A new real-world study from AIG Hospitals, Hyderabad, published in the international journal Endoscopy, has found that Endoscopic Sleeve Gastroplasty (ESG), a 45‑minute advanced endoscopic procedure, delivers significantly stronger short‑term weight loss than oral semaglutide 14 mg in adults with obesity. The comparative cohort study adds important Indian data to the rapidly evolving field of obesity care, where minimally invasive procedures and medical therapies are increasingly used as “bridge” treatments to support sustained lifestyle change.
Obesity is now widely recognised as a chronic metabolic disease rather than simply a matter of willpower, overeating, or lack of exercise. It is closely linked with diabetes, fatty liver disease, hypertension, sleep apnea, cardiovascular risk, and reduced quality of life, particularly in urban India, where long working hours, irregular meals, processed food, poor sleep, stress, and reduced physical activity drive gradual weight gain. Clinicians frequently see patients who have tried multiple diets, lost a few kilograms, regained the weight, and eventually stopped trying, or individuals with diabetes and fatty liver for whom lifestyle modification alone proves difficult to sustain. Modern obesity care aims to give such patients a scientifically guided head start: meaningful early weight loss that improves health markers and motivates long‑term lifestyle change.
The AIG Hospitals study, titled “Endoscopic Sleeve Gastroplasty Versus Oral Semaglutide for Obesity: A Real‑World Comparative Cohort Study,” compared two established, non‑surgical approaches: ESG and oral semaglutide 14 mg once daily. ESG is a minimally invasive procedure performed through the mouth, using an endoscope and suturing device to place full‑thickness sutures inside the stomach and create a sleeve‑like shape without surgically removing any part of the organ. This reduces stomach volume and enhances early satiety, followed by a structured, supervised diet progression from liquids to solids. Oral semaglutide, a GLP‑1 receptor agonist, works via hormonal pathways that regulate appetite and satiety, helping patients feel less hungry and consume fewer calories, but requires ongoing adherence, tolerance, and affordability.
The study analysed 150 adults with obesity treated between January 2024 and April 2025, with 50 patients undergoing ESG and 100 receiving oral semaglutide 14 mg daily. Both groups received standardized lifestyle counselling, including a calorie-deficient diet and moderate physical activity, underscoring that neither ESG nor semaglutide is intended to work in isolation but as part of a comprehensive programme. The primary endpoint was the percentage total body weight loss at six months.
Results showed a clear short‑term advantage for ESG. At six months, patients in the ESG group achieved an average total body weight loss of 12.72%, compared with 8.67% in the semaglutide group. This difference remained statistically significant even after adjusting for age, sex, baseline BMI, and diabetes. Responder rates also favoured ESG: around 70% of ESG patients achieved at least 10% total body weight loss versus 43% in the semaglutide group, while 36% of ESG patients achieved at least 15% weight loss compared with just 7% in the tablet group. Clinically, weight loss beyond 10% is often associated with meaningful metabolic benefits, including better glycaemic control, improvement in fatty liver, reduced blood pressure, and improved mobility.
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