Medical weight-loss procedures compared: sleeve, bypass, duodenal switch, band, revision, endoscopic sleeve gastroplasty and gastric balloons by results, safety, invasiveness and permanence, with FDA device facts.
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
- The FDA regulates three types of weight-loss devices: gastric bands, gastric balloon systems and endoscopic suturing devices.[1]
- In the MERIT trial, endoscopic sleeve gastroplasty led to 13.6% total body weight loss at 52 weeks versus 0.8% with lifestyle changes alone; the device received FDA De Novo authorization in July 2022.[3]
- The sleeve made up 58.2% of about 270,000 U.S. metabolic and bariatric procedures in 2023.[6]
- The FDA has warned about overinflation, acute pancreatitis and perforation with liquid-filled gastric balloons.[2]
- Devices alone are not the solution: the FDA says lifestyle changes remain essential and results cannot be promised.[2]
In short: Medical weight-loss procedures range from metabolic and bariatric surgery, such as the gastric sleeve and gastric bypass, to less invasive endoscopic procedures done through the mouth, such as endoscopic sleeve gastroplasty, and temporary devices such as gastric balloons. The FDA regulates the devices used for weight loss, and none of these is a quick fix: each is used alongside eating and activity changes and needs follow-up. Cosmetic procedures that remove or reshape fat in one area are not weight loss and are covered separately under body contouring.
This hub compares the medical options by how invasive they are, how long recovery takes and whether they are temporary or permanent, and explains how to choose a provider. It is general information; whether any procedure fits you is a decision for you and a qualified team.
Medical weight-loss procedures at a glance
- 270,089metabolic and bariatric procedures in the U.S. in 2023, about 1% of people who meet the criteriaASMBS
- 58.2%of them were gastric sleeves; bands fell to 773ASMBS estimates
- About 0.1%risk of death and about 4% risk of major complications for bariatric surgeryASMBS 2025 fact sheet
- 3 typesof FDA-regulated weight-loss devices: bands, balloons and endoscopic suturingFDA
Checked on October 6, 2026
Start here: do these next 1-2-3
- Make sure you are in the right place. If your goal is the shape of one area rather than weight and health, see body contouring; if it is loose skin after weight loss, see loose skin.
- Compare the categories below by invasiveness, recovery and permanence.
- Talk to your primary care clinician about a referral, and read our medical weight loss guide for the steps that usually come first.
Medical procedures at a glance
| Procedure | Approach | Temporary or permanent | Key points |
|---|---|---|---|
| Gastric sleeve | Surgery | Permanent | About 80% of the stomach removed; the most common operation in the U.S. |
| Gastric bypass | Surgery | Difficult to reverse | Small pouch connected to the small intestine; more weight loss on average, more complications and vitamin risk |
| Endoscopic sleeve gastroplasty | Endoscopic, through the mouth | Stitches; can be reversed or re-tightened | Narrows the stomach without incisions; device authorized by the FDA (De Novo) in July 2022 for BMI 30 to 50 |
| Gastric balloon | Endoscope, or swallowed (Allurion) | Temporary | Takes up space in the stomach; ORBERA stays up to 6 months and Spatz3 up to 8 months; the swallowed Allurion balloon (approved February 2026) empties and passes on its own |
| Duodenal switch (BPD/DS, SADI-S) | Surgery | Permanent | A sleeve plus a long intestinal bypass; the most weight loss and the highest risk of vitamin, mineral and protein shortages |
| Adjustable gastric band | Surgery | Removable | Least weight loss of the operations and frequent reoperations; 773 placed in the U.S. in 2023 |
| Revision surgery | Surgery or endoscopy | Varies | Repairs or converts an earlier operation; 11.9% of U.S. procedures in 2023 |
| Option | Evidence | Invasiveness | Medical supervision | Convenience | Cost | Maintenance |
|---|---|---|---|---|---|---|
| Duodenal Switch (BPD/DS and SADI-S): results, nutrition and risks | Moderate | Surgical | Required | — | $$$$ | Ongoing |
| Endoscopic Sleeve Gastroplasty (ESG): what to know | Moderate | Moderate | Required | — | — | High |
| Gastric Balloon: the endoscopic, temporary option | Moderate | Moderate | Required | — | — | High |
| Gastric Bypass: how it works, results and long-term care | High | Surgical | Required | — | $$$$ | Ongoing |
| Gastric Sleeve Surgery: eligibility, results, risks and cost | High | Surgical | Required | — | $$$$ | Ongoing |
| Lap-Band (Adjustable Gastric Band): status, results and why it declined | Moderate | Surgical | Required | — | — | High |
| Revision Bariatric Surgery: why, options, results and risks | Moderate | Surgical | Required | — | — | Ongoing |
No overall score. Commissions never change the order or the values.
