Comparing Weight Loss Procedures: ESG and ORBERA®

Dr. Christopher McGowan
January 6, 2021

Every January, people from all walks of life start the new year with a long list of resolutions that they feel passionate about achieving. Unfortunately, more often than not, those grand ambitions don’t translate to the kind of life change we have in mind. Of course one of the most popular New Year’s resolutions involves weight loss. This is undoubtedly because, by the time January rolls around, we’ve just been through a holiday season full of sugary treats and suddenly feel the need to shed a few pounds. 

Wanting to lose weight, however, is much easier than actually losing the weight. Besides the many biological and genetic factors that play a role in how much weight we retain, the truth is that the process of losing weight can be a great challenge for almost anyone who makes the attempt. One of the biggest reasons for this is that traditional weight loss methods require restrictive diets and grueling workouts; while a sensible plan for diet and exercise is good for overall health, studies consistently show that they aren’t very effective at actually losing weight. 

In the past, the only alternative to fad diets and unsustainable exercise routines was bariatric surgery. While generally more effective than dieting, this kind of surgery is invasive and requires lengthy recovery times. At True You, we ask: what if you could achieve the same (or better) results as surgery without the actual surgery? Our answer to that is several state-of-the-art procedures that can help you finally get the results you’ve been longing for. Two of our most popular and effective solutions are endoscopic sleeve gastroplasty (ESG) and the ORBERA® Managed Weight Loss System.     

What is Endoscopic Sleeve Gastroplasty?

The essential aim of ESG is to reduce stomach volume by reshaping it into a narrow, sleeve-shaped cavity. The reason this is ideal for weight loss is that reduced stomach volume will lead to feeling full sooner after eating; the literal lack of space means that your stomach will fill up faster. Feeling full faster means eating less, and eating less means ingesting fewer calories. Over time, this reduction in calories will result in weight loss because your body will be forced to fulfill its energy needs from stored fat reserves rather than just ingested food. 

Endoscopic sleeve gastroplasty is so named partly because of the method used to implement it. The term “endoscopic” refers to the type of device that is inserted into the body; an endoscope is a long, flexible tube that has a camera, lights, and surgical tools mounted on the end. Unlike in traditional bariatric surgery (such as gastric bypass), ESG doesn’t require any incisions. The endoscope is inserted through the mouth and is snaked down through the esophagus and into the stomach. 

In order to reshape the stomach into the banana-shaped sleeve, the endoscope is used to stitch together the two sides of the stomach from the inside along the greater curvature of the organ. What this means practically is that a large portion of the stomach is essentially cordoned off so that food can no longer enter that section. This internal stitching creates a bunching effect that looks somewhat like an accordion, which is why the procedure is sometimes referred to as an “accordion procedure.”   

When the procedure is complete, the newly formed gastric sleeve will represent an approximate 70%-80% reduction in stomach volume. With only 20% of remaining stomach space, your ability to consume large quantities of food in a single sitting will be drastically curtailed. This is often a major game changer for people who struggle with overeating, because you literally can’t eat as much as you did before. This new stomach size helps a lot of people lose weight, but, more importantly, it makes the weight loss more sustainable over the long term because it fundamentally changes your eating patterns. 

What is the ORBERA® Managed Weight Loss System?

The ORBERA® system is in some ways very different from ESG, largely because it is meant as a temporary and adjustable weight loss solution. In essence, ORBERA® is a small, silicone gastric balloon that is designed to be placed directly into the stomach cavity. Once in place, the mere presence of the ORBERA® balloon takes up space that by default reduces the overall volume of the stomach. Similar to ESG, the goal of reducing stomach size is to cause fullness to happen sooner and thus to reduce caloric intake. 

Another similarity with ESG is that the ORBERA® balloon is placed in the stomach endoscopically. During the procedure, a deflated balloon is inserted through the mouth and into the stomach via the endoscope. Once in place, the silicone balloon is filled with a sterile saline solution until it reaches the approximate size of a grapefruit. The typical time span for living with ORBERA® is six months; during that time, the balloon takes up stomach space and helps retrain your body to expect less food and to anticipate how much food you really need to make you full.  

What are the Main Differences Between the Two Procedures?

One of the primary differences between ESG and ORBERA® is that ESG is permanent and ORBERA® is not. While ESG is distinct from other bariatric procedures in that no surgery is involved, the internal stomach sutures that reshape it into a sleeve can only be placed on a permanent basis. The ORBERA® balloon, on the other hand, is specifically designed to be in use for six months. During this time, you get the chance—with supervision and support from our talented staff—to learn and adopt new eating habits. When the six months have elapsed, the balloon is removed and your weight loss can continue through the newly developed habits. So while ESG is a permanent change to your stomach capacity, ORBERA® is more like training wheels.

