Published Jul 02, 2026 | 7:00 AM ⚊ Updated Jul 02, 2026 | 7:00 AM
Representative image. Credit: iStock
Synopsis: A new study from Hyderabad’s AIG Hospitals compares Endoscopic Sleeve Gastroplasty (ESG) with oral semaglutide in treating obesity. Researchers found ESG produced greater weight loss at six months, while oral semaglutide largely caught up after one year. The findings highlight how treatment choice depends on patient goals, convenience and long-term care.
An obese patient in Hyderabad asked a doctor a question that has become very common in recent times, “Should I undergo a procedure, or should I take a tablet?”
Earlier, diet sheets and gym routines used to dominate conversations about obesity. Surgery waited at the far end, reserved for patients who had tried everything else. Now, that map has shifted. Patients weigh the stomach procedure against a hormone tablet.
No one had tested the two against each other in the same group until doctors at AIG Hospitals in Hyderabad ran that test.
Their study, published in the journal Endoscopy, followed 150 adults with obesity through a year of treatment. It splits patients between a procedure, endoscopic sleeve gastroplasty, and a tablet, oral semaglutide.
The study covered oral semaglutide only. It does not extend to injectable drugs such as Wegovy or Mounjaro, which act through different pathways and may produce different numbers.
Also Read: Generic semaglutide in India — Game changer or gamble?
Most obesity research draws on patients in Europe and America. Doctors in India treat obesity alongside diabetes and fatty liver disease at lower body weights than doctors abroad usually encounter, so imported data does not always translate.
Dr Nitin Jagtap, who led the study from AIG Hospitals’ Department of Medical Gastroenterology, pointed to a message he wants readers to take from the findings.
“The most important message from this study is that obesity treatment has to be individualised,” Jagtap said. “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.”
Dr D Nageshwar Reddy, Chairman of AIG Hospitals, said patients kept posing the same question to his team without any data to answer it.
“Patients often come and ask us, ‘ Should we undergo surgery, should we get an endoscopy done, or should we take tablets’,” Reddy told South First. “We have been using both approaches, but they have never been compared with each other. So we thought, let us compare them and see the benefits of each.”
Reddy laid out the field patients now navigate. “Normally, for people with obesity, not those who are merely overweight, we now have three treatment options,” he said. “One is bariatric surgery. Bariatric surgery is gradually going out of use because it is an invasive procedure, and most people do not want it. The second option is endoscopic therapy. Using an endoscope, we suture the stomach to reduce its size. This is called endoscopic sleeve gastroplasty (ESG), and it is becoming more common. Then, more recently, GLP-1 receptor agonists have become available.”
ESG runs through the mouth. A doctor passes an endoscope, a tube fitted with a camera, down the throat, then threads a suturing device through it. The device stitches the stomach wall from inside, pulling the stomach into a narrower shape without cutting the skin.
Patients then move through stages of liquids, purees, soft food and solids over a few days, under supervision.
Semaglutide takes a different route through the body. It belongs to a class of drugs called GLP-1 receptor agonists, which act on hormones that signal hunger and fullness to the brain.
Patients swallow a tablet once a day rather than undergo a procedure, though the drug demands daily use, tolerance and cost over time.
Researchers recruited adults aged 18 to 65 who carried a body mass index above 30, or above 27 alongside a condition linked to obesity, such as diabetes or high blood pressure. They tracked patients between January 2024 and April 2025.
Fifty patients chose ESG. A hundred chose the tablet. Doctors paired both treatments with calorie guidance and physical activity, so neither group relied on the procedure or the tablet alone.
Researchers measured the share of body weight each patient lost at six months, then again at 12 months, and ran statistical checks to confirm the pattern held once they accounted for age, sex, starting weight and diabetes.
Patients who underwent ESG lost 12.72 percent of body weight within six months. Patients who took the tablet lost 8.67 percent over that stretch.
Doctors treat a drop of 10 to 15 per cent in body weight as a marker that carries weight beyond the scale. Sugar control tends to improve past that point. Fatty liver often eases. Blood pressure tends to fall.
Seventy percent of ESG patients crossed the 10 percent mark, against 43 percent of tablet patients. Thirty-six percent of ESG patients crossed 15 percent, against seven percent of tablet patients.
Neither group reported a life-threatening complication. Some tablet patients experienced nausea or vomiting. Eighteen patients stopped taking the tablet during the study, citing side effects or cost. Five patients from the ESG group later added the tablet to their treatment too.
