Christina had tried dieting and exercise before. The weight always came off but then crept back on, especially after she gave birth to her son in 2022.
She had hoped that a new class of weight-loss drugs might finally offer something different. Obesity treatments such as Wegovy and Zepbound had just arrived on the scene, helping people slim down with unprecedented ease. But the price tag of these GLP-1 drugs put them out of reach. Christina’s health insurance wouldn’t cover the cost.
Desperate for another option, Christina enrolled in a clinical trial that guaranteed several months on a blockbuster weight-loss therapy—and then the possibility of something more. (Christina, a Texas woman in her early 50s, asked that her last name be withheld to protect her privacy about her weight-loss treatment.)
This article is part of our special report Top Tech 2026.
That something more wasn’t another injection or pill, but a one-time procedure using a new medical device. And instead of targeting the stomach or brain, it focused on the gut itself: rewiring how a part of the upper intestine, known as the duodenum, processes nutrients and regulates metabolism.
Performed via a minimally invasive endoscopic device, this approach is designed to help people who want to stop taking GLP-1 drugs. The goal is to lock in the benefits without the high costs, weekly jabs, or lingering side effects. And in 2026, the first company to develop such a device is likely to seek clearance to bring it to patients.
“We’re creating a new therapeutic area,” says Harith Rajagopalan, cofounder and chief executive of that company, Fractyl Health, based in Burlington, Mass.
Resetting Metabolism for Lasting Weight Loss
You can think of these systems as a middle ground between drugs and bariatric surgery. The endoscope is a slim, flexible tube equipped with a camera and a guidewire that leads a catheter into the digestive system. Doctors send the tools down the throat so they can view and modify the intestines from the inside—remodeling gut tissue and recalibrating its response to food without a single incision. The procedure takes about an hour or so, and patients typically go home the same day.
To understand how the treatment works, it helps to first understand what goes wrong in the gut during years of unhealthy eating. As diets high in sugar and fat bombard the duodenum, the lining there becomes inflamed and its normal signaling pathways distorted. Mucosal cells in the tissue grow abnormally and propagate these maladaptive changes, locking in a dysfunctional pattern that drives cravings, weight gain, and insulin resistance.
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