- BMI in the 30–50 range with weight that has been difficult to move through diet and exercise alone.
- Weight regain after repeated cycles of dieting or weight-loss medications.
- Sleep apnea, snoring, or daytime fatigue that improves modestly with weight loss.
- Type 2 diabetes, pre-diabetes, or worsening insulin resistance.
- High blood pressure or cholesterol partly driven by weight.
- Joint pain — especially knees, hips, or lower back — that limits activity.
- Fatty liver identified on imaging or blood work (NAFLD/MASLD).
- Reflux, breathlessness on exertion, or reduced exercise tolerance.
- Emotional or social impact of weight that affects quality of life.
Next step
If several of these apply, an educational evaluation can help clarify whether ESG or another option deserves further discussion with a qualified physician.
Start an educational evaluationMedically reviewed by Dr. Ariel Ortiz Lagardere, MD, FACS, FASMBS
Bariatric & Metabolic Surgery · Common signs prompting evaluation for bariatric and endoscopic options.
Last reviewed: June 1, 2026
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