Healthline has published an account of Dana Bichler, a former competitive weightlifter from St. Cloud, Minnesota, who told the outlet that three GLP-1 medications each helped him lose weight at first and then stopped working. He went on to have endoscopic sleeve gastroplasty in March 2025 and now weighs 178 pounds, down from somewhere in the 260s at the time of the procedure.

GLP-1 drugs are the injectable weight-loss and diabetes medications sold under names including Mounjaro, which Bichler said he still takes for blood sugar control because he is prediabetic. Endoscopic sleeve gastroplasty, or ESG, is a different route entirely: a doctor passes an endoscope through the mouth and uses sutures to fold the stomach into a narrower sleeve, with no incisions and no part of the stomach removed.

Why he looked past the drugs

Bichler competed at 200 to 210 pounds, and after he stepped away from weightlifting the weight climbed steadily to close to 300 at his heaviest. Dieting took off around 50 pounds at a time, he said, and it came back.

The decisive factor was not the scale. He was diagnosed with fatty liver disease tied to obesity, and two of his siblings developed cirrhosis, with his brother dying after the disease spread.

What the device maker says

Brian Dunkin, chief medical officer at Boston Scientific, which makes the endoscopic suturing system used in the procedure, told Healthline that patients typically go home the same day and return to routine activities within two to three days. He framed ESG as indicated for adults with obesity and a BMI between 30 and 50, while saying BMI is only part of the conversation.

Worth noting who is talking: Dunkin works for the company selling the instruments, and he still declined to pitch the procedure against GLP-1s. One of the best things the drugs have done, he said, is get more people talking to their doctors about obesity as a chronic disease.

The part the before-and-after misses

The month after the procedure was hard. Bichler described a liquid-only diet progressing slowly to cream soups, and an episode of depression he attributes partly to stopping his antidepressant about two weeks beforehand and partly to losing a social life built around food.

He restarted the antidepressant and now exercises four to five days a week. He told Healthline he has not felt this good in 30 years.

Bottom line

This is one patient's account, not a trial, and Healthline reports it as such. What it does illustrate is a question the field has not answered well: what the options look like for people whose response to GLP-1 medications fades.