By twelve months, the numbers pull closer together. ESG patients had 11.92 percent weight loss. Tablet patients held 10.91 percent. Statisticians found no gap between the groups that survived scrutiny at that point.
Reddy explained the pattern behind these figures. “Endoscopic weight-loss treatment produces a fairly dramatic reduction in weight during the initial months,” he said. “Patients lose around 30 to 40 percent of their excess body weight, although they may regain a little weight after a few months. With tablets, the weight loss is more gradual. Initially, patients lose around 10 to 20 percent, and only after about 12 months do they reach a peak weight loss of around 30 to 40 percent.”
He summed up where the two curves land. “By 12 months, both approaches show similar weight loss.”
Put plainly, ESG pulls weight down within weeks, then levels off. The tablet climbs slowly, month after month, until it catches up.
Reddy framed the choice around timing rather than ranking one treatment above the other.
“Some people want to lose weight quickly, for example, before knee surgery or even before marriage,” he said. “For those situations, endoscopy is the better option because it produces faster weight loss.”
He extends that logic to patients pursuing weight loss for appearance. “For aesthetic purposes, if someone wants quick weight loss, endoscopy is the better option.”
Patients who want to skip a procedure and who accept a slower curve tend to reach for the tablet instead.
Cost enters the decision too, though not in the direction most patients expect. A single tablet costs less than a procedure at the outset. That gap narrows once a patient factors in years of continuous use, since ESG happens once, while the tablet continues without a stop date.
“The initial cost of the endoscopic procedure is around 1.5 lakh rupees,” Reddy said. “With tablets, patients have to keep taking them, and we don’t yet know for how long. At one year, tablets may cost about half as much as endoscopy. But if you consider that endoscopy is a one-time procedure while tablets may have to be taken for five years, the overall cost becomes similar.”
Jagtap returned to the same point from a different angle, stressing that neither treatment stands alone. Reddy echoed that view directly.
“It is very important to emphasise that none of these treatments replaces lifestyle modification,” Reddy said. “Patients cannot think that they have undergone the procedure or started tablets and then neglect their lifestyle. They still have to follow healthy lifestyle measures.”
He returned to convenience as the deciding factor, not one treatment outperforming the other. “That is precisely why we conducted this study. We wanted to show that endoscopy and GLP-1 therapies offer similar outcomes at one year. The choice should be based on the patient’s convenience. If someone is comfortable taking medication continuously, then GLP-1 therapy is appropriate. But if they prefer a one-time intervention, then endoscopy is the better choice.”
Also Read: How GLP-1 weight-loss drugs are entering dermatology clinics
Researchers tested oral semaglutide because it stands as the only GLP-1 drug that comes as a tablet. Tirzepatide, sold as Mounjaro, exists only as an injection.
“We used only oral semaglutide because it is the only GLP-1 medicine available in tablet form,” Reddy said. “Tirzepatide is not available orally. Injectable drugs are different, and we are already conducting another study comparing the injectable therapies.”
A separate line of work may reshape how doctors match patients to treatments. Reddy points to variation among patients that current data cannot explain.
“We also found that there is a lot of variation in how people respond to the injections,” he said. “We have another study coming out, which shows something very interesting. Response appears to differ based on a person’s genes.”
He pointed toward a future where a test, not trial and error, guides the decision. “In the future, based on genetic testing, we may be able to tell a patient which treatment is likely to work best,” he said. “I think that is the future, precision medicine, where treatment is tailored to the individual patient.”
This study was conducted at one hospital. It drew on patient records rather than a randomised trial, so patients picked their own treatment rather than researchers assigning it. It covered oral semaglutide alone, not the wider field of GLP-1 drugs reaching patients worldwide. Researchers call their own findings preliminary and want a randomised trial to confirm the pattern.
The larger question stretches past twelve months. Does either treatment hold its ground across five years, or does one path pull ahead again once the study widens its window?
“We have left that question open because we are continuing the study and want to see what happens after five years,” Reddy said. “But currently, our conclusion is that both approaches are similar, and people can choose the option that suits them.”
He pointed to what this study changes for patients weighing that choice today. “I think many people will naturally tend to choose GLP-1 medicines,” he said. “But the problem is that many patients are not aware of what endoscopic treatment can achieve. With this study, they now know the effects of endoscopy as well, and that allows them to make a more informed and considered decision.”
(Edited by Muhammed Fazil.)
