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Every Weight-Loss Procedure Compared: Surgery, Endoscopic and Balloon

Every weight-loss procedure compared: gastric sleeve, bypass, duodenal switch, SADI-S, band, endoscopic sleeve gastroplasty and gastric balloons, with typical weight loss, risks, reversibility, 2023 numbers and Medicare coverage. Not ranked.

By marketing Updated October 7, 2026 Facts checked October 7, 2026

Fact-checked against FDA labels and official sources; not yet reviewed by a licensed clinician. This page is education, not medical advice. Talk to your doctor before starting, stopping or changing any treatment.

Key takeaways

  • In 2023 there were an estimated 270,089 metabolic and bariatric procedures in the U.S.; 58.2% were gastric sleeves.[1]
  • In 65,093 U.S. adults, average weight loss at one year was 31.2% after bypass, 25.2% after sleeve and 13.7% after band.[10]
  • In the MERIT trial, endoscopic sleeve gastroplasty led to 13.6% weight loss at one year vs 0.8% with lifestyle changes alone.[11]
  • In its FDA trial, the ORBERA balloon led to 10.2% weight loss at six months vs 3.3% with diet and behavior support alone.[14]
  • Medicare covers bypass, duodenal switch and the laparoscopic band nationally, leaves the sleeve to regional contractors and does not cover balloons.[8]

In short: Weight-loss procedures range from a temporary balloon in the stomach (placed by endoscope, or swallowed as a capsule since the Allurion balloon’s approval in February 2026), to stitching the stomach smaller from the inside (endoscopic sleeve gastroplasty), to operations that remove or bypass part of the digestive tract: the gastric sleeve, gastric bypass, duodenal switch and SADI-S, and the now-rare adjustable band. In general, the more a procedure changes the digestive tract, the more weight people lose on average and the more lifelong follow-up and supplements it needs. In large U.S. data, people lost about 25% of their weight one year after a sleeve and 31% after a bypass, compared with roughly 7% to 15% in the main balloon and endoscopic trials. None is “best”: the right fit depends on your health, BMI, goals and what you are willing to live with afterward.

This page puts every procedure available in the U.S. side by side, from the American Society for Metabolic and Bariatric Surgery (ASMBS), FDA approval records, Medicare’s coverage rules and the main trials. For each one in depth, start at our procedures hub and bariatric surgery guide. If you are weighing surgery against medicines, see GLP-1 vs bariatric surgery. This is general education, not advice: whether any procedure suits you is a decision for you and a bariatric team.

Weight-loss procedures in the U.S. in four numbers

Checked on October 6, 2026

Every procedure at a glance

The table lists each option from least to most change to the digestive tract. It is ordered by how the procedure works, not by results, and it is not a ranking.

ProcedureWhat it doesHow it’s doneReversible?U.S. procedures, 2023Medicare
Intragastric balloon (ORBERA, Spatz3, Allurion)A fluid-filled balloon takes up space in the stomachEndoscope through the mouth, removed after 6 (ORBERA) or 8 (Spatz3) months; Allurion is swallowed and filled through a thin tube, then empties and passes on its own after about four months (no endoscopy)Yes, always removed or passed1,461Not covered
Endoscopic sleeve gastroplasty (ESG)Stitches fold the stomach into a narrower sleeve from the insideEndoscope through the mouth; no cutsThe FDA summary describes it as reversible and re-tightenable4,587Not listed among covered procedures
Adjustable gastric band (Lap-Band)An inflatable band around the top of the stomachLaparoscopic surgeryYes, removable773Laparoscopic covered
Gastric sleeveAbout 80% of the stomach is removed, leaving a banana-shaped tubeLaparoscopic surgeryNo157,254At the regional contractor’s discretion
Roux-en-Y gastric bypassAn egg-sized stomach pouch is connected 3 to 4 feet down the small intestineLaparoscopic surgeryDifficult to reverse63,132Covered
SADI-S (single-anastomosis duodeno-ileal bypass)A sleeve plus one intestinal connection that bypasses more intestineLaparoscopic surgeryNo2,387Not named in the national policy; ask
Duodenal switch (BPD/DS)A sleeve plus a bypass of about 75% of the small intestineLaparoscopic surgeryNo3,775Covered
Revision or conversionChanges or replaces an earlier procedureUsually laparoscopic or endoscopicDepends32,267No separate national rule
Sources: ASMBS procedure descriptions and 2023 estimates; NIDDK; FDA PMA P140008, P190012 and P250023 and De Novo DEN210045; CMS National Coverage Determination 100.1. Checked October 7, 2026.
U.S. metabolic and bariatric procedures, 2023
U.S. metabolic and bariatric procedures, 2023
ItemValue
Gastric sleeve157,254
Gastric bypass63,132
Revisions32,267
Duodenal switch and SADI-S6,162
ESG and balloons6,048
Band, one-anastomosis bypass and other5,226

Total 270,089. Groups summed from ASMBS rows: BPD-DS 3,775 + SADI 2,387; ESG 4,587 + balloons 1,461; band 773 + OAGB 555 + other 3,898.

