GLP-1 medications such as tirzepatide and semaglutide have become increasingly popular for weight loss, but many patients face challenges with side effects or insurance coverage. While these drugs are approved by the U.S. Food and Drug Administration for weight loss, most health insurance plans do not cover them for patients without diabetes. This has led some individuals to seek alternative treatments.
One option now available is the Endoscopic Sleeve Gastroplasty (ESG) procedure, offered by the University of Miami Health System (UHealth). ESG is a minimally invasive, non-surgical procedure that reduces the size of the stomach without incisions. Patients typically feel full after eating less food, and the procedure may also affect hormones that regulate appetite.
“Patients typically lose approximately 15 to 20% of their total body weight,” said Robert F. Cubas, M.D., FACS, a bariatric surgeon at UHealth. He noted that these results surpass “10 to 15% total weight loss that patients typically experience with GLP-1 injections.”
Dr. Cubas explained further: “80 to 90% of the weight loss occurs in the first six months, with total weight loss typically achieved within one year. You will also see better control of your glucose levels, blood pressure, and cholesterol levels. You will feel less hungry, more energetic, and move easier.” However, he added that “unfortunately, 10% of ESG patients may not experience a significant weight loss or may regain the weight they lost.”
The ESG procedure is newly available from UHealth’s team of accredited bariatric surgeons. It is intended for adults with obesity who have not succeeded with traditional methods and are ready to make lifestyle changes. According to Dr. Cubas: “Many adults with obesity who have failed to lose weight with traditional weight-loss methods and are committed to making significant lifestyle changes are good candidates for the ESG procedure.”
Candidates generally include those with a BMI between 30 and 40 or higher who have not been able to achieve or maintain a healthy BMI through diet and exercise alone. For those with a BMI between 30 and 35, other surgical options like Gastric Sleeve or Gastric Bypass are not available.
Certain individuals should not undergo ESG. “Patients with severe gastroesophageal reflux disease (GERD), large hiatal hernias, or a history of gastric surgery do not qualify for this type of weight-loss treatment,” Dr. Cubas said.
He also mentioned that heavy drinking could disqualify someone from receiving ESG: “No bariatric procedure is appropriate for people dealing with food addiction or compulsive eating behavior.” All patients at UHealth are evaluated by a psychologist before surgery to screen for behavioral and eating disorders.
During ESG, performed under general anesthesia, surgeons use an endoscope to fold and suture the stomach from inside, reducing its capacity. Recovery usually takes about five days—faster than traditional surgeries—and results can be permanent unless reversed.
Complications are rare but can include insufficient weight loss; revision procedures may address this issue.
After ESG, patients receive nutrition counseling from registered dietitians at UHealth and are encouraged to follow balanced diets with smaller portions as well as regular exercise routines. Dr. Cubas emphasized: “Studies demonstrate that patients who do moderate exercise at least three times per week for 30 to 45 minutes have better results keeping their weight loss, compared with those that don’t.”
Before scheduling an ESG procedure, patients should consider required lifestyle changes such as quitting smoking four weeks in advance: “You should quit smoking at least four weeks prior to your scheduled ESG procedure so as to not alter the healing process,” Dr. Cubas said.
He also cited guidelines regarding medication use: “The American Society of Anesthesiology recommends stopping any GLP-1 medications one week prior to any procedure (like ESG) that requires general anesthesia due to the risk of gastric food retention… and aspiration during induction.”
Pregnancy should be postponed for at least one year following ESG: “Pregnancy should be postponed for at least one year,” he said,“and you definitively cannot be pregnant during the procedure.”
Recent reports indicate major insurance changes affecting GLP-1 drugs for weight loss could impact patient access in coming months (https://edition.cnn.com/2025/07/01/health/zepbound-wegovy-insurance-cvs-bcbs-weight-loss).
Those interested in learning more about their options can contact UHealth experts by phone or online consultation.
