Think about how much weight you're hoping to lose, how much time you feel like it should take, and how your diet and lifestyle may need to change to keep weight off.
Finding the weight loss approach that's right for you
Many people try more than one weight loss approach before deciding what fits best. Learn more about your options—medications, non-surgical procedures, surgery—so you can have an informed conversation with your doctor. Remember, no matter which approach you choose, you’ll need to make diet and lifestyle changes too.
Non-surgical weight loss procedure
Consider if you’re seeking weight loss without surgery or ongoing weight loss medications. Procedures like Endoscopic Sleeve Gastroplasty (ESG) are performed through the mouth with no incisions or scars.
Weight loss medication
Consider whether you prefer a medication-based approach. Doctor-prescribed GLP-1 medications are pills or injections typically taken daily or weekly to help regulate appetite.
Weight loss surgery
Consider if you’re looking for an option that may lead to significant weight loss. Traditional bariatric or gastric sleeve surgeries typically have a more extensive recovery.
A closer look: ESG, GLP-1s, gastric sleeve surgery
The following table includes information about three specific approaches to weight loss: ESG is one type of non-surgical weight loss procedure, Wegovy®* is one of many GLP-1 medications available, and there are weight loss surgeries beyond gastric sleeve. Other options may have different information, so be sure to check online and speak to a doctor about what option may be right for you.
| ESG procedure | Wegovy® (semaglutide)* | Gastric sleeve surgery | |
|---|---|---|---|
| What it is | One-time, non-surgical weight loss procedure plus ongoing diet and lifestyle changes to lose weight and keep weight off1 | Ongoing prescription weight loss medicine (injections or pills) plus reduced-calorie diet and increased physical activity to lose weight and keep weight off | One-time weight loss surgery plus ongoing nutrition and lifestyle changes to lose weight and keep weight off4 |
| Who it's for | Adults with obesity who have a body mass index (BMI) of 30–50 kg/m2, prefer a non-surgical weight loss option, are not eligible for weight loss surgery, and have not been able to lose weight or maintain weight loss through diet and exercise alone1 | Adults and children 12 and up with obesity, or some adults with excess weight (overweight) who also have weight-related medical problems, and have not been able to lose weight or maintain weight loss through diet and exercise alone | Adults with obesity who have a BMI of 40+ kg/m2 or 35–39.9 kg/m2 with a serious weight–related health condition and have not been able to lose weight or maintain weight loss through diet and exercise alone4 |
| How it works | Non-surgical procedure performed by a specially trained doctor that reduces stomach capacity by 70–80% to help you feel full with less food1 | Daily or weekly medication that helps to reduce your appetite, so you eat less and lose weight | Surgical procedure performed by a bariatric surgeon that removes 75–80% of your stomach, leaving a smaller, sleeve-shaped stomach that holds less food to help you feel fuller faster5,6,7 |
| Can it be reversed? | Yes1 | N/A | No5 |
| Recovery time | Studies have shown that most people typically went home the same day as the procedure and returned to routine daily activity in 2–3 days2,3 | No downtime | Typically, people stay at the hospital for 1–2 nights after the surgery, depending on your recovery4,8 |
| Long-term guidance | Diet and lifestyle changes are necessary to maintain weight loss after ESG1 | Medication, together with a reduced-calorie diet and increased physical activity, are necessary to maintain weight loss | Diet, exercise, nutrition monitoring, and follow-up care are necessary after gastric sleeve surgery4,6,8 |
| Most common side effects | Nausea, abdominal pain, vomiting, abdominal discomfort, constipation, heartburn, and bloating1 | Nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, changes in skin sensations, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, low blood sugar in people with type 2 diabetes, gas, stomach flu, heartburn, and hair loss | Body aches, feeling tired, feeling cold, dry skin, hair thinning or hair loss, and mood changes4 plus surgical risks such as bleeding, blood clots, infection, anesthesia reactions, leaking from staple line, stomach juices leaking at surgical site, vitamin and iron deficiency, hiatal hernia, poor nutrient absorption, bowel blockage, poor wound healing, and heart and lung problems7,8 |
Ready to talk through your weight loss options?
A weight loss specialist can help you understand which approach may best fit your weight loss goals, health history, and lifestyle needs.
Before choosing a weight loss approach, ask yourself...
List the ways you’ve tried to lose weight before and then consider your comfort level for medical, surgical, or non-surgical solutions. Not everyone is eligible for every weight loss approach, so talk to a doctor to find out which options are available to you.
As with any medical decision, it’s important to understand the most common risks and side effects associated with each weight loss option, and how they may impact your health and day-to-day life. Talk to a doctor before making your decision.
Be sure to reach out to your insurance provider and doctor to understand coverage for each weight loss option, any available FSA or HSA savings, and potential out-of-pocket costs you may need to cover. Review ESG coverage
Consider how much recovery time you’re able to take in your personal life and your job, and how you may need to adjust your diet and lifestyle based on the weight loss option you choose.
