Nonsurgical Weight Loss Procedures and Bariatric Alternatives
A Look at the Options
Medically reviewed by Robert Burakoff, MDMedically reviewed by Robert Burakoff, MD
Weight loss is a complex process that often requires a combination of lifestyle changes, medications, and outpatient procedures. Bariatric (weight loss) surgeries are highly effective, but many people opt for other weight loss options due to the associated costs, commitment, and risks.
This article reviews weight loss outpatient procedures, reasons to consider bariatric surgery alternatives, insurance coverage, and nonsurgical weight loss support.
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Weight Loss Outpatient Procedures and Interventions
Endoscopic weight loss procedures are minimally invasive outpatient interventions. Before the procedure, you will get medicine to make you sleepy. The healthcare provider uses an endoscope (a thin, flexible tube with a camera) to reach your stomach through your esophagus. Below are examples of standard endoscopic weight loss procedures and their pros and cons.
Intragastric Balloons
A healthcare provider places an intragastric balloon, like Orbera or Obalon, in your stomach and fills it with liquid or air to help you feel full sooner.
Pros
Average weight loss of 29% within a year
Quick recovery
Temporary
Cons
A year of medical supervision
Potential upset stomach
Requires removal after a few months
Aspiration Therapy
AspireAssist is a type of aspiration therapy in which a healthcare provider places a tube in your stomach. The tube connects to a button that allows you to drain your stomach contents after meals, cutting calories by about 30%.
Pros
Adjustable drainage rate
Minimally invasive
Promotes gradual weight loss
Cons
Potential for misuse
Potential side effects like heartburn
Risk of infection
Bypass Liners
A healthcare provider places bypass liners, like EndoBarriers, into your small intestine (the tube that carries food between your stomach and the large intestine). These liners create a barrier that reduces appetite and changes how you absorb calories.
Pros
Averages an 11% weight decrease
Can reduce blood sugar, blood pressure, and cholesterol
Minimally invasive
Cons
Potential discomfort after insertion
Requires removal at some point
Risk of device moving
Endoscopic Sleeve Gastroplasty (ESG) and Gastric Plication
An endoscopic sleeve gastroplasty (ESG) reduces stomach size by stitching and reshaping it into a tubular shape, making you feel full sooner. An ESG can reduce total body weight by 16% and excess weight by 60%. Gastric plication achieves a similar result by folding and stitching the stomach, creating wrinkles.
Pros
Gradual weight loss
No incision
Quick recovery
Cons
Not everyone is eligible
Requires lifestyle changes
Side effects like nausea for a few days
Endoscopic Gastric Bypass Revision
An endoscopic gastric bypass revision is an endoscopic procedure that modifies a previous gastric bypass without requiring additional major surgery.
Reasons to Consider Bariatric Surgery Alternatives
The following bariatric surgeries can reduce excess weight by up to 75%. However, they require a lifelong commitment to dietary changes and can cause side effects like dumping syndrome (food moves too quickly from your stomach to small intestine). Types of bariatric surgery include:
Many people explore nonsurgical alternatives to reduce risk; some favor them for the following reasons:
Broader eligibility
Convenience
Fewer complications
Gradual weight loss
Lower cost
Reversibility
Insurance Coverage for Weight Loss Procedures and Interventions
Bariatric surgery costs between $15,000 and $25,000 without insurance.
Medicare, Medicaid, or private insurance companies often cover bariatric surgery if you meet certain requirements. If this is the case, surgery may be less expensive than endoscopy. However, with growing support for endoscopic effectiveness, insurance coverage and cost-effectiveness are increasing for these procedures.
Comparing initial vs. long-term costs should also be considered. One study shows that endoscopic sleeve gastroplasty (ESG) costs more than Wegovy (semaglutide) in the first year, but after five years, ESG is much less expensive:
Timeline | ESG | Wegovy (semaglutide) |
First 12 months | $17,229 | $11,742 |
After five years | $19,685 (cumulative cost) | $53,268 |
The manufacturer offers a coupon card program for Wegovy, costing some consumers nothing each month.
Nonsurgical Weight Loss Support and Resources
Healthcare providers design medical weight loss programs to monitor progress, identify modifiable behavior, and recommend lifestyle changes, supplements, medications, injections, and special devices, or alternative care like acupuncture.
Supplements
Weight loss supplements containing African mango, green tea extract, carnitine, curcumin, and rhubarb might help you achieve your weight loss goals, but the evidence to support their use varies and isn't always strong.
Supplement safety and effectiveness vary as well. Supplements could interact with the medicines you take, and some are costly or even dangerous. For example, for safety reasons, in 2004, the Food and Drug Administration (FDA) banned ephedra, a substance derived from an evergreen shrub that contains stimulant compounds, for safety reasons.
Talk to your healthcare team about the risks and benefits if you are considering supplements.
Weight Loss Programs
Some weight loss programs offer meal plans or prepackaged meals, calorie counting, portion control, and behavior modification. While these plans are convenient, some people avoid them due to restrictive rules, time commitments, and potentially high costs.
Weight Loss Medications
The following weight loss medications affect how your body processes food or reduce your appetite:
Alli, Xenical (orlistat)
Contrave (bupropion and naltrexone)
Qsymia (phentermine and topiramate)
The following glucagon-like peptide (GLP) medications work by mimicking the body's natural hormones. They can result in 15% to 20% weight loss. In the past, bariatric surgery was the only option for this range of weight loss. GLP drugs include:
Ozempic, Wegovy (semaglutide) (strongest success rate)
Saxenda, Victoza (liraglutide)
Below are the pros and cons associated with weight loss medications.
Pros
Convenient
Effective
May offer additional health benefits
Cons
May forget to take them
Some require self-injection
May need to take them indefinitely
Not everyone qualifies
Potential side effects
Some medications are costly
Uncertain long-term effects of newer medications
Injection Therapies
Your provider may recommend the following injections to help dissolve fat, boost metabolism, or curb appetite:
Vitamin B12
Lipolysis like Kybella (deoxycholic acid)
Lipotropic (amino acid) injections
Peptides
Pros
Convenient
Rapid action
Target specific areas
Cons
Can be expensive
May cause discomfort at the injection site
Potential long-term reliance
Potential side effects
Body Contouring or Sculpting
An esthetician, usually found in dermatology or plastic surgery clinics, specializes in body sculpting, which reshapes your body by reducing fat in certain areas. Techniques include:
Electromagnetic lipolysis
Radiofrequency lipolysis
Red light therapy
Ultrasound cavitation
Pros
Noninvasive
Low-risk
Quick
Limited downtime
Cons
Will not help with overall weight loss
May cause discomfort, swelling, bruising, or discoloration
Not typically covered by insurance (because it is cosmetic)
The average cost is $1,226 per session
Results may require repeat sessions
Summary
Weight loss success often involves multiple methods. In addition to lifestyle changes or bariatric surgery, there are also nonsurgical methods. Medical weight loss teams may recommend behavioral therapy, supplements, weight loss medications, and nonsurgical interventions.
For example, endoscopic procedures are less invasive than surgery and have a minimal recovery time. However, it’s essential to check insurance coverage as many cover surgery but will not cover weight loss medications or endoscopic procedures.
Read the original article on Verywell Health.