The other main difference is in terms of how the procedure is actually performed. Although both procedures utilize an endoscope, the ORBERA® balloon only needs to be placed in the stomach. It is a relatively simple process that usually takes less than 20 minutes to perform. ESG, by contrast, takes a little bit longer (30 to 45 minutes) because it requires the gastroenterologist to carefully place sutures to create an optimal stomach size and shape. This also means that recovery times are different; ESG patients require a few days of recovery at home while ORBERA® patients can usually return to normal routines the same day.

What are the Main Similarities Between the Two Procedures?

Even though ESG and ORBERA® seem fairly different, in reality they both operate on the same principle of reduced stomach size. The ultimate goal of both procedures is to essentially force the body to only be able to ingest as much food as the smaller stomach size allows. Since many people with a weight problem tend to struggle with overeating, either procedure can be beneficial at helping to curb the urge to overeat by retraining the body. 

Closely linked to this similarity is the commitment to a program. At True You, all of our procedures require a commitment to following the recommendations of our staff in order to achieve the best outcome. Whether you opt for ESG or ORBERA®, you will receive a nutritional consultation as well as follow-up visits with the doctor to ensure that you’re healthy as well as making progress toward your weight loss goals. From our extensive experience, we have seen that the greatest success stories happen when patients really buy into all of the recommended lifestyle adjustments. This often includes a modified (and more nutritious) diet as well as regular exercise. These weight loss procedures aren’t magic wands that make all the fat go away; they are tools to help you achieve the life you want.

Who Can Benefit From These Procedures?

ESG and ORBERA® are ideal for obese adults who hasn’t been able to achieve their weight loss goals through traditional routines and methods. Obesity and overweight can be defined in different ways, but one of the most common metrics is body mass index (BMI). This metric is a value that is derived based on a person’s height and weight, and it is useful for broadly categorizing different levels of overweight. Both ESG and ORBERA® are designed for adults with a body mass index (BMI) of 30-40, but it can be helpful for even those who fall above or below that range.  

How Much Weight Can I Expect to Lose?

The amount of weight you can lose is partly dependent on your starting weight as well as your level of motivation to stick with the program. We at True You are so passionate about these offerings, though, because of how significant the weight loss actually can be—especially when compared to traditional diets. 

ESG patients we’ve worked with over the years have been able to experience around 23% total body weight loss (TBWL) 12 months after the procedure. As an example, a person who weighs 400 pounds at the beginning can expect to lose nearly 100 pounds in the first year! These kinds of results are possible when you are committed to following the recommendations for nutrition and exercise, but the good news is that the procedure itself makes it so much easier to be successful. 

Like with ESG, optimal results with ORBERA® are dependent on your starting weight and adherence to the program. In this case, the balloon is designed to stay in your stomach for six months until it is removed. After that, it’s even more important to take the lessons learned from the first six months and apply them to eating and exercise habits over the long term. One of the benefits of ORBERA®, though, is that weight loss can be rapid; most patients lose the most weight in the initial 3-4 months after the procedure. At the six-month mark, the average person can expect to have 13% TBWL, which is about three times better than traditional weight loss programs. 

Which Procedure is Right for Me?

ESG and ORBERA® are both safe, effective, non-surgical alternatives to the often demoralizing and endless quest to lose weight, but they may appeal to different people for different reasons. The sutures involved in ESG can’t be removed, for example, but that’s because it provides the opportunity to permanently reorder your eating habits in a way that fosters long-term, sustainable weight loss. For people who have really struggled with being overweight or obese for a long time, a permanent solution may indeed be the perfect choice. 

For others, who may not like the idea of a permanent change to their stomach capacity, ORBERA® can be a perfect alternative. The temporary nature of the gastric balloon means that you can try it out without a lifelong commitment. The ORBERA® system is also ideal for someone who feels that they need just a little bit of help to achieve their goals rather than a major overhaul of their eating habits. In either case, the staff at True You is dedicated to helping you find the best solution for your goals.   

Freedom is Waiting 

Losing weight can be an amazing feeling, especially as your clothes start to fit better and you begin to experience life without worrying about your weight all the time. But the benefits of weight loss go even beyond waist size; losing weight is associated with a variety of good health outcomes like lower blood pressure, lower cholesterol levels, better mobility, longer life, and overall improved health and wellbeing. If you’ve been struggling for too long to achieve your desired weight, it may be time for a new direction. If you’d like to learn more about ESG or ORBERA®, contact us today to request a consultation.

Dr. Christopher McGowan
Dr. Christopher McGowan
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