Government retiree Nor Azmin Aziz has tried various methods to lose weight over the past 10 years after being diagnosed with cirrhosis, a serious liver condition linked to his obesity.
“For 10 years, I’ve been living with cirrhosis… I weighed between 90 to 93 kg (kilogrammes) and (my weight) never once dropped below 90 kg even though I tried everything, including controlling my diet, exercising and joining slimming programmes,” he said.
He said he was close to giving up on his efforts to lose weight before, on the advice of doctors at Hospital Canselor Tuanku Muhriz (HCTM) Universiti Kebangsaan Malaysia (UKM) here, deciding to undergo endoscopic sleeve gastroplasty (ESG) which, he was told, is a safe, non-surgical procedure to help him manage his weight and improve his liver health.
Nor Azmin, 60, was among the first three patients to undergo the ESG procedure at HCTM on March 11, which coincided with UKM’s first ESG workshop on ‘Weight Loss Without Scars’. HCTM is the first Malaysian government hospital to carry out this procedure.
ESG, an innovative obesity treatment also known as the ‘accordion procedure’, is a minimally invasive, non-surgical weight loss procedure that reduces stomach volume by suturing the stomach into a smaller, tube-like shape using an endoscope.
It is an alternative to traditional gastric sleeve surgery – a type of bariatric or weight loss surgery – offering fewer incisions and a potentially faster recovery.
Speaking at a recent press conference here on ESG, Nor Azmin said the procedure is not very complex and is quite similar to undergoing a regular endoscopy, where the patient can usually be discharged after about two hours.
“However, since I was (among) the first few (ESG) patients and because I had previously undergone a laparoscopic cholecystectomy to remove my gallbladder due to gallstones, the doctor had to admit me for a few days for observation,” he said.
He noticed positive changes in his well-being and energy levels soon after undergoing the procedure. His weight has dropped to 80.9 kg while his body mass index (BMI) is 26.12, down from 29.1 in February this year.
(For his height of 176 cm, a weight range of 60-70 kg and BMI of 20-24 are considered healthy for Nor Azmin.)
“ESG has been a crucial step in my recovery journey,” said Nor Azmin, adding, “I feel better and my (over 10 kg) weight loss has motivated me to maintain a healthier lifestyle.
“Now, I get full quickly when I eat or drink. Previously, I could drink two full glasses of water but now even half a glass makes me feel full.”
MINIMALLY INVASIVE
According to HCTM upper gastrointestinal and obesity surgeon Associate Prof Datuk Dr Nik Ritza Kosai Nik Mahmood, ESG is emerging as a breakthrough option for obesity management, offering a minimally invasive alternative to traditional bariatric surgery.
“Unlike surgical options that require incisions, ESG is performed entirely through the mouth using an endoscope and a suturing device to reduce the stomach’s size and volume by about 70 percent.
“The procedure usually takes one to two hours under mild sedation or anaesthesia and most patients are discharged the same day and can return to their daily activities within a few days,” he said, adding the first three patients to undergo the procedure at HCTM were all safely discharged without any complication.
Dr Nik Ritza Kosai described ESG as a “safe and effective” option to help patients achieve significant weight loss to improve their quality of life.
“All obesity treatments will cause rapid weight loss in a short period. What we want to avoid is weight regain six months later,” he added.
Pointing to the findings of studies involving over 15,000 patients worldwide, he said ESG was found to be effective in achieving up to 49 percent weight loss within a year, which is about 15 to 16 percent of the patient’s total body weight, and leading to an average weight loss of 15.9 percent within five years.
He said the studies also found that ESG has a low complication rate of around 1.25 percent.
“More than 90 percent of patients were able to maintain their weight loss while 70 percent managed to control their high blood pressure. As for the complication rate for acid reflux, it was at less than one percent or none at all,” he added.
He said an ideal candidate for ESG is someone with a BMI of between 30 and 50 and who has faced challenges losing weight through conventional methods like diet and exercise.
He, however, stressed that patients who have undergone ESG must stay highly motivated and adopt a healthy lifestyle to prevent weight gain and obesity.
OBESITY A CHRONIC DISEASE
Dr Nik Ritza Kosai also opined that obesity should be recognised as a chronic disease that requires structured, long-term interventions rather than short-term fixes.
He said the Ministry of Health’s National Health Screening initiative in 2023 revealed that 53.5 percent of those screened were either overweight (31.3 percent) or obese (22.2 percent), attributing the high rates to sedentary lifestyles and unhealthy diets.
“Treating obesity isn’t just about achieving quick weight loss, it is about sustained and lifelong management in which patients need ongoing support to prevent relapses and manage associated health risks,” he said.
Meanwhile, HCTM consultant endocrinologist Prof Dr Norlela Sukor said as a procedure with the potential for long-term weight loss, ESG can treat metabolic disease and improve diabetes and high cholesterol by up to 55 percent.
“In fact, it also enhances insulin sensitivity, reduces the risks associated with metabolic syndrome and supports sustained weight loss, especially in patients with complex endocrine disorders,” she explained.
She said obesity remains one of the major drivers behind insulin resistance and the development of metabolic syndrome.
“Obesity triggers a cascade of hormonal disruptions in the body, significantly affecting how we regulate appetite, manage metabolism and respond to weight loss interventions.
“These imbalances make it far harder for patients to lose weight through lifestyle changes alone,” she said.
Dr Norlela said excessive body fat, particularly visceral fat around the organs, worsens insulin resistance, which sets the stage for chronic diseases like type 2 diabetes, hypertension and dyslipidemia – all hallmarks of metabolic syndrome.
“Early identification is very important as the longer obesity and its related conditions are left untreated, the higher the risk of irreversible complications like cardiovascular disease, fatty liver disease and kidney failure,” she said.
FATTY LIVER
ESG can also improve fatty liver disease when combined with lifestyle changes, according to HCTM head of gastroenterology Dr Deborah Chew Chia Hsin.
She said fatty liver often develops silently, with few or no symptoms in the early stages, but can progress to more serious conditions such as liver fibrosis, cirrhosis and even liver cancer if left unmanaged.
“About 94 percent of fatty liver patients also suffer from abdominal obesity, characterised by excess fat around the abdomen. On average, 25 percent are diagnosed with diabetes, 75 percent high cholesterol and 48 percent high blood pressure,” she said.
She said fatty liver disease is now being detected in patients as young as 18 to 30 years old, largely due to overeating and diets high in fructose, adding that patients need to lose at least three percent of their body weight to reverse fatty liver disease if there is only fat in the liver without any inflammation.
However, if there are large clusters of fat in the liver accompanied by inflammation, the patient must lose at least five percent of their body weight within a year.
“If the inflammation is severe, a weight loss of seven percent is required, and if liver scarring (fibrosis) has already occurred, patients must lose at least 10 percent of their body weight,” she said.
Once the fat content in the liver exceeds 50 percent, the liver sends signals to inflammatory cells throughout the body to destroy the excess fat, which cause the liver cells to become damaged, leading to inflammation known as steatohepatitis.
“This is considered the second stage of fatty liver disease. If the inflammation is not controlled, the liver will attempt to heal itself through scarring, leading to advanced fibrosis.
“At this stage, if weight loss is insufficient and more than 50 percent of the liver fat is not reduced, the scarring will progress to liver shrinkage, known as cirrhosis.
“When the liver begins to lose its ability to detoxify the body and regulate fluid balance, it will eventually fail completely. That is why early detection is very important so that appropriate treatment can be performed,” she added.
