POSE2.0 With GLP-1 Agonist for Obesity Management

Inclusion Criteria: * Participants will be adult patients (22 years of age or above and less than 60 years of age) * Body mass index (BMI) ≥30 and \<40 kg/m2 * Provision of signed and dated informed consent form. * Subject agrees to be compliant with study requirements and adhere to dietary \& exercise recommendations for the duration of the study. * If female, be either post-menopausal, surgically sterile, or agree to practice birth control during year of study and have negative serum HCG at screening/baseline. * Absence of current severe systemic disease (including, but not limited to: coronary artery disease, chronic obstructive pulmonary disease, congestive heart failure, cancer, and chronic renal disease). * Agrees not to undergo any additional weight loss interventional procedures or liposuction for 12 months following study enrollment. * Have not taken any prescription or over the counterweight loss medications OR those that can suppress appetite/induce weight loss for at least 6 months and agrees not to utilize for 12 months following study enrollment (including all stimulant medication). * Subjects must be willing to possibly forego any future weight loss procedures (i.e. Vertical Sleeve Gastrectomy) following the study given the unknown long-term effects. * Residing within a reasonable distance from the Investigator's treating office (\~50 miles) and willing and able to travel to the Investigator's office to complete all routine follow-up visits Exclusion Criteria: * Prior bariatric, gastric or esophageal surgery. * Esophageal stricture or other anatomy and/or condition that could preclude passage of endoluminal instruments or procedure execution. * Moderate gastro-esophageal reflux disease (GERD), defined as symptoms that cause subject severe discomfort, compromise performance of daily activities, and/or condition is not entirely controlled with drug therapy. * Large hiatal hernia (\>3 cm) by history or as determined by pre-enrollment endoscopy. * Pancreatic insufficiency/disease. * History of gastroparesis or symptoms that would be suggestive of gastroparesis or generalized dysmotility (e.g. esophago-gastric motility issues and lower esophageal sphincter abnormalities). * Pregnancy or plans of pregnancy in the next 12 months. * History of a known diagnosis or pre-existing symptom of rheumatoid arthritis, scleroderma, system lupus, or other autoimmune connective tissue disorder. * Immunosuppressive medications or systemic steroids (i.e., oral prednisone) within 6 months of Visit 1. Intranasal/inhaled steroids are acceptable. * Unable or unwilling to avoid use of aspirin and/or non-steroidal anti-inflammatory drugs (NSAIDs), or other medications known to be gastric irritants beginning two weeks prior to enrollment and throughout the entire study. * History of inflammatory disease of the GI tract; coagulation disorders; hepatic insufficiency or cirrhosis. * Active gastric erosion, lesion, or gastric/duodenal ulcer. * History of or current platelet or coagulation dysfunction, such as hemophilia. * History or present use of insulin or insulin derivatives for treatment of diabetes. * Type II Diabetes Mellitus (as defined by HgbA1c \>6.5%) for greater than 11 years at the time of enrollment. * If smoker, plans to quit smoking in the year after enrollment. * Portal hypertension and/or varices. * Patient has a history of drug or alcohol abuse or positive at screening for drugs of abuse. - Patient is currently using marijuana/cannabis for either medicinal or recreational use, or has plans to start using over the next 12 months. * Present or history of psychosis, bipolar disease, or obsessive-compulsive disorder after pre-enrollment history and medical /psychological assessment. * Uncontrolled depression after pre-enrollment psychological and medical assessment. * If significant findings for depression and/or suicidal ideation are identified, the psychologist(s) assigned to the study will be contacted and arrangement will be made for immediate intervention according to the Institution's standard procedure. * Non-ambulatory or has significant impairment of mobility (i.e. cannot ambulate for 30 minutes). * Known hormonal or genetic cause for obesity including untreated hypothyroidism (TSH \>5.0 U/ml). * Participating in another clinical study. * Subjects with a personal history of allergic/anaphylactic reactions including hypersensitivity to the drugs or materials that will be utilized in the study procedure. * Physician's assessment that the subject is not an appropriate candidate. * Breastfeeding * Personal or family history of medullary thyroid cancer or MEN2 * Suicidal ideation and behavior. * Injection site reaction