In July 2022, two prospective randomized trials were published for two different treatment modalities for class one and two obesity (BMI between 30 and 40). One trial was published in the Lancet journal and the other trial was published in the New England Journal of Medicine. Endoscopic sleeve gastroplasty (ESG), MERIT trial, showed a mean percentage total body weight loss of 13.6% vs 0.8% for control group at 52 weeks. At 72 weeks, once weekly injection of Mounjaro (Tirzepatide) trial showed 15% total body weight loss with 5 mg dose and 20.9% total body weight loss with 15 mg dose vs 3.1% with placebo dose.
Both trials have shown significant weight loss compared to control group with low risk of adverse events. However, there is a major difference between a purely restrictive procedure like ESG and a metabolic treatment like Mounjaro. ESG does not alter gut hormones that are central to weight loss like GLP_1 and PYY. ESG forces you to eat less leading to a calorie deficit or starvation and subsequent weight loss. Mounjaro, a GLP_1 and GIP agonist, decreases your appetite leading to decreased caloric intake and weight loss. Contrary to sleeve gastrectomy, ESG decreases gastric emptying. Thus, it prevents the stimulation of gut hormones that decrease insulin resistance and increase satiety levels. Starvation induced weight loss is never durable. Yet, some researchers and medical companies continue to push stomach restrictive procedures hoping to achieve weight loss. The driving force behind these innovations is not a valid mechanism of action for weight loss but rather an incisionless procedure that appeals to millions of patients who are apprehensive of minimally invasive surgery.
Mounjaro is more effective and less invasive than endoscopic sleeve gastroplasty. Pharmaceutical companies are winning the race for obesity treatment against endoscopic procedures. Medications like Mounjaro and Ozempic partially mimic the effect of reliable metabolic procedure like sleeve gastrectomy and gastric bypass. Endoscopic sleeve gastroplasty mimics the restrictive effect of Lap Band surgery. Gastric banding is no longer performed because of poor outcome. However, those of us who fail to learn from history are doomed to repeat it !!