Source: ASMBS, Estimate of Bariatric Surgery Numbers, 2011-2023 (checked on October 6, 2026)

Who these procedures are generally for

Each option has its own threshold, and the thresholds come from different places. For surgery, the 2022 ASMBS and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guideline recommends it for adults with a BMI of 35 or more regardless of other conditions, and says it can be considered from a BMI of 30 with metabolic disease such as type 2 diabetes; lower thresholds apply for people of Asian descent. Medicare uses an older rule: a BMI of 35 or more, at least one obesity-related condition and previous unsuccessful medical treatment. The devices carry FDA-approved ranges: the ORBERA balloon for a BMI of 30 to 40, the Spatz3 balloon for 35 to 40 (or 30 to 34.9 with a major related condition), and ESG for 30 to 50. You can check your BMI with our BMI calculator, but a bariatric team looks at much more than one number.

Teenagers are a separate case. The 2022 guideline says surgery should be considered for adolescents with a BMI over 120% of the 95th percentile and a major related condition, or over 140% of the 95th percentile, after evaluation at a specialty center. In the Teen-LABS study of 242 adolescents with an average age of 17, average weight was 27% lower three years after surgery, and type 2 diabetes went into remission in 95% of those who had it, while low iron stores were common and 13% needed another abdominal procedure. The guideline also sets no upper age limit for adults; instead, teams assess frailty and overall health.

Typical weight loss: what the studies found

The figures below come from different studies with different people, lengths and comparison groups, so they show the general pattern, not a contest. The largest U.S. comparison of surgeries, a PCORnet study of 65,093 adults, found average total weight loss at one year of 31.2% after bypass, 25.2% after sleeve and 13.7% after band, and at five years 25.5%, 18.8% and 11.7%. In the MERIT trial, people having ESG lost 13.6% of their weight at one year, compared with 0.8% with lifestyle changes alone. In the FDA approval trials, people with the ORBERA balloon lost 10.2% at six months (3.3% with diet and behavior support alone), and with the Spatz3 balloon 15.0% at 32 weeks (3.3% in the control group).

Average total weight loss reported for each procedureValues in %
Average total weight loss reported for each procedure
ItemValue
Gastric bypass, 1 year (PCORnet)31.2%
Gastric sleeve, 1 year (PCORnet)25.2%
Spatz3 balloon, 32 weeks (FDA trial)15%
Adjustable band, 1 year (PCORnet)13.7%
ESG, 1 year (MERIT trial)13.6%
ORBERA balloon, 6 months (FDA trial)10.2%
Allurion balloon, 48 weeks (FDA trial)6.9%

Different studies, populations and time points: not a head-to-head comparison and not a ranking. ORBERA and Spatz3 are removed after 6-8 months; Allurion was measured at 48 weeks after up to two balloons. Some weight often returns afterward.

Source: Arterburn D et al., Annals of Internal Medicine 2018 (PCORnet); Abu Dayyeh BK et al., Lancet 2022 (MERIT); FDA SSED P140008, P190012 and P250023 (checked on October 7, 2026)

Two points matter for the long run. Weight loss after surgery usually peaks within the first one to two years and settles somewhat after that, which is why the five-year PCORnet figures are lower. For balloons, ORBERA’s loss narrowed to 7.6% at 12 months, six months after removal, versus 3.1% in the control group. The duodenal switch produces the most weight loss of the operations; in a small Swedish randomized trial of people with a very high BMI, total weight loss 13 to 17 years later was 37.5% after a duodenal switch vs 22.8% after a bypass, with about three times as many adverse events per patient. A national registry comparing ESG with sleeves found 12.33% vs 18.51% weight loss at six months.

