without a long recovery or high risk factors.
Your Lifestyle and Results With GLP-1s vs. ESG
Endoscopic sleeve gastroplasty (ESG) and GLP-1 medications such as semaglutide and tirzepatide are all tools that can significantly influence your weight loss journey, but the most important element that will influence your success will depend on you.
Your dedication to making lifestyle changes like eating a healthy, well-balanced, low-calorie diet, getting plenty of exercise, an adequate amount of sleep, staying hydrated, and managing stress are all involved in how successful you will be in reaching your weight loss goals.
Where Can I Get Endoscopic Sleeve Gastroplasty in New Jersey?
The fact that you can lose a significant amount of weight without having to undergo bariatric surgery is amazing, but these newer non-surgical weight loss solutions will not do all the work for you.
Reveal Weight Loss specializes in helping people reach their goal weight and improve their health without surgery. We offer numerous non-surgical weight loss options, including ESG and GLP-1 prescription weight loss medication.
You will have to put in the effort, but the team at Reveal Weight Loss will be by your side helping you navigate your weight loss journey so you can reach your goals for better health. Set up your personal consultation today to learn more about how we can help you successfully lose weight with a personalized plan.
