Making Sense of Your Weight Loss Options: Medications, Endoscopy, and Surgery

If you’re exploring options for weight loss, you’re probably seeing a lot of information—some of it hopeful, some confusing, and some that sounds too good to be true. New medications and endoscopic procedures are being advertised everywhere. But as a patient, how do you know what really works—and what lasts?

Let’s look at the main options together.

Medications for Weight Loss

New medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound) are helping many people lose weight. These medications work by reducing hunger and helping with blood sugar control, and people can lose about 10–15% of their total body weight.

But there are limitations:
- These medications must be taken long-term—sometimes for life.
- If you stop taking them, weight regain is common.
- The cost can be very high, especially if insurance doesn’t cover it.
- We still don’t know whether these medications lead to long-term improvements in conditions like diabetes or sleep apnea the way surgery does.

Endoscopic Procedures: A Closer Look

Endoscopic procedures like the intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG) are being offered as alternatives to surgery. They are done through the mouth using a scope and do not involve external incisions.

These procedures are often marketed as new or breakthrough treatments—but the truth is, they’ve actually been around in various forms for many years. And unfortunately, the long-term results have been disappointing.

Here’s what we know:
- Intragastric balloons are temporary. They are usually removed after six months, and weight regain is common. That’s one reason they are no longer widely used.
- Endoscopic sleeve gastroplasty (ESG) is being presented as a newer option—but it is built on an older idea. The equipment may be different now, but the technique is very similar to earlier endoscopic procedures that failed to show long-term success.
- Current studies on ESG show short-term weight loss, but we still lack long-term data beyond a few years.
- These procedures often involve implanted materials or permanent changes to the stomach, which could make future surgery more complex or risky if needed later.

While these options may sound appealing at first, they simply do not have the same track record as bariatric surgery. And many of the studies promoting them are small or sponsored by companies that make the equipment—something that can introduce bias into the results.

Bariatric Surgery: The Most Proven Option

Bariatric surgery—including sleeve gastrectomy and gastric bypass—is still the most effective, most studied, and most durable option for people who are struggling with obesity.

With robotic-assisted surgery, the safety and precision of these procedures have improved dramatically. In fact, bariatric surgery today is as safe—or safer—than many common surgeries like gallbladder removal or childbirth.

Why surgery stands out:
- Durability: Weight loss and health benefits are sustained for 10+ years in most patients.
- Health impact: Surgery can resolve or improve type 2 diabetes, sleep apnea, high blood pressure, and fatty liver disease.
- Safety: When performed by experienced surgeons in a comprehensive program, complications are rare.

So What Should You Choose?

At Inspire Bariatrics, we believe that every patient deserves a personalized plan. But we also believe in being honest: bariatric surgery has by far the strongest long-term evidence for success, both in terms of weight loss and overall health.

Newer treatments—like medications or endoscopic procedures—may be helpful in the short term. But we simply don’t have strong, long-term evidence showing they work as well or as safely as surgery. And in some cases, they may make surgery more difficult in the future if further treatment is needed.

That’s why we encourage patients to take the time to learn the facts, ask questions, and choose a program that will support them for the long haul—not just through the latest trend.