Bariatric and metabolic surgery
Surgery has the longest track record. The 2022 ASMBS and IFSO guidelines recommend metabolic and bariatric surgery for people with a BMI over 35 and say it should be considered from a BMI of 30 for people with metabolic disease. In 2023, U.S. surgeons performed about 270,000 metabolic and bariatric procedures, 58.2% of them sleeves and 23.4% gastric bypasses, according to ASMBS estimates. Our bariatric surgery guide covers the types, results, risks and life after, and sleeve vs bypass compares the two most common operations.
| Item | 2011 | 2023 |
|---|---|---|
| Gastric sleeve | 28,124 | 157,254 |
| Gastric bypass | 57,986 | 63,132 |
| Adjustable band | 55,932 | 773 |
| Revisions | 9,480 | 32,267 |
| Duodenal switch (BPD-DS) | 1,422 | 3,775 |
Estimated U.S. procedures per year. In 2023 there were also 2,387 SADI, 4,587 ESG and 1,461 balloon procedures.
Source: ASMBS, Estimate of Bariatric Surgery Numbers, 2011-2023 (checked on October 6, 2026)
Results differ a lot between options. The chart puts the main published figures side by side; they come from different studies with different people and time points, so they show the general size of the effect, not a head-to-head comparison.
New pages go deeper into each operation: the duodenal switch for very high BMIs, the Lap-Band and why it declined, revision surgery when a first operation needs fixing, and life after bariatric surgery with diet stages, vitamins and follow-up.
Endoscopic procedures and devices
The FDA groups weight-loss devices into three types: gastric bands placed around the top of the stomach, gastric balloon systems that take up space and slow stomach emptying, and endoscopic suturing devices that place permanent stitches to reduce the stomach’s volume. It separately lists weight-management devices, which aid weight control with more modest effects. Our overview of every FDA-authorized weight-loss device lists each one with whether it is actually sold today. The FDA’s consumer advice is that devices alone are not the solution, that lifestyle changes remain essential and that results cannot be promised.
Endoscopic sleeve gastroplasty (ESG). A doctor passes an endoscope through the mouth and stitches the stomach into a narrower shape, without incisions. In the MERIT trial, published in the Lancet in 2022, 209 adults with class 1 or 2 obesity were randomized to ESG with lifestyle changes or lifestyle changes alone; at 52 weeks, total body weight loss was 13.6% with ESG versus 0.8% in the control group, and serious adverse events related to ESG occurred in 2% of participants. The FDA granted the Apollo ESG system De Novo authorization (DEN210045) on July 12, 2022, for adults with a BMI of 30 to 50 who have not lost weight, or kept it off, with more conservative measures. In the FDA’s review, nausea (70%) and abdominal pain (68%) were the most common side effects, usually resolving within 30 to 60 days.
Gastric balloons. These are temporary devices. ORBERA (approved 2015) is for a BMI of 30 to 40, is placed and removed by endoscopy and stays up to 6 months; in its pivotal trial, average weight loss was 10.2% at removal versus 3.3% with a lifestyle program alone. Spatz3 (approved 2021) is adjustable and stays up to 8 months; weight loss was 15.0% versus 3.3%. The Allurion balloon, approved on February 20, 2026 (PMA P250023), is swallowed as a capsule and filled through a thin tube, with no endoscopy or anesthesia, and empties and passes on its own after about four months. It is approved for “short-term limited weight loss” in adults aged 22 to 65 with a BMI of 30 to 40; in its trial, weight loss at 48 weeks was 6.87% versus 3.09% with a lifestyle program alone, and the company reported its first U.S. commercial patients in April 2026. The FDA has warned about serious problems with liquid-filled balloons, including overinflation, acute pancreatitis and stomach perforation, and advises people to seek care for persistent stomach or back pain, vomiting, bloating or trouble breathing. Medicare does not cover gastric balloons.