Safety: early complications and long-term follow-up

ASMBS puts the overall risk of death at about 0.1% and of major complications at about 4%, varying by procedure. In the PCORnet study, major adverse events within 30 days were 5.0% after bypass, 2.9% after band and 2.6% after sleeve. In the MERIT trial, 2% of people who had ESG had a serious procedure-related event. In the balloon trials, serious adverse events affected 10% of ORBERA patients and 3.7% of Spatz3 patients, and nausea and vomiting were very common early on; 18.8% and 16.6% had the balloon removed early. In the Allurion trial, 3.0% had a device-related serious adverse event, all after the second balloon, with no deaths. The FDA has issued letters to health care providers about rare deaths, overinflation and pancreatitis with liquid-filled balloons.

Major adverse events within 30 days of surgery (PCORnet)Values in %
Major adverse events within 30 days of surgery (PCORnet)
ItemValue
Gastric bypass5%
Adjustable band2.9%
Gastric sleeve2.6%

Observational data from 41 U.S. health systems. Rates depend on the patient and the center.

Source: Arterburn D et al., Annals of Internal Medicine 2018 (PCORnet, 65,093 adults) (checked on October 6, 2026)

The longer-term picture differs more than the early one. The National Institutes of Health says about one in three people have a follow-up procedure or hospital stay within five years, more often after bypass. The sleeve cannot be reversed and can worsen reflux in some people: in the SM-BOSS trial, reflux worsened in 31.8% after sleeve, while it went into remission in 60.4% after bypass. Procedures that bypass intestine raise the risk of vitamin and mineral deficiencies, which are greatest after a duodenal switch, so lifelong supplements and blood tests are part of the plan. ASMBS lists slower weight loss and a high reoperation rate among the band’s disadvantages, and its use fell from 55,932 operations in 2011 to 773 in 2023. Our gastric sleeve vs gastric bypass comparison goes deeper on the two most common operations, and life after bariatric surgery covers the diet stages and follow-up.

When a first procedure needs revising

Revisions and conversions are a large share of bariatric surgery: an estimated 32,267 in 2023, or 11.9% of all procedures. In national accreditation data from 2020 to 2022, about 11.8% of operations were revisions or conversions, the main reasons shifted toward weight regain and reflux, and conversions from a sleeve to a bypass grew from 41.2% to 53.6% of them. In the 10-year SLEEVEPASS trial, 15.7% of people who had a sleeve and 18.5% who had a bypass needed another operation. Endoscopic options exist too: the same FDA authorization that covers ESG also covers an endoscopic tightening of the connection after a bypass. Our revision surgery guide explains how teams decide.

Beyond the procedures in the table, the FDA’s weight-loss device page also lists two other approved balloon-type devices that you are unlikely to be offered. The swallowable Obalon Balloon System (approved 2016) is not on sale: its owner, ReShape Lifesciences, reported no Obalon revenue in its 2025 filings and has licensed it to another company. For the TransPyloric Shuttle (approved 2019) we found no evidence that it is sold. Two other approved devices are gone too: AspireAssist, a stomach-draining tube, was withdrawn on April 8, 2022, for financial reasons, and we found no evidence that the Maestro (vBloc) nerve-blocking implant is still sold. Our overview of every FDA-authorized weight-loss device has the status of each. ASMBS counts a small number of one-anastomosis gastric bypasses (555 in 2023). Ask any program which devices and techniques it actually offers and how much experience it has with each.

Health conditions beyond weight

Surgery often changes more than weight. In the STAMPEDE trial of people with type 2 diabetes, 29% after bypass and 23% after sleeve had an HbA1c of 6.0% or less at five years, compared with 5% on intensive medical therapy alone. The Swedish Obese Subjects study linked surgery with lower long-term death rates than usual care. ASMBS’s fact sheet also links surgery with fewer severe heart events and obesity-related cancers. For ESG, 80% of MERIT participants improved at least one weight-related condition. Ask your team which of your own conditions might change, and how they will be followed.

Cost and coverage

ASMBS gives an average cost for bariatric surgery of $17,000 to $26,000 (checked October 6, 2026). Coverage varies more than price. Medicare covers gastric bypass, the duodenal switch and the laparoscopic band nationally, leaves the sleeve to its regional contractors, and does not cover balloons. ESG is not among the procedures named in Medicare’s national policy, and we found no official dated price for ESG or balloons, so ask for a written self-pay quote. Private plans set their own rules, and some ask for a supervised diet first; the 2022 ASMBS/IFSO guideline calls insurer-required preoperative weight loss “scientifically unfounded”. Our insurance guide explains how to check your plan.

