Less-Invasive Weight-Loss Surgery Choices Coming

Weight-loss surgery turns 70 in 2024, and the procedures doctors use have gotten better over time. Today, you have several options that are safer, less invasive and quicker to heal than ever. Within just a few weeks, you’ll be on the path to a thinner, healthier body — and ultimately see improvement in weight-related struggles such as diabetes, hypertension and asthma.

The medical community is not done expanding your choices. More weight-loss methods are in the works. Researchers have been testing alternative ways to help obese and overweight people lose weight more easily. Here’s what’s on the horizon.

Endoscopic Procedures Involve No Cutting

Weight-loss surgery has already gotten shorter and simpler thanks to robotics, where machines — operated by doctors — perform surgical functions more quickly and efficiently than humans can. In the United States, robotics are already used in many bariatric surgeries.

Next up is a series of weight-loss procedures that won’t involve incisions. They are done endoscopically. That means the doctor will enter through your mouth (you’ll be asleep) to do what needs to be done — without cutting any skin, muscles or organs. You’ll see some of these benefits, depending what you choose:

• Fewer incisions than with surgery
• Fewer complications
• Some can be done as an outpatient, so you’ll be able to go home the same day
• They might take only 15 to 30 minutes
• They eventually can be repeatable, so you can stop using one of these options, then try it again if necessary
• These are available if you don’t qualify for surgery because your BMI isn’t high enough, you’re in poor health or you simply don’t want surgery
• No drugs are involved, unless you choose to use them together with one of the popular new drugs in the GLP-1 agonist category

Some endobariatric methods have already been approved by the FDA and are waiting for insurance companies to cover them. Others are inching toward that status or still under development. Within 10 years, we’ll see a revolution in this area.

The Ins and Outs of Endobariatrics

Overall, with an endobariatric procedure you’ll lose less weight than with a traditional bariatric surgery; you’ll shed up to 20 percent of your bodyweight or more going the tried-and-true route, which literally reroutes how your body processes foods by altering internal organs. However, you’ll still lower your BMI significantly — without incisions. Here’s what to expect:

• Intragastric balloon —  Usually called gastric balloons, these have been around for a quarter-century and, after extensive testing globally and use abroad, are ready for widespread use in the U.S. for patients with a BMI of 30 to 40. A surgeon will insert an uninflated balloon into your stomach via your mouth, then fill it with liquid. With one version, they can add more filling if you need that, or make it smaller upon request. You’ll keep it for six to nine months. During that time, after an adjustment period of a week or so, you’ll feel full and your stomach will empty more slowly. By the time a doctor punctures the balloon and removes it, you’ll have lost 10 percent to 15 percent of your bodyweight. There is no anatomical change, so, if you need to lose yet more weight, you can have a traditional bariatric surgery once this is complete. Gastric balloons are FDA-approved and already have a designated insurance code; insurance companies are likely to cover costs in the near future.
• Endoscopic sleeve gastroplasty — With this more powerful procedure, the surgeon will remodel your stomach so it’s the shape of a sleeve. First tried in 2012, this involves suturing your stomach so it’s smaller and holds less food. This, too, delays gastric emptying, meaning the food stays inside you, keeping you satiated longer. The sleeve approach lasts longer than the balloon and leads to losing 15 percent to 20 percent of your bodyweight. You’re less likely to feel discomfort the first week, and you’ll likely go home the day you have the procedure done. This has been FDA-approved and will likely be approved by insurance within the next year or so.
• The robots return. Two companies are developing flexible endoscopic robotic platforms. That means even the endoscopic balloon and sleeve methods can be faster, more accurate and less risky.

Over time, many weight-loss procedures will be done without surgery, just as heart patients today often receive stents and valves in ways that don’t involve cutting their chests open.

Whatever weight-loss procedures you choose, and whenever you have it, do not focus on that alone. Surgical, laparoscopic, robotic, endoscopic … you still need to change your lifestyle. Otherwise, some or all of the weight you lost can return.

Take Care of Your Weight Now

Should you wait until an endoscopic procedure is available and paid for by your insurance provider? No.

If your weight is so high that it’s hurting your health or it will over time, seek treatment. Obesity is the same as any dangerous condition; it’s a chronic disease and it doesn’t make sense to wait to get the help that you need. If you had cancer now, you wouldn’t stall treatment for a few years until a new therapy became available.

It’s great to know, though, that you’ll have more choices within the next few years.