Who these procedures are for
Each option has its own criteria, set by guidelines, by the device’s FDA authorization and by insurers. For surgery, the 2022 ASMBS and IFSO guidelines use a BMI over 35, or 30 to 34.9 with metabolic disease, with lower thresholds for Asian populations. The ESG device is indicated for a BMI of 30 to 50, ORBERA and Allurion for 30 to 40 (Allurion for ages 22 to 65), and Spatz3 for 35 to 40, or 30 to 34.9 with a major obesity-related condition. The NIH describes weight-loss devices as an option when other treatments have not worked, and notes that data on their long-term safety and effectiveness are still limited. Medicare covers certain bariatric operations for people with a BMI of 35 or more, an obesity-related condition and previous unsuccessful medical treatment, but not gastric balloons. A specialist team decides whether a given procedure fits a particular person.
Temporary or permanent
Permanence is one of the biggest differences. According to the NIH, the gastric sleeve cannot be reversed because part of the stomach is removed, gastric bypass is difficult to reverse, and the adjustable band can be adjusted or removed. No part of the stomach is removed in endoscopic sleeve gastroplasty, and the FDA’s review notes from published reports that an ESG can be reversed or re-tightened. Gastric balloons are temporary by design. The FDA’s weight-management devices, such as a removable device worn in the mouth during meals (the SMART device) and swallowed capsules that release a gel to fill space in the stomach, are used day to day rather than placed once. The Epitomee capsule was cleared on September 13, 2024 (510(k) K240544), by prescription for adults with a BMI of 25 to 40 with diet and exercise, and its maker runs a pre-launch program with selected U.S. clinics. The older Plenity capsule is no longer a current option: its maker, Gelesis, filed for Chapter 7 liquidation on October 30, 2023, and although an over-the-counter version was cleared in January 2024, we found no current U.S. seller. Whatever the option, the FDA reminds people that lifestyle changes remain essential.
Invasiveness, sedation and recovery
The procedures differ a lot in what they ask of your body. Surgery is an operation with incisions in the abdomen. Endoscopic procedures avoid incisions because the instruments pass through the mouth, though they still need sedation or anesthesia and still carry risks. Balloons are temporary by design, so their effect depends on what happens after removal. If you take a GLP-1 medicine, tell the team before any procedure with anesthesia or deep sedation, because these medicines slow stomach emptying and raise the risk of inhaling stomach contents. Each procedure page lists sedation, typical recovery and risks from its sources.
Safety: what the studies report
Every option carries risk, and studies measure it in different ways, so compare within a study rather than across them. In the PCORnet study of 65,093 U.S. adults, major adverse events within 30 days were 5.0% after gastric bypass, 2.9% after a band and 2.6% after a sleeve. In the device trials, serious adverse events related to the device or procedure occurred in 2% of ESG patients (MERIT), 10% of ORBERA balloon patients and 3.7% of Spatz3 patients, and 18.8% and 16.6% of balloons were removed early. Over the longer term, the NIH reports that about one in three people have a follow-up procedure, operation or hospital stay within five years of weight-loss surgery.
After any procedure: a lifelong plan
Whatever the procedure, results depend on what comes after. After surgery, guidelines call for a staged diet over about six to eight weeks, at least 60 grams of protein a day, vitamins and blood tests for life, regular activity and years of follow-up; balloons and ESG come with a supervised diet and behavior program. Our life after bariatric surgery guide covers each step, and the keep it off hub covers the long term.
