Non-surgical and endoscopic weight-loss options
Bariatric surgery is not the only evidence-based treatment for obesity. Depending on your health, goals, previous treatment and local access, your healthcare team may discuss medical weight management, pharmacotherapy or an endoscopic procedure. These options may be used on their own, in combination or at different stages of long-term care.
Simplified educational diagram: Sleeve gastrectomy (gastric sleeve surgery). Not to surgical scale. Clinical review required before publication.
Weight-loss medications (pharmacotherapy)
Prescription weight-loss medications can help regulate appetite, improve fullness or affect how the body absorbs nutrients. Options used in different countries include GLP-1 receptor agonists, dual GIP/GLP-1 medicines and other oral or injectable therapies. Examples may include semaglutide, tirzepatide, liraglutide, naltrexone–bupropion, phentermine–topiramate and orlistat. Availability, approved indications, brand names, funding and prescribing rules vary considerably between countries.
How does it work?
The mechanism depends on the medicine. Some therapies act on appetite and fullness signals, some slow stomach emptying, and others reduce the absorption of dietary fat.
What should I know?
Medication is prescribed after an individual assessment and works best as part of comprehensive care. Side effects, contraindications, pregnancy plans, other medicines, cost and the likely need for ongoing treatment must be discussed with a qualified prescriber. Weight regain can occur after treatment is stopped, so follow-up and a longer-term plan matter. Never buy or use prescription weight-loss medication without appropriate medical supervision.
Endoscopic Sleeve Gastroplasty (ESG)
What happens?
While you are under anaesthesia or deep sedation, a specialist passes a flexible endoscope through the mouth into the stomach. Using an endoscopic suturing device, the stomach is folded and stitched internally to reduce its usable volume. There are no abdominal incisions and no stomach is removed.
How does it work?
The altered stomach shape helps people feel satisfied with smaller portions and may slow the movement of food through the stomach.
What should I know?
ESG is less invasive than bariatric surgery and generally involves a shorter recovery, but it is still a medical procedure with possible complications. Average weight loss is usually lower than after surgical sleeve or bypass, and results are strongest when ESG is combined with structured nutrition, activity and behavioural support. Suitability, availability and local regulation vary. Although revision or reversal may sometimes be technically possible, ESG should not be described as routinely or easily reversible.
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Simplified educational diagram: endoscopic sleeve gastroplasty. No stomach is removed. Not to surgical scale. Clinical review required before publication.
Simplified educational diagram: intragastric balloon. The device is temporary and must be removed as directed. Not to scale. Clinical review required before publication.
Intragastric balloon
What happens?
A deflated balloon is placed inside the stomach, usually through the mouth using an endoscope, and then filled. Some balloon systems use different placement methods. The device remains in place for a limited period and must be removed or passed according to the specific system and local instructions.
How does it work?
The balloon occupies space in the stomach, which may help people feel satisfied after eating less.
What should I know?
An intragastric balloon is temporary. Nausea, vomiting, reflux, discomfort and intolerance can occur, particularly soon after placement. Rare but serious complications are possible. A clear maintenance plan is important because weight regain may occur after the balloon is removed. Device availability, approved duration and clinical requirements differ between countries.
How do medical, endoscopic and
surgical options compare?
No treatment is automatically right for everyone. Pharmacotherapy avoids a procedure but may require ongoing use.
ESG and balloons are less invasive than surgery but still require specialist assessment and follow-up.
Bariatric surgery generally produces the greatest and most durable average weight loss, but it also involves an operation and lifelong nutritional care.
Your decision should consider expected benefit, risks, health conditions, previous treatment, personal preferences, affordability, access
and willingness to continue long-term follow-up.
Option | What it involves | Treatment duration | Follow-up |
|---|---|---|---|
Bariatric Surgery | Surgical change to stomach and/or intestine | Permanent anatomical change | Lifelong surgical and nutritional care |
Intragastric Balloon | Temporary stomach device | Time-limited; varies by device | Removal/passage plan + ongoing care |
ESG | Endoscopic internal sutures | Long-lasting; revision may be possible | Endoscopic + multidisciplinary care |
Pharmacotherapy | Prescription medicine | Often ongoing | Prescriber + multidisciplinary care |