Health Matters: A Minimally Invasive Approach to Treating Obesity


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By Monica Saumoy, MD

Millions of people across the United States struggle with obesity. This common and serious disease increases the risk for a variety of other health conditions, such as diabetes, high blood pressure, and infertility, and it can negatively impact body image and self-esteem.

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Treating obesity, however, has been shown to decrease the risk for many of these conditions and to help people overcome the damaging physical and emotional effects of being overweight.

A Complex Disease

Obesity is a complex disease influenced by a range of factors, including:

  • Certain medications.
  • Eating and physical activity patterns.
  • Environmental factors, such as lack of access to healthy foods or not having parks nearby.
  • Genetics.
  • Hormone problems, such as underactive thyroid and polycystic ovary syndrome.
  • Insufficient sleep.
  • Stress.

In addition, obesity itself can cause hormonal and other chemical changes in your body that contribute to the disease and make it difficult to lose weight solely through diet and exercise.

More than 42% of U.S. adults have obesity, which is defined as having a body mass index (BMI) of 30 or above, according to the Centers for Disease Control and Prevention (CDC).

Diet and Exercise Often Not Enough

Many people who have obesity have struggled for years — or even decades — to lose weight on their own, trying various diets and or exercise programs that promise rapid results.

Diet and exercise alone are often not enough to treat obesity.

This is in part because when your body notices a calorie deficit it starts to get nervous, afraid it could be starving to death. Your brain and your gut then work together to fight the perceived threat, conserving calories to keep your body alive.

A Minimally Invasive Treatment Approach

Endoscopic sleeve gastrectomy is a minimally invasive procedure for weight loss that reduces the size of the stomach so the patient will eat less and lose weight.

With endoscopic sleeve gastroplasty, doctors insert an endoscope equipped with a suturing device into your throat and down to your stomach. The doctor then sutures the stomach to create a smaller, tube-shaped pouch, which effectively restricts the amount of food you can eat.

The procedure is available through the Center for Digestive Health at Penn Medicine Princeton Medical Center, in consultation with the Center for Bariatric Surgery & Metabolic Medicine at Princeton Medical Center. It takes about an hour to 90 minutes to perform and does not require any incisions. Most patients go home the same day.

Following endoscopic sleeve gastroplasty, a liquid diet is temporarily prescribed in order to allow for healing and to jumpstart the weight-loss process. There generally are no other restrictions beyond diet following the procedure. Patients usually return to work within a few days after the procedure and begin to integrate a diet and exercise routine to help lose weight and keep it off.

Studies show that the endoscopic sleeve gastroplasty can result in rapid weight loss, and the average patient can expect to lose 15-18% of their body weight within one year. For example, if you weigh 250 pounds, you could lose up to 45 pounds over time.

Obesity-related medical problems will likely improve with a modest degree of weight loss following the procedure. With steady weight loss, patients often require lower doses of medications for diabetes and high blood pressure, and in some cases, they may no longer need medication at all.

Candidates for endoscopic sleeve gastroplasty include patients with obesity who have a BMI greater than 30 and have not had success with weight loss through diet and exercise.

One Piece of the Puzzle

Successful weight loss is a process, and a procedure like endoscopic sleeve gastrectomy is just one piece of the puzzle. Patients who undergo endoscopic sleeve gastrectomy are encouraged to follow these eight tips to help ensure long-term weight loss success:

1. Attend each and every follow-up visit with the doctors and support staff.
2. Eat smaller portions and listen to your “fullness” signals.
3. Choose healthier foods for better nutrition.
4. Exercise regularly doing the physical activities you enjoy most.
5. Participate in support groups both in person and online.
6. Join a bariatric exercise program for support and motivation.
7. Get into the habit of monitoring your weight.
8. Celebrate your weight loss success with friends and family.

When it comes to weight loss, there is no such thing as a quick fix. Endoscopic sleeve gastrectomy, however, is an effective treatment for obesity that can help jump start your weight loss and give you the leverage you need to build lifelong healthy habits. Coverage for the procedure varies by insurance plan. Check with your plan to see if it is covered.

To find a gastroenterologist with Penn Medicine Princeton Health or for more information about the Center for Bariatric Surgery & Metabolic Medicine at Princeton Medical Center, call 888-742-7496 or visit

Monica Saumoy, MD, is board certified in gastroenterology and internal medicine and specializes in obesity medicine. She is a member of the Medical Staff at Penn Medicine Princeton Health.

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