Weight loss injections have become an increasingly popular option for medical weight management, offering the possibility of substantial weight loss without undergoing a procedure. Their convenience and effectiveness have made them appealing to many people, particularly those who may be hesitant about more invasive treatments.
However, when considering weight management over several years, the initial results are only part of the picture. Long-term effectiveness, ongoing treatment requirements and cumulative costs can all influence which approach is more suitable.
Endoscopic sleeve gastroplasty (ESG) is one option that may be less familiar. This minimally invasive procedure reduces stomach capacity using endoscopic sutures, without removing stomach tissue. Although both ESG and weight loss injections can support meaningful weight reduction, their approaches to long-term management differ in several important ways.
Key Takeaways
- ESG offers a different approach to long-term weight management, reducing stomach capacity through a minimally invasive procedure without routinely requiring continued weight loss injections.
- ESG can support meaningful weight reduction for several years, although maintaining results still requires appropriate eating habits, physical activity and follow-up care.
- Weight loss injections can be effective, but maintaining results often requires continued treatment. Stopping medication may lead to increased appetite and weight regain.
- The long-term commitment differs between treatments. ESG involves an upfront procedure and recovery period, while injections may involve recurring medication costs and regular medical reviews.
How Do ESG and Weight Loss Injections Compare in Long-Term Results?
Both ESG and weight loss injections can help patients achieve substantial weight reduction, but they work through different mechanisms. While injections influence appetite and weight regulation through medication, ESG reduces stomach capacity to help patients feel full after eating smaller portions.
These differences may influence how weight loss is achieved and maintained over time.
How Much Weight Can You Expect to Lose?
ESG is performed by passing an endoscope through the mouth into the stomach, where specialised sutures are used to reduce its capacity. This allows patients to feel full after consuming smaller amounts of food, supporting gradual weight reduction. Studies have reported average total body weight reductions of approximately 15%–20% within the first 1–2 years, although individual results vary.
Weight loss injections can also produce significant results, depending on the medication used. A clinical trial reported average weight reductions of 13.7% with semaglutide and 20.2% with tirzepatide over 72 weeks. However, these figures come from different studies involving different patient populations and follow-up periods, so they should not be interpreted as a direct comparison of treatment effectiveness.
How Well Is Weight Loss Maintained Over Time?
One potential advantage of ESG is that it creates a lasting anatomical change to the stomach without requiring regular weight loss injections. Studies have shown that meaningful weight reduction can be maintained for several years following ESG, although some weight regain is possible. The extent to which results are sustained depends on factors such as dietary habits, physical activity and continued medical follow-up.
Weight loss injections can also help maintain weight reduction, but continued treatment is often necessary. Because obesity is a chronic condition, stopping medication may allow appetite and other weight-regulating mechanisms to return towards their previous patterns.
What Happens When Weight Loss Injections Are Stopped?
Weight regain following discontinuation is an important consideration for patients using injectable medications. Research on semaglutide found that participants regained approximately two-thirds of their previous weight loss within one year of stopping treatment, although individual experiences vary.
This does not mean that injections are ineffective. Rather, it highlights the importance of viewing medication as a potentially long-term treatment instead of a short-term solution.
ESG, by comparison, does not require continued medication to preserve the anatomical changes made during the procedure. However, these changes do not guarantee permanent weight loss, and patients must still maintain appropriate dietary habits and follow-up care.
ESG vs Weight Loss Injections: Long-Term Results at a Glance
| Factor | Endoscopic Sleeve Gastroplasty (ESG) | Weight Loss Injections |
|---|---|---|
| How it works | Reduces stomach capacity through endoscopic sutures | Influences appetite and weight regulation through medication |
| Average weight loss | Approximately 15%–20% of total body weight in reported studies | 13.7% with semaglutide and 20.2% with tirzepatide in a 72-week trial |
| Long-term maintenance | Weight loss may be sustained for several years, although regain is possible | Weight loss can be maintained with continued treatment |
| Ongoing treatment | Does not routinely require continued weight loss medication | Regular medication may be needed to maintain results |
| Follow-up | Dietary support, lifestyle management and medical reviews | Medication reviews, lifestyle management and monitoring |
Note: Weight loss figures come from different studies and should not be interpreted as a direct comparison of treatment effectiveness.
How Do the Long-Term Costs and Side Effects Compare?
Beyond weight loss results, the financial and medical commitments associated with each approach can influence treatment decisions. ESG involves an initial procedure and recovery period, while weight loss injections generally require regular medication use. Their costs, side effects and follow-up requirements also differ.
Upfront Costs vs Ongoing Medication Expenses
ESG typically involves a one-time procedural cost, alongside expenses for consultations, investigations and follow-up care. Although the initial investment may be substantial, the procedure does not routinely require ongoing weight loss medication.
Weight loss injections, on the other hand, involve recurring medication expenses that can accumulate over months or years. For patients who require prolonged treatment, these cumulative costs may become a significant consideration. However, whether ESG is more economical depends on individual treatment needs, medication prices and the duration of therapy.
