ESG is a Cost Effective and Sustainable Solution!

May 30, 2024By Murat Üstün
Murat Üstün

Endoscopic Gastric Sleeve Gastroplasty: A More Cost-Effective and Sustainable Weight Loss Solution Compared to Semaglutide

In the ever-evolving landscape of weight loss treatments, a recent study published in JAMA Network Open highlights the cost-effectiveness and efficacy of Endoscopic Sleeve Gastroplasty (ESG) over a five-year period when compared to semaglutide, the active ingredient in popular weight loss drugs like Ozempic and Wegovy. This study underscores the potential of ESG as a more sustainable and affordable option for long-term weight management.

What is Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic Sleeve Gastroplasty (ESG) is a nonsurgical weight loss procedure that involves reducing the size of the stomach using a specialized suturing device. Unlike traditional gastric sleeve surgery, which involves surgically removing a large portion of the stomach, ESG uses an endoscopic approach. The procedure is performed by inserting the suturing device through the throat into the stomach, where it folds and sutures the stomach lining, thereby reducing its volume.

The Study: Methodology and Key Findings

The study conducted between September 1, 2022, and May 31, 2023, utilized a Markov cohort model to simulate the experiences of a hypothetical group of patients over a set period. The participants were adults within the U.S. healthcare system, all having a body mass index (BMI) ranging from 35 to 39.9, which classifies them within the obesity range.

Initially, over a one-year period, ESG was found to be less cost-effective compared to semaglutide. However, the dynamics shifted significantly when the researchers extended the observation period to five years. 

clinic, profession, people, health care and medicine concept - happy group of medics or doctors at hospital corridor

Cost Comparison Over Five Years

The projections indicated that "the semaglutide strategy" would cost approximately $33,583 more than the ESG strategy over five years. A crucial factor contributing to this cost difference is the likelihood of discontinuation among semaglutide users. The study estimated that about 20% of individuals on semaglutide would stop using the drug due to intolerance or other reasons, leading to probable weight regain.

Conversely, ESG demonstrated a more enduring solution with greater weight loss and cost savings. The researchers concluded that for semaglutide to be a cost-competitive alternative, its annual cost would need to be drastically reduced from $13,618 to $3,591.

Expert Opinions on ESG vs. Semaglutide

Marina Kurian, MD, president of the American Society for Metabolic and Bariatric Surgery, highlighted the economic and practical advantages of ESG. According to Dr. Kurian, medications like semaglutide, while initially effective, are expensive and often lead to significant weight regain upon discontinuation. In contrast, patients undergoing surgical weight loss procedures, such as ESG, tend to maintain their weight loss more effectively over the long term, even though some weight regain can occur.

Dr. Kurian pointed out that weight loss surgeries typically achieve cost recoupment or become cost-neutral over two to three years, reinforcing the financial viability of ESG as a weight loss strategy.

The Role of Semaglutide in Weight Loss

Originally developed to treat type 2 diabetes, semaglutide gained popularity for its weight loss benefits. The drug functions by stimulating insulin release in response to high blood sugar levels, particularly after meals, and by reducing the amount of sugar produced by the liver. Administered as a weekly injection, semaglutide has proven effective in promoting weight loss.

However, the long-term economic sustainability of semaglutide is questionable, especially when compared to the more cost-effective ESG. The study suggests that despite its initial success in aiding weight loss, semaglutide may not be a financially viable option over an extended period.

Healthy fit and sportive couple running in nature at summer day

The Importance of Lifestyle Changes

Both ESG and semaglutide require a commitment to lifestyle modifications to achieve and maintain weight loss. Medical professionals emphasize the necessity of dietary changes, regular exercise, and other lifestyle adjustments to ensure the success of either treatment. These components are essential in sustaining weight loss and improving overall health outcomes.


The study published in JAMA Network Open presents compelling evidence that Endoscopic Sleeve Gastroplasty (ESG) is a more cost-effective and sustainable weight loss solution over a five-year period compared to semaglutide. While semaglutide can facilitate initial weight loss, its high cost and the potential for weight regain upon discontinuation make it less economically viable in the long run.

ESG, with its nonsurgical approach and significant long-term cost savings, offers a promising alternative for individuals seeking effective weight management solutions. By combining ESG with necessary lifestyle changes, patients can achieve and maintain significant weight loss, enhancing their overall health and quality of life.

For those considering weight loss treatments, it's essential to weigh the costs and benefits of each option. As this study illustrates, ESG may provide a more practical and financially sustainable path to achieving long-term weight loss goals.


This post aims to provide a detailed comparison of ESG and semaglutide, emphasizing the long-term benefits and cost-effectiveness of ESG for weight loss. It is crucial for individuals to consult with healthcare professionals to determine the most appropriate treatment based on their specific health needs and financial considerations.