How procedures compare with medication
Many people now weigh a procedure against FDA-approved medicines such as Wegovy and Zepbound. Medicines avoid an operation but are labeled for long-term use, and weight tends to return after stopping; procedures change anatomy, carry procedural risks and still need lifelong habits and follow-up. The options can be combined. See GLP-1 vs bariatric surgery and our medications hub.
All medical procedures
7 results
SurgicalDuodenal Switch (BPD/DS and SADI-S): results, nutrition and risksSurgical · 2+ weeks
Medical deviceEndoscopicEndoscopic Sleeve Gastroplasty (ESG): what to knowEndoscopic
Medical deviceEndoscopicGastric Balloon: the endoscopic, temporary optionEndoscopic · 1-3 days
SurgicalGastric Bypass: how it works, results and long-term careSurgical · 2+ weeks
SurgicalGastric Sleeve Surgery: eligibility, results, risks and costSurgical · 2+ weeks
Medical deviceSurgicalLap-Band (Adjustable Gastric Band): status, results and why it declinedSurgical
SurgicalRevision Bariatric Surgery: why, options, results and risksSurgicalBadges come from the FDA label or FDA records and show the date we last checked. Listing order is never paid for.
Choosing a provider
For surgery, look for a center accredited by MBSAQIP, the American College of Surgeons program that has evaluated nearly 1,000 sites in the U.S. and Canada and offers a search for accredited centers. For any procedure, ask how many the doctor has performed, what their complication rates are, which FDA-authorized device they use, what follow-up and nutrition support are included, and what the total cost will be in writing. Ask, too, what the plan is if the procedure does not give the result you hoped for, and who you call if a problem comes up after you go home. Our guides to bariatric surgeons and finding a provider explain how to check credentials, and our costs hub and insurance hub cover payment.
In this section
Bariatric Surgery: types, eligibility and life afterBariatric surgery explained: sleeve, bypass, duodenal switch and band compared, the 2022 eligibility guidelines, results, risks,…
Life After Bariatric Surgery: diet stages, vitamins, follow-up and the long termLife after bariatric surgery: guideline diet stages, protein, vitamins and minerals for life, follow-up visits and…Related guides
Bariatric Surgery: types, eligibility and life afterBariatric surgery explained: sleeve, bypass, duodenal switch and band compared, the 2022 eligibility guidelines, results, risks,…Life After Bariatric Surgery: diet stages, vitamins, follow-up and the long termLife after bariatric surgery: guideline diet stages, protein, vitamins and minerals for life, follow-up visits and…
Medical Weight Loss: physician-supervised options explainedMedical weight loss explained: who provides it, what a visit and labs include, programs, medications, procedures,…Tools for this topic
Latest research
A History of Bariatric Surgery: From 1954 to the SleeveA history of bariatric surgery from the original papers and FDA and Medicare records: the 1954…
Weight-Loss Devices FDA Has Authorized: Balloons, Capsules and MoreEvery weight-loss device the FDA has authorized, from the Lap-Band to swallowable balloons and gel capsules:…
Questions to Ask a Bariatric Surgeon (and How to Check Credentials)The questions to ask a bariatric surgeon and how to check credentials: American Board of Surgery…Questions to ask a professional
- Which procedures could fit my health and goals, and which would you not recommend for me?
- Is the procedure permanent, and what happens if it does not work for me?
- What sedation or anesthesia is used, and what does recovery look like?
- Which FDA-authorized device do you use, and how many of these procedures have you done?
- What will the total cost be, and does my insurance cover it?
Frequently asked questions
What is the least invasive weight-loss procedure?
Gastric balloons and endoscopic procedures such as endoscopic sleeve gastroplasty avoid incisions; the Allurion balloon, approved in February 2026, is swallowed and needs no endoscopy. Balloons are temporary; ESG uses permanent stitches. Each still carries risks, and the right choice depends on your health and goals.
Is a gastric balloon permanent?
No. Gastric balloons are temporary: ORBERA and Spatz3 are removed by endoscopy at the time specified in their labeling, and the swallowed Allurion balloon empties and passes on its own after about four months.
What is endoscopic sleeve gastroplasty?
