Know Your Weight Loss Options

GLP-1 medications, like tirzepatide and semaglutide, are growing in popularity for weight-loss. Yet, some people can’t tolerate these medications without serious side-effects or risks. Also, health insurance typically will not cover the cost of a GLP-1 for patients without diabetes, even though these injectable drugs are approved for weight loss by the U.S. Food and Drug Administration. For people seeking another treatment approach for obesity, the Endoscopic Sleeve Gastroplasty (ESG) procedure can offer a low-risk, drug-free, permanent solution to overeating. 

ESG is a minimally invasive, non-surgical, incision-free weight-loss procedure that reduces the size of the stomach. As a result, patients experience fullness and satiety after consuming less food. This procedure may also influence appetite-regulating hormones. 

The ESG procedure can result in sustainable weight loss.

“Patients typically lose approximately 15 to 20% of their total body weight,” says Robert F. Cubas, M.D., FACS, a bariatric surgeon at the University of Miami Health System. These results are more dramatic than the “10 to 15% total weight loss that patients typically experience with GLP-1 injections.”

With the ESG procedure, “80 to 90% of the weight loss occurs in the first six months, with total weight loss typically achieved within one year. You will also see better control of your glucose levels, blood pressure, and cholesterol levels. You will feel less hungry, more energetic, and move easier,” he says. “Unfortunately, 10% of ESG patients may not experience a significant weight loss or may regain the weight they lost.”

ESG is newly offered by UHealth’s team of expert bariatric surgeons, including Dr. Cubas, which is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

Who is a candidate for ESG?

“Many adults with obesity who have failed to lose weight with traditional weight-loss methods and are committed to making significant lifestyle changes are good candidates for the ESG procedure,” Dr. Cubas says.

Adult patients with the following characteristics may quality for and benefit from the ESG procedure:

• obesity (BMI 30 to 40)
• severe or morbid obesity (BMI greater than 40)
• unable to reach a healthy BMI with diet and lifestyle changes
• unable to successfully maintain weight loss through diet and lifestyle efforts alone

If you have a BMI of 30 to 35, you do not qualify for other weight-loss procedures, such as Gastric Sleeve, Gastric Bypass, BPD-DS, and SADI. 

Who should not get the ESG procedure?

“Patients with severe gastroesophageal reflux disease (GERD), large hiatal hernias, or a history of gastric surgery do not qualify for this type of weight-loss treatment,” Dr. Cubas says. 

Heavy drinking might disqualify a patient from getting an ESG.

In addition, “no bariatric procedure is appropriate for people dealing with food addiction or compulsive eating behavior,” he says. “As part of our weight-loss program, every patient undergoing bariatric surgery or procedures is evaluated by a psychologist to screen them for behavioral and eating disorders, especially Binge Eating Disorder and Night Eating Syndrome, in order to receive proper treatment.”

How does the ESG procedure work?

While the patient is under general anesthesia, a bariatric surgeon guides a thin, flexible tube with a camera (endoscope) into their stomach. The surgeon folds the stomach, like an accordion, then stitches those folds together with sutures. This reduces the stomach’s size, capacity, and volume.

Recovery from the ESG procedure is faster than other weight-loss surgeries, typically lasting five days.

The results of ESG are long-lasting and can be permanent. But, if the patient wants or needs to regain their stomach’s full capacity, the procedure can be reversed.

Complications from ESG are rare. In some cases, insufficient weight loss results can be fixed with an ESG revision procedure.

What should you expect after the ESG procedure?

As part of UHealth’s bariatric surgery program, patients also receive nutrition counseling with a UHealth registered dietitian. All ESG patients are advised to follow a well-balanced diet including smaller portions and nutrient-dense foods.

Post-procedure, ESG patients are encouraged to exercise regularly and building muscle, which supports bone health. “Studies demonstrate that patients who do moderate exercise at least three times per week for 30 to 45 minutes have better results keeping their weight loss, compared with those that don’t.”

Before you schedule your ESG procedure, consider the lifestyle and medical changes required for your safety and successful weight loss results. 

“You should quit smoking at least four weeks prior to your scheduled ESG procedure, so as to not alter the healing process,” Dr. Cubas says.

“The American Society of Anesthesiology recommends stopping any GLP-1 medications one week prior to any procedure (like ESG) that requires general anesthesia, due to the risk of gastric food retention, which is the main side effect of GLP-1s, and aspiration during the induction of general anesthesia.”

After the ESG procedure, “pregnancy should be postponed for at least one year,” he says, “and you definitively cannot be pregnant during the procedure.”

To learn more about weight loss options that meet your needs, speak with a UHealth expert. Call 305-689-1910, or request a consultation online.

Written by Dana Kantrowitz.

Experts in Comprehensive Weight Loss
and Bariatric Surgery

Now at UHealth Doral Medical Center

Make an Appointment!
Call 305-689-1910 

Tags: american society for metabolic and bariatric surgery, Dr. Robert Cubas, heart disease, long term weight loss, weight management