The socioeconomic burdens associated with obesity are palpable, as access to high-quality food, health club memberships, and even the time and resources for physical fitness can be restricted by economic circumstances. It is incumbent upon us, as a society, to address these disparities and engage in discussions about equitable access to treatment for this pervasive disease.
A study just published in JAMA could unveil a new direction in the landscape of weight loss interventions. Endoscopic Sleeve Gastroplasty, or ESG, has emerged as a more cost-effective option for losing significant amounts of weight compared to using semaglutide, the active ingredient in popular weight loss drugs such as Ozempic and Wegovy. ESG also proved to be more effective at helping patients lose more weight than the medications over a 5-year time horizon.
ESG stomach tightening is a minimally-invasive, non-surgical procedure for weight loss that reduces the size and capacity of the stomach by 70%, creating a sleeve-like shape. The endoscopic procedure takes less than 60 minutes to perform and patients lose an average of 18% of their body weight.
Collaborating with esteemed colleagues from the School of Public Health at Harvard University, we embarked on a comprehensive study aimed at rigorously assessing the cost-effectiveness of ESG compared to medication-based approaches. We have deep experience with minimally invasive non-surgical weight loss procedures at our institution, and more than a decade ago I pioneered the ESG stomach tightening procedure that is now implemented worldwide. Our shared goal was to conduct research of the highest caliber, rooted in objectivity and scientific rigor, to ascertain whether ESG truly stands as a cost-effective solution relative to pharmaceutical interventions, leveraging the most robust evidence available.
Study Results
- Patients on a semaglutide regimen over a 5-year period incurred an additional cost of $33,583 compared to the ESG strategy.
- ESG emerged as the more cost-effective option compared to semaglutide within just 2 years, maintaining its advantage over the remaining 5-year horizon.
- To achieve parity with ESG in terms of cost-effectiveness, the annual price of semaglutide would need to be reduced by more than 3-fold, from $13,618 to $3,591.
- The ESG strategy resulted in more weight loss with patients achieving a lower body mass index over the 5-year period compared to medication.
- Approximately 20% of individuals utilizing semaglutide would discontinue its use due to medication intolerance or other factors, potentially leading to weight regain.
ESG Beats Semaglutide on Cost & Weight Loss
Obesity is an epidemic, affecting 42% of Americans and only a mere 4% seek out medical treatment. It is imperative to recognize obesity not merely as a condition but as a disease, a realization that society still struggles to acknowledge.
Obesity is not really about a number on a scale. Our body weight is just a symptom of the underlying condition. Obesity manifests as inflamed adipose tissue. People with obesity have activated macrophages populating the fat tissue and secreting toxic cytokines that circulate throughout the body that propagate numerous other ailments, from heart disease to diabetes and beyond.
The stakes are also high for these patients financially. The NIH reports that the aggregate medical cost due to obesity among adults in the United States was $260.6 billion in 2016. It’s crucial to acknowledge that obesity doesn’t discriminate; it affects individuals across all socioeconomic strata, presenting unique challenges to maintaining health, particularly for those facing financial constraints.
Although this study showed that ESG provides a cost-effective solution, the procedure has limitations hindering broader adoption and restricting access. There is a long learning curve and relatively few providers currently have the proper training to safely perform the procedure and achieve optimal outcomes. Further, broad insurance coverage could lead to a rush of unqualified providers prematurely offering the procedure, resulting in unintended consequences. These issues should resolve over the next few years, however, in the meantime patients must carefully investigate provider experience level and clinical outcomes.
The importance of identifying solutions that not only deliver significant weight loss but also offer long-term economic viability cannot be overstated. Additionally, improving access to the full spectrum of care, including this emerging class of lower-cost non-surgical procedures, could help address the worsening disparities in obesity management and may be a critical piece to the obesity solution.