Procedural Risks vs Medication-Related Side Effects
ESG is performed endoscopically under sedation or general anaesthesia, without abdominal incisions or removal of stomach tissue. Temporary abdominal pain, nausea and vomiting may occur, while uncommon but serious complications include bleeding, infection and stomach injury.
Weight loss injections avoid procedural risks but may cause nausea, vomiting, diarrhoea and constipation, particularly during dose escalation. Less common complications include gallbladder problems and pancreatitis. For patients requiring long-term medication, tolerability remains an ongoing consideration rather than one limited to the start of treatment.
Recovery Time vs Long-Term Treatment Commitment
ESG involves an initial recovery period, during which patients follow a structured dietary progression before gradually returning to regular meals. Thereafter, the focus shifts towards maintaining appropriate eating habits, physical activity and follow-up care.
Weight loss injections generally do not require procedural recovery, making them a convenient option initially. However, patients may need regular injections, dosage adjustments and continued medical reviews over the long term.
Which Weight Loss Approach Is More Suitable for You?
Choosing between ESG and weight loss injections involves more than comparing weight loss results. Factors such as your body mass index (BMI), medical history, obesity-related conditions and personal treatment preferences can influence which approach is more appropriate.
| Consideration | Endoscopic Sleeve Gastroplasty (ESG) | Weight Loss Injections |
|---|---|---|
| Clinical suitability | For patients who meet the eligibility criteria based on their BMI and overall health | For patients who meet the prescribing criteria based on their BMI and obesity-related conditions |
| Treatment preference | May appeal to those who prefer a procedure-based approach | May appeal to those who prefer a non-procedural approach |
| Treatment commitment | Requires an initial recovery period, dietary adjustments and ongoing follow-up | Requires regular injections and potentially long-term medication use |
| Medical considerations | May not be suitable for patients with certain gastrointestinal or other medical conditions | May not be suitable for patients with certain medical conditions or medication contraindications |
Ultimately, neither approach guarantees permanent weight loss. A medical assessment can help determine which option is appropriate based on your health needs, treatment preferences and ability to maintain the necessary lifestyle changes.
Making an Informed Choice for Long-Term Weight Management
Both ESG and weight loss injections can support meaningful weight reduction, but their long-term considerations differ. While injections offer a non-procedural approach, ESG provides an alternative that may reduce reliance on ongoing medication. Understanding the differences in weight maintenance, costs and treatment commitments can help patients make an informed decision.
At Digestive Centre, Dr Shanker takes a personalised approach to weight management, considering each patient's health needs, medical history and long-term goals when recommending suitable treatment options. Our team focuses on identifying a suitable treatment based on each patient's individual needs. Schedule a consultation to discuss your weight management options.
FAQs About ESG and Weight Loss Injections
Can you switch from weight loss injections to ESG?
Yes, some patients who have been using weight loss injections may be suitable for ESG. However, eligibility depends on factors such as BMI, medical history and previous treatment response. Your doctor will also need to review your medication use and advise on any adjustments required before the procedure.
Can you still use weight loss injections after ESG?
Weight loss injections may be prescribed after ESG in selected cases, particularly if additional weight reduction or management of weight regain is needed. However, combining treatments is not necessary for every patient. The decision depends on individual progress, medical suitability and the overall weight management plan.
Does ESG permanently reduce stomach size?
ESG uses endoscopic sutures to reduce the stomach's capacity without removing stomach tissue. Although the procedure creates a lasting change to the stomach's structure, some stretching or loosening of the sutures may occur over time. Maintaining weight loss still depends on dietary habits, physical activity and ongoing follow-up.
Do weight loss injections become less effective over time?
Weight loss typically slows or reaches a plateau after an initial period of treatment. This does not necessarily mean the medication has stopped working, as it may still help maintain the weight already lost. However, individual responses vary, and your doctor may review your treatment plan if weight loss stalls or weight regain occurs.
Is ESG reversible if you are unhappy with the results?
Unlike surgical sleeve gastrectomy, ESG does not involve removing part of the stomach. However, this does not mean the procedure is easily or completely reversible. Endoscopic revision or removal of sutures may be possible in selected circumstances, but restoring the stomach to its original anatomy cannot be guaranteed.
Meet Our Doctor
Dr Shanker Pasupathy
Upper Gastrointestinal & Bariatric Surgeon
MBBS, National University of Singapore
Fellow of the Royal College of Surgeons (Glasgow)
Fellow of the Royal College of Surgeons (Edinburgh)
Dr Shanker Pasupathy has extensive international training in gastrointestinal endoscopy, laparoscopy and robotic surgery, with experience gained in the UK, France and Germany. Previously, he led the metabolic-bariatric surgery service at Singapore General Hospital as Director of the LIFE Centre and Senior Consultant. He remains actively involved in regional surgical training and was awarded the Dean’s Award for teaching excellence by NUS Medicine, reflecting his longstanding commitment to advancing surgical practice and medical education.
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