When weight, blood sugar, blood pressure, and cholesterol levels continue to rise, many people try their best to “eat less” and “move more,” yet still see little improvement. This often leads to frustration and discouragement. Weight loss is far more closely tied to health than mere appearance. Therefore, when weight gain has exceeded one’s ability to manage, seeking professional medical assistance may be the right first step.
According to Dr. Wong Lai Fen, Bariatric Surgery Consultant at Gleneagles Hospital Johor, individuals with obesity typically have higher levels of hunger hormones when their Body Mass Index (BMI) reaches 32 or above. This makes them feel hungry more frequently and makes appetite control difficult. For such patients, weight-loss procedures such as Endoscopic Sleeve Gastroplasty (ESG) can serve as a starting point.
She added that BMI is only one assessment indicator. Doctors also evaluate other health parameters, and in some cases, patients with a BMI of around 30 may also be suitable candidates for surgery depending on their condition.
Besides these assessments, the recommended age range for weight-loss procedures is generally between 18 and 65. For patients above 65, doctors may consider medication depending on their health status. For children aged 12 and above, parental consent and a psychologist’s evaluation are required to ensure they are mentally prepared to cope with post-surgery lifestyle changes.
“Many people want to lose weight. Some may have a BMI of only 24 or 25 and still hope to undergo surgery, but we typically do not recommend it. People within this BMI range can usually achieve weight loss through their own efforts.”
She emphasized that the main goal of weight-loss surgery is to help patients return to a healthier state. A better appearance is secondary—an added “bonus.” “Some patients with early-stage hypertension or diabetes are able to stop their medications after surgery, and cholesterol levels also improve significantly.”
Dr. Wong explained that Endoscopic Sleeve Gastroplasty (ESG) involves passing an endoscope through the mouth into the stomach and using a specialized suturing device to “stitch” the stomach smaller, reducing its volume by about 70%.
Although the technique is relatively new in Malaysia, it has been practiced for over 10 years in Western countries and for around 7 years in Taiwan, making it a mature and safe procedure.
“Unlike traditional sleeve gastrectomy, which removes 70% of the stomach, ESG does not involve cutting at all. The endoscope enters through the mouth, and the stomach is tightened with sutures to reduce its size. There are no external wounds, and importantly, the procedure is reversible.”
She added that ESG is considered a gentler weight-loss option compared to other procedures. Unlike gastrectomy, which causes rapid and visible weight loss (potentially leading to social judgment), ESG results in more gradual changes. Nor is it like gastric balloon procedures, which require patients to adapt to the discomfort of having a foreign object in the stomach.
However, since ESG involves stomach wall suturing, Dr. Wong noted that patients may experience stomach pain within 24–48 hours after the procedure—this is normal and can be managed with IV medication and oral painkillers.
“Typically, patients stay one night for observation. If the procedure is done on Friday and everything goes smoothly, they can be discharged on Sunday and return to normal work or routine by Monday.”
On average, patients can lose 15–20% of their body weight within a year after ESG. However, achieving this requires lifestyle changes—adjusting eating habits and incorporating moderate exercise.
Before undergoing any weight-loss surgery, all patients receive counseling to understand the benefits, side effects, requirements, and lifestyle adjustments involved. Only after thorough evaluation will the surgery be arranged.
“Patients must also be mentally prepared for potential social pressure. For example, those who undergo gastrectomy may lose 8–12 kg in one month, which can lead to misunderstandings such as people assuming they are seriously ill.”
She recommends informing family members before the procedure so they can provide proper support and understand that weight-loss surgery is a medical treatment for health—not an attempt to conform to beauty standards.
At Gleneagles Hospital Johor, patients who undergo ESG will receive ongoing guidance from a dietitian, who will provide tailored dietary plans and make adjustments based on follow-up appointments.
To prevent excessive strain on the stomach, patients follow a staged diet after ESG:
- First week: liquid diet only
- Second week: dairy products
- Third week: soft foods
- Afterwards: gradual progression to regular meals
Hydration is essential, though patients should avoid drinking too much at once.
The hospital also provides exercise guidance based on the patient’s weight status. For example, some may begin with walking—starting with 5,000 steps a day, gradually increasing to 8,000 and then 10,000 steps. As weight decreases, exercise options will be adjusted according to individual needs.
Unlike gastrectomy, ESG does not impair nutrient absorption, so long-term nutritional supplements are not required. Patients simply need to monitor their daily energy needs and maintain a balanced diet.
“Even though the stomach becomes smaller—perhaps going from one full bowl of food to just a quarter bowl—patients must still be mindful of calorie intake. Eating less does not mean you can eat high-calorie foods without consequences. If you snack frequently or drink milk tea after ESG, you can still gain weight.”
She stressed that lifestyle habits are a major cause of obesity. After ESG, patients must relearn healthy eating patterns. With proper cooperation, losing 5 kg in a month is not difficult.
Dr. Wong humorously noted that undergoing ESG may mean saying goodbye to buffets, but it does not mean giving up all foods forever. Desserts like cake and chocolate are still allowed—what matters is balancing intake and output, and practicing portion control.
“The stomach is like a balloon. Even if we shrink it with sutures, it is still expandable. If patients continue overeating, they can stretch it back out.” She acknowledged that not every patient succeeds after ESG. The key factor is whether they recognize their goals, follow dietary and exercise guidelines, and are willing to make long-term lifestyle changes.
She emphasized again that weight-loss surgery simply provides a starting point. With surgery, diet control, and exercise, patients can see meaningful results and gain positive reinforcement that their efforts matter. But reaching the final goal ultimately depends on personal commitment—weight-loss surgery is not a shortcut.
EN
e-Shop
Find A Doctor
Request an Appointment
International Patient
+607 560 1000
+607 560 1111