What each option asks of you afterward

  • Balloons: a long-term diet and behavior or lifestyle program is part of the FDA approval, plus a second endoscopy for removal with ORBERA and Spatz3 (the Allurion balloon passes on its own).
  • ESG: the FDA authorization says it is to be used with a lifestyle program; nausea and stomach pain are common in the first weeks.
  • Band: frequent visits for adjustments, according to the AACE/TOS/ASMBS guideline.
  • Sleeve and bypass: a staged diet from liquids to regular food over about 6 to 8 weeks, at least 60 grams of protein a day and lifelong vitamins, per the same guideline.
  • Duodenal switch and SADI-S: the closest nutrition monitoring and the most supplements, because absorption is reduced the most.
  • All of them: regular follow-up, physical activity and support; a team accredited through the MBSAQIP program, which covers nearly 1,000 U.S. and Canadian sites, can be found through the American College of Surgeons.

How to use this comparison

Next steps

  1. Check the thresholdsCompare your BMI and health conditions with the guideline and device ranges above.
  2. Think about trade-offsWeigh how much change to the digestive tract, follow-up and supplements you are ready for.
  3. Meet a bariatric teamAsk about each option for you, their results, and their accreditation.
  4. Check coverageAsk your plan what it covers and what it requires before approval.

Our guide to finding a bariatric surgeon explains accreditation and what to ask, and our history of bariatric surgery shows how today’s procedures replaced older ones. To see every approach to weight loss, including medicines and programs, use Find My Options or our comparison of every way to lose weight.

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Questions to ask a professional

  • Which procedures fit my BMI, health conditions and goals, and why?
  • What weight loss and complication rates does your program see for each option?
  • How reversible is each option, and what follow-up and supplements will I need for life?
  • Is your program accredited through MBSAQIP?
  • What will my insurance cover, and what will I pay?

Frequently asked questions

Which weight-loss procedure is the most effective?

There is no single answer. On average, procedures that change the digestive tract more lead to more weight loss, but they also need more follow-up and lifelong supplements, and the studies behind each option differ. A bariatric team can explain which fits your health and goals.

What is the least invasive weight-loss procedure?

Intragastric balloons and endoscopic sleeve gastroplasty are done with an endoscope through the mouth, with no cuts. ORBERA and Spatz3 balloons are removed after six to eight months, and the Allurion balloon (approved in February 2026) is swallowed, with no endoscopy, and passes on its own; the FDA summary describes ESG as reversible and re-tightenable.

What BMI do you need for bariatric surgery?

The 2022 ASMBS/IFSO guideline recommends surgery from a BMI of 35 and says it can be considered from 30 with metabolic disease, with lower thresholds for people of Asian descent. Insurers and Medicare have their own rules.

Does insurance cover weight-loss procedures?

Often for surgery, rarely for devices. Medicare covers bypass, duodenal switch and the laparoscopic band, leaves the sleeve to regional contractors and does not cover balloons. Private plans vary; ask yours for its criteria.

How much does bariatric surgery cost?

ASMBS lists an average of $17,000 to $26,000 (checked October 6, 2026). We found no official dated average for ESG or balloons, so ask for a written self-pay quote.

