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‑deficit 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.
“The most important message from this study is that obesity treatment has to be individualized,” said Dr. Nitin Jagtap, Consultant Gastroenterologist at AIG Hospitals and corresponding author of the study. “ESG appears to offer a stronger early push in weight loss, especially for patients who need a meaningful reduction in a short period. But the procedure is not a shortcut. It is a structured intervention that gives patients a window of opportunity to reset eating patterns, improve satiety and then build sustainable lifestyle habits.”
Safety outcomes were encouraging in both groups. No major adverse events were reported, and most side effects were limited to mild gastrointestinal symptoms such as nausea or vomiting. The stronger short‑term weight loss seen with ESG was not associated with an increased risk of serious complications in this cohort. In the semaglutide group, some patients discontinued therapy during follow‑up, including due to side effects and cost, highlighting real‑world challenges where medicines are effective only if patients can continue them safely, consistently and affordably.
By 12 months, the gap in weight loss between ESG and oral semaglutide narrowed. Mean total body weight loss was 11.92% in the ESG group and 10.91% in the semaglutide group, with no statistically significant difference. This suggests that both approaches can support sustained weight reduction over a year, while the early advantage of ESG may converge over time as patients change or discontinue medication, or add pharmacotherapy after plateaus or partial weight regain.
“Obesity care is entering a new phase where endoscopy, pharmacology, nutrition and lifestyle medicine must come together,” said Dr. D. Nageshwar Reddy, Chairman, AIG Hospitals. “This study is important because it reflects real patients, real choices and real limitations. ESG and medicines like semaglutide should not be seen as competing therapies. They are complementary tools. The larger goal is to help patients achieve clinically meaningful weight loss and then sustain it through long-term behavioral and metabolic care.”
The researchers emphasise that the findings should be interpreted responsibly. The analysis was a retrospective, single‑centre, real‑world cohort study rather than a randomized trial and specifically compared ESG with oral semaglutide 14 mg. The results cannot be directly extrapolated to higher‑dose injectable GLP‑1 agents or newer dual‑incretin drugs, which may deliver different outcomes. However, the strength of the study lies in its Indian real‑world setting, standardized follow‑up and repeated statistical analyses that consistently showed greater short‑term weight loss with ESG.
The broader implications are especially relevant for India, where obesity frequently coexists with diabetes, fatty liver disease and cardiovascular risk at lower BMI thresholds than in Western populations. Many people delay seeking help, attributing weight issues to personal failure, or move between diets and medications without structured medical guidance. Studies like this help shift the conversation from blame to biology and from quick fixes to evidence‑based, multidisciplinary obesity care.
Ultimately, ESG, semaglutide and other modern therapies should be viewed as bridge interventions rather than permanent substitutes for lifestyle change. They are designed to help patients cross the most difficult first phase of weight loss, where losing the initial 8–12% of body weight can be the difference between giving up and believing that lasting change is possible. The AIG Hospitals study in Endoscopy reinforces the role of advanced endoscopic therapies such as ESG in delivering strong short‑term outcomes with a favourable safety profile, while pointing toward a future of obesity care that is personalised, minimally invasive where possible, and firmly anchored in long‑term behavioural and metabolic support.
