Conditions
Obesity and weight management — the options available and how to choose
Care for obesity and weight management starts with medically supervised lifestyle and nutrition care — the foundation under every route — then GLP-1 medication, an intragastric balloon, and ESG (endoscopic sleeve gastroplasty). The 2024 ASGE–ESGE guideline recommends considering endoscopic weight-loss procedures in adults with a BMI of 30 or above, or 27.0–29.9 with at least one obesity-related condition.
Điểm Chính Cần Nhớ
Được thẩm định bởi The YOUNIFY Clinic medical team · Internal medicine and procedural specialties · Cập nhật 14 tháng 8, 2026 · 6 min read
- Most people who come to talk about weight are not here because of a number on a scale. They come because something in daily life has shifted. This page works as a map: what the options are, how each works, who it suits, and where its limits sit. It names no better route, because that answer differs from person to person.
01
The signs that bring people to us
- Tiring more easily than before: breathless after one flight of stairs, or unable to keep up with the children
- Knee or back pain that tracks with weight: the load-bearing joints usually signal first
- Snoring, or a partner noticing pauses in breathing during sleep: waking unrefreshed, drowsy through the day
- Blood results starting to drift: rising glucose or glycated haemoglobin, abnormal lipids, liver values affected by fatty liver, blood pressure that now needs medication
- Weight lost and regained every time: the most common story we hear, usually carrying a sense of personal failure, even though regain is a well-recognised physiological response
None of this is a diagnosis. It is a signal that a structured assessment is worth doing once.
02
When it is worth talking to the medical team
The joint 2024 ASGE–ESGE guideline, which graded its evidence using GRADE, recommends considering endoscopic weight-loss procedures in adults with a BMI of 30 or above, or a BMI of 27.0–29.9 with at least one obesity-related condition, always *alongside* a lifestyle programme rather than instead of one [1].
BMI is weight in kilograms divided by height in metres squared; 85 kg at 165 cm is about 31.2. An obesity-related condition means something linked to weight: diabetes or elevated glucose, high blood pressure, abnormal lipids, or fatty liver, each confirmed on bloodwork.
A BMI below those thresholds does not mean nothing is worth doing: a medically supervised weight and metabolic programme is still the right starting point.
03
All the care options
| Option | How it works | Who it suits | Limits worth knowing |
|---|---|---|---|
| Medically supervised lifestyle and nutrition care | Adjusting eating patterns, activity, sleep, and eating triggers, with periodic metabolic monitoring | Everyone: the foundation under every route, and the starting point if you have not done this in a structured way | Takes time and consistency · for some it falls short of the health target · the guideline treats it as part of every route, not a removable option [1] |
| GLP-1 receptor agonists (semaglutide · tirzepatide) | Injectable medication acting on satiety and appetite signalling; dose stepped up gradually | Those not ready for a procedure, or with metabolic conditions where an early start matters | Requires continuous use · gastrointestinal side effects are common during dose escalation · continuity is the central issue (figures below) · cost recurs monthly |
| Intragastric balloon (starting from THB 159,000) | A device placed endoscopically occupies space in the stomach, so fullness arrives sooner; removed on schedule | Those wanting a temporary, reversible route | Must be removed on schedule · some cannot tolerate the device and need early removal · endoscopy is needed to place and to remove it |
| ESG (endoscopic sleeve gastroplasty) (starting from THB 490,000) | Endoscopic suturing through the mouth folds the stomach wall inwards, reducing volume, with no tissue removed and no external incision | Those within the BMI criteria above, cleared on gastroscopy, and ready to change how they eat and attend follow-up | Gastroscopy first, and several contraindications are detectable only that way · it does not address appetite drive or eating for stress relief · results depend on follow-up |
| Bariatric surgery | Permanently alters the anatomy of the stomach and/or digestive tract | Starting weights above the range endoscopic procedures cover, or more severe related conditions | Permanent · longer recovery · long-term vitamin and mineral management · not offered at YOUNIFY; we refer on to a bariatric surgical team where that is the better fit |
04
Research figures, read side by side
These figures come from separate studies with different baseline populations and follow-up periods, so they cannot be compared directly. Read them for the order of magnitude, not as a ranking.