What happens next?
There are a lot of weight loss options available today, and it can feel overwhelming to decide which one is right for you. You don't have to figure this out on your own. A weight loss specialist can help you understand your options and build a plan based on your goals.
Talk with a weight loss specialist to review your health history and weight loss goals
Choose the weight loss option that best fits your goals making sure you understand your insurance coverage
Start treatment or have the weight loss procedure or surgery
Follow your doctor’s guidance on recovery allowing yourself the time you need
Build healthy habits to stay on track with follow-up care, nutrition guidance, and diet and lifestyle changes
Important OverStitch Endoscopic Suturing System Safety Information
ESG is performed using a suturing device called OverStitch. Learn about the risks of the OverStitch Endoscopic Suturing System & OverStitch NXT Endoscopic Suturing System (“OverStitch”) for bariatric surgery.
Talk with your doctor to fully understand all the risks and benefits associated with using this device. Ask your doctor whether this device is right for you.
Indications for Use:
OverStitch is for adult patients with obesity with BMI between 30-50 kg/m2. OverStitch can reduce the size of the stomach by stitching the inside. It can also fix the stomach outlet from previous bypass surgery.
When OverStitch is used to help with weight loss, you need to follow a healthy diet and exercise program. You may not lose weight if you do not adopt healthy habits.
Contraindications:
Your doctor will ask you about your medical history and perform a physical exam to decide if OverStitch is right for you. At the time of your procedure, the doctor may detect internal issues that prevent you from receiving OverStitch. For example, stomach ulcers or inflammation in the stomach may impact device placement.
You should not receive OverStitch if you: have a large hiatal hernia; have a history of bleeding in your stomach or food pipe; have a history of eating disorders; are pregnant; have bleeding disorders or are on blood thinners.
Warnings:
Talk to your doctor if you develop major, continued upper abdominal or back pain with difficulty breathing at any time after getting OverStitch.
OverStitch contains nickel. Nickel may cause an allergic reaction in people with nickel sensitivity.
Potential Risks:
Breathing any foreign object or substance such as food, saliva, or stomach contents into your lungs; Intestine blockage; Switching to a different type of surgery; Nausea, vomiting, dehydration; Bleeding; Infection; Swelling, redness, and pain in tissues caused by injury or damage; Damage to or a hole through the tissue around the stomach, food pipe or surrounding organs; Unintended transfer of fluid or gas from one area of the body to another; Pain; Feeling pins and needles; Buildup of fluid around the stomach; Air leaking from the lungs; Difficulty breathing; Narrowing or tightening in the stomach; Wound opening; Death
MRI Safety Information:
OverStitch can be MRI scanned under certain conditions. Scanning under other conditions may result in injury or device malfunction. Inform your doctor or MRI technician of the device before undergoing an MRI scan. This allows them to take any needed precautions.
Individual weight loss may vary.
For the OverStitch Endoscopic Suturing System you need to follow a healthy diet and exercise program to lose weight. You may not lose weight if you do not adopt healthy habits. Your doctor’s clinical team, including dietitians, nutritionists and/or exercise trainers, should help you on your weight loss journey.
*Wegovy® (semaglutide) is included as a representative example of a GLP-1 medication, based on information available on the Wegovy® website (www.wegovy.com) as of June 2026. Individual GLP-1 medications may differ in mechanism of action, indications, efficacy, dosing and administration, safety profile, and other characteristics. Accordingly, information presented for Wegovy® should not be interpreted as representative of all GLP-1 medications. This comparison is provided for informational purposes only and does not constitute an endorsement of Wegovy® or any other GLP-1 medication.
All trademarks are the property of their respective owners. Any use of third-party trademarks, logos, or brand names is for identification purposes only and does not imply endorsement or affiliation.
1. Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. The Lancet. July 2022;400(10350): 441–451.
2. Kumar N, Abu Dayyeh BK, Lopez-Nava Breviere G, et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc. Apr 2018;32(4):2159-2164.
3. Abu Dayyeh BK, Acosta A, Camilleri M, Mundi MS, Rajan E, Topazian MD, Gostout CJ. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clinical Gastroenterology and Hepatology. 2017;15(1):37-43.e1.
4. Source: https://www.mayoclinic.org/tests-procedures/sleeve-gastrectomy/about/pac-20385183. Accessed September 2026.
5. Source: https://asmbs.org/condition_procedures/sleeve-gastrectomy/. Accessed September 2026.
6. Source: https://my.clevelandclinic.org/health/treatments/bariatric-surgery. Accessed September 2026.
7. Source: https://my.clevelandclinic.org/health/treatments/22931-gastric-sleeve-surgery. Accessed September 2026.
8. Source: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopic-sleeve-gastrectomy-overview. Accessed September 2026.
Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.
All photographs taken by Boston Scientific.