The fat you can pinch may be unsightly, but it has little health consequence. It is that fat which you cannot see, deep inside your belly that causes all the morbidities of obesity – sleep apnea, GERD, type 2 diabetes, hypertension, kidney disease, arteriosclerotic vascular disease, heart attacks, strokes, cancers, and autoimmune diseases.
This video may explain why this is so.
Despite the emergence of new pharmacologic alternatives to traditional bariatric surgery, the global obesity epidemic continues to escalate. Semaglutides, while effective for some, are costly, require weekly injections, and often cause side effects that lead many patients to discontinue treatment and subsequently regain much or all of the weight they lost. Both bypass and restrictive bariatric procedures carry significant risks, side effects, and long-term lifestyle adjustments, and most patients ultimately reach a weight-loss plateau. Endoscopic visceral lipectomy, though not yet clinically validated or widely adopted, offers the potential for a more permanent solution one that might help patients achieve a lower, more sustainable weight plateau without the same tradeoffs. Clinicians can work together to tailor combinations of pharmacologic and surgical strategies to best support the health of individual patients. Earlier intervention may help future generations.
Continued development of new medications and research into alternative surgical approaches should be encouraged. However, the widespread availability of highly addictive, calorie-dense, nutrient-poor junk and ultra-processed foods-paired with increasingly sedentary lifestyles and the pervasive use of addictive social media-continues to drive the epidemic beyond our current capacity to control it. Meaningful progress will require coordinated efforts among governments, schools, and food manufacturers to improve labeling, reduce the caloric density of snack foods, promote physical activity, limit screen time, decrease youth exposure to junk-food advertising, and foster healthier eating and exercise habits. A fuller discussion of the critical question of when-and how early-we should intervene to reverse the tightening spiral of obesity found in a recent article: The Next Frontier in Obesity and Type 2 Diabetes Treatment: Permanent Minimally Invasive Visceral Fat Removal and the Emerging Role of Early Intervention. R. L. Cucin OAJS 17:555952 (2025)
In a recent study published in JAMA Network Open, 65% of those without diabetes discontinued their semaglutide drug in less than one year.
The quit rates were not only for cost but for the side effects and complications. Those who trimmed more weight were more likely to persevere with the drugs and those that regained weight after stopping the medications were more likely to pursue a second course.
While health insurers widely cover this class of glucagon-like peptide (GLP-1) agonists for diabetes, most don’t pay for these drugs for weight loss. List prices often exceed $1,000 per month and insurance is spotty. Just 1% of Affordable Care Act marketplace plans last year covered these drugs for obesity according to KFF, a nonprofit health policy organization.
Medicare paid $5.6 Billion for semaglutides in 2022, demonstrating the immensity of the obesity problem.
As reports of complications and side effects of these drugs continue to accumulate as fast as articles on discontinuance rates, it is evident that even though patients prefer pills to surgery, the semaglutides are not miracle drugs. As with every single drug we use OTC or prescribe, a side effect is just really just one of the many effects of any drug other than the desired one. We consider Endoscopic Visceral Lipectomy both complementary to patients taking the GLP-1’s and suitable as an alternate modality to those patients who don’t start or stop taking them.