Hyderabad, July 3 : Obesity is no longer viewed simply as a matter of willpower, overeating or lack of exercise. It is now widely understood as a chronic metabolic disease, often linked with diabetes, fatty liver disease, hypertension, sleep apnoea, heart disease risk and reduced quality of life.
For many people, especially in urban India, weight gain creeps in slowly over years as a result of longer working hours, irregular meals, high-calorie processed food, poor sleep, stress and reduced physical activity, all of which play their own part.
According to the press release, a recent real-world study by doctors at AIG Hospitals, Hyderabad, published in the prestigious journal Endoscopy, adds important Indian data to this evolving field. The study, titled "Endoscopic Sleeve Gastroplasty Versus Oral Semaglutide for Obesity: A Real-World Comparative Cohort Study," compared two established non-surgical approaches for obesity: Endoscopic Sleeve Gastroplasty, commonly called ESG, and oral semaglutide 14 mg, a tablet used as part of medical weight-loss therapy.
The study was authored by Dr Nitin Jagtap, Dr Aman Golchha, Dr Anudeep Katrevula, Dr Shujaath Asif, Dr Hardik Rughwani, Dr Krithi Krishna Koduri, Dr Priyanka Balenki, Dr Rakesh Kalapala and Dr D Nageshwar Reddy from the Department of Medical Gastroenterology, AIG Hospitals, Hyderabad.
Endoscopic Sleeve Gastroplasty is a minimally invasive, advanced endoscopic procedure performed through the mouth without external cuts. Using an endoscope and a suturing device, the stomach is reshaped from inside by placing full-thickness sutures. This reduces the functional volume of the stomach and helps patients feel full earlier. In simple terms, ESG gives the stomach a sleeve-like shape without removing any part of it surgically. Patients usually progress through a structured diet plan after the procedure, moving from liquids to pureed foods, soft foods and then solids under supervision within a few days.
Oral semaglutide, on the other hand, works through a different mechanism. It belongs to a class of drugs called GLP-1 receptor agonists. These medicines act on hormonal pathways that regulate appetite, satiety and food intake. For many patients, the tablet helps reduce hunger, makes them feel full earlier, and supports calorie restriction. It is less invasive than a procedure, but it requires regular intake, adherence, tolerance and affordability over time.
The AIG Hospitals study compared 150 adults with obesity treated between January 2024 and April 2025. Fifty patients underwent ESG, and 100 patients received oral semaglutide 14 mg once daily. The primary endpoint was percentage total body weight loss at six months. Both groups also received standardised lifestyle advice, including a calorie-deficit diet and moderate physical activity, reinforcing an important point that neither ESG nor semaglutide is meant to work in isolation. They work best when combined with dietary discipline, physical activity and follow-up.
The key finding was clear. At six months, ESG produced significantly greater weight loss than oral semaglutide. 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 significant even after statistical adjustment for factors such as age, sex, baseline BMI and diabetes, the release stated.
Responder rates also favoured ESG. Around 70% of patients who underwent ESG achieved at least 10% total body weight loss, compared with 43% of those on oral semaglutide. More strikingly, 36% of ESG patients achieved at least 15% total body weight loss, compared with 7% in the semaglutide group. In practical terms, this matters because weight loss beyond 10% can often translate into more meaningful metabolic improvement with better sugar control, improvement in fatty liver, reduced blood pressure burden and improved mobility.
Dr Nitin Jagtap, Consultant Gastroenterologist at AIG Hospitals and corresponding author of the study, said, "The most important message from this study is that obesity treatment has to be individualised. ESG appears to offer a stronger early push in weight loss, especially for patients who need 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."
At 12 months, the difference between the two groups 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 is an important observation. It suggests that both approaches can help sustain weight loss, but the early advantage of ESG may gradually converge over time, especially as real-world patients change therapies, discontinue medication or add pharmacotherapy after a plateau or weight regain.
Dr D Nageshwar Reddy, Chairman, AIG Hospitals, said, "Obesity care is entering a new phase where endoscopy, pharmacology, nutrition and lifestyle medicine must come together. 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 behavioural and metabolic care."
In the end, ESG, semaglutide and other modern obesity therapies should be understood as bridge therapies and not permanent substitutes for lifestyle change.
These are scientifically guided interventions that help patients cross the difficult first stage of weight loss. For many patients, losing the first 8-12% of body weight may be the difference between giving up and believing change is possible.
