Endoscopic Sleeve Gastroplasty Proves More Cost-Effective Than Semaglutide

Dr. Christopher McGowan
April 30, 2024

There is no argument that medications containing semaglutide, like Ozempic and Wegovy, have gone viral for weight loss. Maybe you have considered trying one of these medications or have already tried one.

While these medications are highly effective in the short term, they are costly and may not be as effective in the long term compared to other weight loss methods.

A study published in April 2024 in the JAMA Network Open by Dr. Muhammad Haseeb and colleagues compared the long-term cost and effectiveness of two popular weight loss methods: endoscopic sleeve gastroplasty (ESG) and semaglutide. The study found that semaglutide medications were significantly more expensive and not as effective long-term when compared to the ESG procedure.

If you’re trying to decide between a semaglutide or ESG for weight loss, here’s what you need to know about semaglutide and both options' cost and long-term success.

What is Semaglutide?

Semaglutide is a synthetic version of the GLP-1, or glucagon-like peptide 1, hormone.  The main action of this medication is to stimulate the hormone insulin while inhibiting the hormone glucagon, which helps to regulate blood sugar. The GLP-1 hormone also acts on the satiety centers in your brain, telling your brain you’ve had enough to eat. This results in a lower calorie intake and weight loss.

There are several GLP-1 medications on the market. The most popular contains an active ingredient called semaglutide. It is sold under the brand names Ozempic or Wegovy. A semaglutide alternative with an active ingredient called tirzepatide is sold under the brand names Mounjaro or Zepbound.

These medications were initially developed for people with type 2 diabetes to help manage blood sugar. However, it was discovered that they also helped people lose weight. Doctors started prescribing it for weight loss, even for those without diabetes. 

The Food and Drug Administration (FDA) approved these medications for weight loss alone in 2021 and 2023. They are now sold under the brand names Wegovy and Zepbound.

Cost of Semaglutide

Even though these medications are incredibly popular, there’s one significant downside–the price tag. The cost of semaglutide and similar medications is out of reach for many patients. The JAMA study found that over five years, semaglutide costs over $53,000. These medications are often not covered by insurance and cost patients between $1,000 and $1,500 per month.

The GLP-1  medications must be used long-term to maintain weight loss. However, semaglutide cost is simply too high for most people, which means many drop off the treatment, resulting in weight regain.

What is Endoscopic Sleeve Gastroplasty?

ESG is a non-surgical, incision-less, minimally invasive procedure that reduces the overall size of the stomach to promote weight loss. By reducing the stomach size by 70-80%, the amount of food that can be eaten is limited, resulting in a lower calorie intake and weight loss. 

While a procedure may seem more expensive than medication, this is not the case when it comes to the cost and effectiveness of ESG vs semaglutide over a five-year period.

Cost of Endoscopic Sleeve Gastroplasty

The authors of the JAMA study found that ESG was a much more cost-effective and sustainable weight loss method. According to the study, the average endoscopic sleeve gastroplasty cost over five years is less than $20,000. The endoscopic sleeve gastroplasty price is $11,995 at True You Weight Loss. The authors of the JAMA study concluded that the annual cost of semaglutide would need to be reduced from $13,618 to $3,591 to be considered a comparable intervention cost-wise.

Long-Term Sustainable Results

Not only was the cost of endoscopic sleeve gastroplasty significantly less than the cost of semaglutide, but ESG offered better weight loss results over five years for those with class II obesity, defined as a BMI of 35 to 39.9 kg/m2. 

In terms of initial weight loss, the average patient who undergoes ESG loses approximately 23.1% of their body weight at 12 months after surgery. A 2022 study found that the average weight lost after 68 weeks of semaglutide was 9.6-17.4% of initial body weight. Current research shows that ESG is more effective at helping patients lose weight.

What about long-term results? The JAMA study found that ESG was also more effective. The average BMI after five years was 31.7 for ESG versus 33.0 for the GLP-1 medications. Part of this discrepancy in results is because an estimated 20% of semaglutide patients will stop their medication due to side effects or intolerance, leading to subsequent weight gain. 

While semaglutide or other GLP-1 medications are a non-invasive, easy-to-use option for weight loss, the JAMA study indicates these medications may not be the best option for long-term weight maintenance. Weighing against the cost of the medication, which is meant to be used long-term, ESG for weight loss is a more effective and cheaper option.

Cost-Effective Alternatives to Semaglutide

When choosing a weight loss method, it is crucial to consider the pros and cons of semaglutide and ESG. The best way to determine which option is best for you is to speak with an experienced physician.

Contact True You Weight Loss for a free virtual consultation to discuss your options. We will personalize our programs to fit your unique needs and lifestyle, ensuring long-lasting results.


  1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2817480
  2. https://pubmed.ncbi.nlm.nih.gov/17928588/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707151/
  4. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management
  5. https://pubmed.ncbi.nlm.nih.gov/31853865/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807016/
Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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