- ESG at one year: the MERIT randomised controlled trial (*The Lancet*, 2022; n=209) reported 13.6% mean total body weight loss at 52 weeks, against 0.8% with lifestyle alone [2]
- ESG at five years: a follow-up cohort (n=216, 68 completing five years) reported 15.9% (95% CI 11.7–20.5), with 61% maintaining at least 10% [3]
- Semaglutide: STEP-1 (*NEJM*, 2021; n=1,961) reported −14.9% at 68 weeks on 2.4 mg, against −2.4% on placebo [4]
- Tirzepatide: SURMOUNT-1 (*NEJM*, 2022) reported around 20.9% at 72 weeks on 15 mg, against around 3.1% on placebo [5]
- Staying on medication: a 2026 analysis in *eClinicalMedicine* reports up to 65% of GLP-1 users stop within a year, with roughly two-thirds of the weight lost typically returning within a year of stopping and cardiometabolic measures reverting alongside [6]
That last point is why planning for the long term matters as much as the choice of method.
The wording YOUNIFY uses for ESG results is typically around 15–18% of body weight over one year; individual results may vary.
05
The care pathway at the clinic
- Assessment and history: weight, height, body composition, previous attempts, medication, existing conditions, and how you actually eat
- Blood tests and metabolic assessment: glucose and glycated haemoglobin, lipids, liver and kidney function. For the 27.0–29.9 band, this answers whether a qualifying condition is present
- Gastroscopy, where an endoscopic procedure is considered: required before both ESG and a balloon, because several key contraindications are detectable only on endoscopy
- Choosing together: we set out the routes that are realistic for you, with the trade-offs of each. If a procedure is not appropriate yet, we say so and propose alternatives
- Follow-up through the first year: the period carrying most of the dietary adjustment, symptom management, and metabolic monitoring, and the one that shapes the result
06
Read next — grouped by the question you have
"What is ESG, and how is it done?" → ESG: endoscopic sleeve gastroplasty (main guide)
"Am I eligible?" → Am I a candidate for ESG? · BMI criteria and contraindications
"Which route first?" → ESG vs gastric balloon · ESG or GLP-1: which first?
"What is life like afterwards?" → ESG recovery and diet timeline
"How long do results last?" → ESG long-term results · five-year follow-up data
"What does it cost?" → ESG cost: what's included and is it worth it · ESG cost guide for Thailand
"Is it safe?" → Is ESG safe? Side effects and risks · pooled complication rates
Câu hỏi thường gặp
At what BMI should I start considering treatment?
The 2024 ASGE–ESGE guideline uses a BMI of 30 or above, or 27.0–29.9 with at least one obesity-related condition, always alongside a lifestyle programme. Below that, medically supervised weight management is still the right start.
Do I need to have tried losing weight on my own first?
No. Come in while you are still unsure where to start. The assessment tells you where you stand and what routes are realistic. Lifestyle care underpins every route anyway.
How do GLP-1 medications and ESG differ?
The medication acts on satiety and appetite signalling; ESG reduces stomach volume. Their published figures come from separate studies with different baseline populations and cannot be compared directly. The practical difference is continuity: a 2026 analysis reports up to 65% stop within a year, with roughly two-thirds of the loss returning within a year of stopping.
Will the weight come back?
It can, on any route. Five-year ESG follow-up reports 15.9% mean total body weight loss with 61% maintaining at least 10%, which also means a portion did not hold at that level. The first year and continued follow-up shape the outcome most.
What does it cost?
ESG starts from THB 490,000 and the intragastric balloon starts from THB 159,000. Assessment, gastroscopy, and follow-up are separate items, set out in full before you decide. For medication and surgery, please ask case by case.
Bài viết liên quan
Tài liệu tham khảo
- ASGE–ESGE guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity (Gastrointest Endosc, 2024)
- Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial (Lancet, 2022)
- Five-year outcomes of endoscopic sleeve gastroplasty for the treatment of obesity (Clin Gastroenterol Hepatol, 2021)
- Once-weekly semaglutide in adults with overweight or obesity (STEP 1) (N Engl J Med, 2021)
- Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1) (N Engl J Med, 2022)
- Weight maintenance after discontinuation of GLP-1 therapies (eClinicalMedicine, 2026)
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