New Delhi, July 01: 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 apnea, 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.
A common example seen in clinical practice is the 38-year-old professional who has tried multiple diets, lost 4–5 kg, regained it, and then stopped trying altogether. Or the middle-aged person with diabetes and fatty liver who is told repeatedly to “lose weight,” but finds that lifestyle modification alone is difficult to sustain beyond a few weeks. This is where modern obesity care is changing. The goal is not to replace diet and exercise, but to give patients a scientifically guided head start, a bridge that helps them lose meaningful weight, experience early improvement, and then use that momentum to build long-term lifestyle change.
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.
The publication of this work in Endoscopy is significant because it places Indian real–world clinical experience on an international scientific platform. Obesity treatment data from Asian and Indian populations remain relatively limited, and treatment responses, patient preferences, cost considerations and long-term adherence may differ from Western trial populations. For AIG Hospitals, this study reflects not only clinical expertise in advanced therapeutic endoscopy, but also the institution’s growing contribution to evidence-based metabolic and obesity care.
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 standardized lifestyle advice, including a calorie-deficit diet and moderate physical activity, reinforcing an important point that is 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.
Responder rates also favored 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 individualized. 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.”
The safety profile was also encouraging. There were no major adverse events reported in either group. Most side effects were mild gastrointestinal symptoms such as nausea or vomiting. Importantly, the stronger short-term weight loss seen with ESG did not come with an increased signal of serious complications in this cohort. In the semaglutide group, some patients discontinued therapy during follow-up, including due to adverse effects and cost. This again reflects a real–world challenge that a medicine works only as long as the patient can continue it safely, consistently and affordably.
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 behavioral and metabolic care.”
The researchers also caution that the findings must be interpreted responsibly. This was a retrospective, single-center, real–world cohort study, not a randomized trial. The comparison was specifically with oral semaglutide 14 mg, and the findings should not be extrapolated to higher-dose injectable GLP-1 drugs or newer dual-incretin therapies, which may produce different outcomes. However, the strength of the study lies in its real–world Indian setting, standardized follow-up, and multiple statistical analyses that consistently showed greater short-term weight loss with ESG.
The broader message is particularly relevant for India, where obesity often coexists with diabetes, fatty liver disease and cardiovascular risk at lower BMI thresholds than Western populations. Many patients delay seeking help because they believe weight loss is entirely their personal failure. Others jump from diet to diet, or medicine to medicine, without structured medical supervision. Studies like this help move the conversation from blame to biology, and from quick fixes to evidence-based obesity 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.
The AIG Hospitals study published in Endoscopy reinforces that advanced endoscopic therapies such as ESG can play a powerful role in this journey, especially by delivering better short-term outcomes with a favorable safety profile. More importantly, it highlights the future direction of obesity care which is personalized, multidisciplinary, minimally invasive where possible, and always anchored in long-term lifestyle transformation.