A procedure done through the mouth with an endoscope that stitches the stomach into a smaller shape without incisions. In the MERIT trial it led to 13.6% total body weight loss at one year versus 0.8% with lifestyle changes alone.
Is liposuction a weight-loss procedure?
No. Liposuction and other contouring treatments reshape specific areas; they are not treatments for obesity. See body contouring.
Which weight-loss procedure leads to the most weight loss?
On average, the duodenal switch and gastric bypass, then the sleeve; balloons, ESG and the band lead to less. In the PCORnet study, average weight loss at one year was 31.2% after bypass, 25.2% after sleeve and 13.7% after band. Individual results vary, and more weight loss usually comes with more nutritional risk.
What is the safest weight-loss procedure?
Risks differ in kind. In PCORnet, major adverse events within 30 days were 2.6% after sleeve, 2.9% after band and 5.0% after bypass. Endoscopic procedures avoid incisions but still have serious events (2% with ESG in MERIT). A team weighs risks against your health.
Is the Lap-Band still used?
Rarely. ASMBS estimates 773 bands in the U.S. in 2023, down from 55,932 in 2011, mainly because of less weight loss and frequent reoperations.
What happens if a weight-loss procedure does not work?
Guidelines call for a full evaluation of habits, medicines, mental health and anatomy. Options include nutrition support, medicines, endoscopic revision or revision surgery.
Does insurance cover weight-loss procedures?
It depends on the procedure and the plan. Medicare covers certain bariatric operations for people who meet its criteria but does not cover gastric balloons. Ask your plan for its written criteria.
References
- 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
- Medical Devices for Weight Loss and Weight Management: What to Know. U.S. Food and Drug Administration (Consumer Update), 2022. (accessed October 7, 2026) Government page
- 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
- Types of Weight-loss Surgery. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 6, 2026) Government page
- 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
- Estimate of Bariatric Surgery Numbers, 2011-2023. American Society for Metabolic and Bariatric Surgery. (accessed October 7, 2026) Society statement
- National Coverage Determination 100.1: Bariatric Surgery. Centers for Medicare and Medicaid Services. (accessed October 7, 2026) Government page
- Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). American College of Surgeons. (accessed October 7, 2026) Society statement
- Treatment for Overweight and Obesity. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 6, 2026) Government page
- 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
- 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
- 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
- De Novo Classification Request decision summary, DEN210045. U.S. Food and Drug Administration. (accessed October 6, 2026) Drug label
- Summary of Safety and Effectiveness Data: ORBERA Intragastric Balloon System (P140008). U.S. Food and Drug Administration. (accessed October 6, 2026) Drug label
- Summary of Safety and Effectiveness Data: Spatz3 Adjustable Balloon System (P190012). U.S. Food and Drug Administration, 2021. (accessed October 7, 2026) Drug label
- Side Effects of Weight-loss Surgery. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 6, 2026) Government page
- 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
- WEGOVY (semaglutide) injection and tablets: prescribing information. Novo Nordisk, via DailyMed, 2026. (accessed October 7, 2026) Drug label
- PMA P250023: Allurion Gastric Balloon System (approved 2026-02-20). U.S. Food and Drug Administration, 2026. (accessed October 7, 2026) Government page
- 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
- Allurion treats first commercial patients in the United States (company-reported). Allurion Technologies (press release), 2026. (accessed October 7, 2026) News (reported facts only)
- 510(k) K240544: Epitomee, cleared 2024-09-13 (indications and RESET trial summary). U.S. Food and Drug Administration, 2024. (accessed October 7, 2026) Government page
- Get Epitomee (prescription device; US pre-launch program). Epitomee Medical. (accessed October 7, 2026) Other
- 510(k) K230133: Plenity (over-the-counter), cleared 2024-01-19. U.S. Food and Drug Administration, 2024. (accessed October 7, 2026) Government page
- Gelesis Holdings, Inc. Form 8-K: voluntary petition under Chapter 7 (October 30, 2023). U.S. Securities and Exchange Commission (EDGAR), 2023. (accessed October 7, 2026) Government page
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.