References

  1. Estimate of Bariatric Surgery Numbers, 2011-2023. American Society for Metabolic and Bariatric Surgery. (accessed October 7, 2026) Society statement
  2. 2025 Fact Sheet: Metabolic and Bariatric Surgery (incl. SADI and OAGB counts). American Society for Metabolic and Bariatric Surgery, 2025. (accessed October 7, 2026) Society statement
  3. Bariatric Surgery Procedures. American Society for Metabolic and Bariatric Surgery. (accessed October 6, 2026) Society statement
  4. Metabolic and Bariatric Surgery (fact page, incl. average cost). American Society for Metabolic and Bariatric Surgery. (accessed October 6, 2026) Society statement
  5. Eisenberg D, Shikora SA, Aarts E, et al.. 2022 ASMBS and IFSO: Indications for Metabolic and Bariatric Surgery. Surgery for Obesity and Related Diseases, 2022. doi:10.1016/j.soard.2022.08.013 · PMID 36280539 (accessed October 6, 2026) Guideline
  6. Types of Weight-loss Surgery. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 6, 2026) Government page
  7. Side Effects of Weight-loss Surgery. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 6, 2026) Government page
  8. National Coverage Determination 100.1: Bariatric Surgery. Centers for Medicare and Medicaid Services. (accessed October 7, 2026) Government page
  9. Inge TH, et al.. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents (Teen-LABS). New England Journal of Medicine, 2016. doi:10.1056/NEJMoa1506699 · PMID 26544725 (accessed October 6, 2026) Other
  10. Arterburn D, et al.. Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study. Annals of Internal Medicine, 2018. doi:10.7326/M17-2786 · PMID 30383139 · NCT02741674 (accessed October 6, 2026) Other
  11. Abu Dayyeh BK, et al.. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. The Lancet, 2022. doi:10.1016/S0140-6736(22)01280-6 · PMID 35908555 (accessed October 7, 2026) Randomized trial
  12. De Novo DEN210045: APOLLO ESG, ESG SX, REVISE and REVISE SX Systems. U.S. Food and Drug Administration, 2022. (accessed October 7, 2026) Government page
  13. De Novo Classification Request decision summary, DEN210045. U.S. Food and Drug Administration. (accessed October 6, 2026) Drug label
  14. Summary of Safety and Effectiveness Data: ORBERA Intragastric Balloon System (P140008). U.S. Food and Drug Administration. (accessed October 6, 2026) Drug label
  15. Summary of Safety and Effectiveness Data: Spatz3 Adjustable Balloon System (P190012). U.S. Food and Drug Administration, 2021. (accessed October 7, 2026) Drug label
  16. PMA P250023: Allurion Gastric Balloon System (approved 2026-02-20). U.S. Food and Drug Administration, 2026. (accessed October 7, 2026) Government page
  17. Summary of Safety and Effectiveness Data: Allurion Gastric Balloon System (P250023), AUDACITY trial. U.S. Food and Drug Administration, 2026. (accessed October 7, 2026) Government page
  18. ReShape Lifesciences Form 10-Q, Q1 2025 (Lap-Band active; no Obalon revenue; Obalon licensed to Biorad). U.S. Securities and Exchange Commission, 2025. (accessed October 7, 2026) Other
  19. PMA P180024: TransPyloric Shuttle (approved 2019-04-16). U.S. Food and Drug Administration, 2019. (accessed October 7, 2026) Government page
  20. Aspire Bariatrics company update (AspireAssist withdrawn from the market, April 8, 2022). Aspire Bariatrics. (accessed October 7, 2026) Other
  21. The FDA alerts health care providers about potential risks with liquid-filled intragastric balloons (updated 2020-04-27). U.S. Food and Drug Administration, 2017. (accessed October 6, 2026) Government page
  22. Weight-Loss and Weight-Management Devices (content current as of 2026-03-12). U.S. Food and Drug Administration. (accessed October 7, 2026) Government page
  23. Sleeve Gastrectomy Shows Advantages over Endoscopic Sleeve Gastroplasty (ACS Brief, on Leslie ZD et al., J Am Coll Surg 2026). American College of Surgeons, 2026. (accessed October 7, 2026) News (reported facts only)
  24. Peterli R, et al.. Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss (SM-BOSS). JAMA, 2018. doi:10.1001/jama.2017.20897 · PMID 29340679 · NCT00356213 (accessed October 6, 2026) Randomized trial
  25. Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial. Obesity Surgery, 2023. doi:10.1007/s11695-023-06767-0 · PMID 37584851 (accessed October 6, 2026) Randomized trial
  26. Evaluating the impact of the COVID-19 pandemic on outcomes of conversion and revisional bariatric surgery: an MBSAQIP study. Surgery for Obesity and Related Diseases, 2025. doi:10.1016/j.soard.2025.03.004 · PMID 40234141 (accessed October 6, 2026) Other
  27. Salminen P, et al.. Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass at 10 Years (SLEEVEPASS). JAMA Surgery, 2022. doi:10.1001/jamasurg.2022.2229 · PMID 35731535 · NCT00793143 (accessed October 6, 2026) Randomized trial
  28. Schauer PR, et al.. Bariatric Surgery versus Intensive Medical Therapy for Diabetes: 5-Year Outcomes (STAMPEDE). New England Journal of Medicine, 2017. doi:10.1056/NEJMoa1600869 · PMID 28199805 · NCT00432809 (accessed October 6, 2026) Randomized trial
  29. Sjöström L, Narbro K, Sjöström CD, et al.. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. New England Journal of Medicine, 2007. doi:10.1056/NEJMoa066254 · PMID 17715408 (accessed October 6, 2026) Other
  30. Mechanick JI, Apovian C, Brethauer S, et al.. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures: 2019 Update (AACE/TOS/ASMBS/OMA/ASA). Endocrine Practice, 2019. doi:10.4158/GL-2019-0406 · PMID 31682518 (accessed October 6, 2026) Guideline
  31. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). American College of Surgeons. (accessed October 7, 2026) Society statement
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Facts checked on October 7, 2026

Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.