Beyond GLP-1: Endoscopic and Oral Options to Sustain Weight Loss
Real-world data show weight loss from GLP-1 therapy is often not sustained after discontinuation, with most patients regaining weight and metabolic benefits fading within about 1.4 years. Emerging strategies—endoscopic approaches such as endoscopic sleeve gastroplasty, duodenal mucosal resurfacing, and the newly approved oral GLP-1 orforglipron—offer potential for longer-term maintenance, but cost, insurance coverage, and access remain barriers. When cost is considered, bariatric surgery can be more cost-effective long term; more head-to-head studies and guidelines are needed to define optimal maintenance after GLP-1 therapy.