The objective for this clinical study is to provide FDA with clinical evidence regarding the effectiveness and safety of the AGBS + moderate intensity lifestyle modification therapy program, indwell time of the AGBS inside the stomach, and outcomes at 48 weeks.

Prospective, open-label, multi-center, randomized study comparing the AGBS + moderate intensity lifestyle modification therapy program vs. moderate intensity lifestyle modification therapy program for the treatment of adults with obesity.

Inclusion Criteria:

1. Age ≥22 years and ≤ 65 years of age
2. BMI ≥30 kg/m2 and ≤ 40 kg/m2
3. Have signed study-specific Informed Consent Form
4. Willing to comply with study requirements, including follow-up visits
5. Documented negative pregnancy test in women of childbearing potential
6. Women of childbearing potential not intending to become pregnant for the duration of study participation. (Note: Women of childbearing potential must not be nursing at the time of treatment).
7. Fully ambulatory without any severe chronic orthopedic disease that requires reliance on crutches, walkers, or a wheelchair that could preclude exercise during the study
8. At least one unsuccessful attempt at weight loss, such as self-administered, commercial, or medically supervised lifestyle therapy program attempted within the 24 months preceding enrollment

Exclusion Criteria:

1. Unable to walk 400 meters (the length of one loop of a track and field race track) without the use of an assistance device (e.g. cane, crutches, walker, wheel chair)

2. Symptomatic congestive heart failure, cardiac arrhythmia or unstable coronary artery disease

3. Pre-existing significant respiratory disease such as chronic obstructive pulmonary disease (COPD), severe sleep apnea and pneumonia

4. Previous bariatric surgery including adjustable gastric band and endoscopic sleeve gastroplasty, or likely to undergo bariatric surgery during the study period

5. Previous use of an intragastric gastric balloon

6. Current use of an intragastric device, PlenityTM and digital weight loss solutions (e.g. Noom or Calibrate)

7. History of any cancer other than non-melanoma skin cancer or papillary thyroid cancer within the last 5 years

8. Benign or malignant gastrointestinal tumors

9. History of chronic pancreatitis or acute pancreatitis within 12 months of enrollment

10. History of, or current, small bowel obstruction

11. History of severe GI motility disorder, such as severe gastroparesis

12. History of any esophageal, gastric, or small bowel surgery

13. History of, or current inflammatory bowel disease

14. Any history of intraperitoneal adhesions

15. Any history of open abdominal or gynecological surgery and/or radiation therapy to the abdomen, with the exception of cesarean sections performed at least 12 months prior to study enrollment

16. History of/or signs and symptoms of/or radiographic evidence of esophageal, gastric, or duodenal disease including, but not limited to hiatal hernia ≥5cm, inflammatory diseases, varices, severe gastroparesis, recent history of gastric or duodenal ulcers, stricture/stenosis, achalasia, severe GERD requiring maximal medical therapy, or LA Grade B, C, or D esophagitis

17. Diagnosis of autoimmune connective tissue disorder (e.g. lupus, erythematous, scleroderma)

18. Immunocompromised due to medications or medical disease or diagnosed with HIV

19. History of genetic or endocrine causes of obesity not adequately controlled by medication, including hypothyroidism

20. Type 1 diabetes or Type 2 diabetes with HgbA1c ≥ 7%, or treated with any anti-diabetic medications other than metformin

21. Significant acute and/or chronic infections

22. Severe coagulopathy defined as INR 1.5 or higher or platelet count <150, hepatic insufficiency, or cirrhosis

23. Unable or unwilling to discontinue use of aspirin and/or nonsteroidal anti-inflammatory agents (NSAIDs) at least 7 days prior to Allurion Deployment and continuing for 7 days after the Allurion Balloon is excreted

24. Currently taking the following medications (within 30 days prior to enrollment) and/or there is a need or anticipated need for these medications during the study: Excluded Medications Systemic corticosteroids Anticoagulant therapy (e.g., warfarin, dabigatran) or anti-platelet therapy Immunosuppressive therapy (e.g., azathioprine, cyclosporine) Narcotics, opiates, or benzodiazepines Insulin for treatment of diabetes Anti-seizure therapy (e.g., clonazepam, phenytoin) Anti-arrhythmics (e.g., amiodarone)

25. Inability or unwillingness to take anti-emetics during the device residence

26. Prescription or over-the- counter weight loss medication known to cause significant weight gain or weight loss within 90 days of study enrollment through study participation

27. Uncontrolled or severe psychiatric disease other than mild depression with a patient health questionnaire score of 9 or below

28. History of pulmonary embolism or deep venous thrombosis

29. Has cardiac pacemaker or other electric implantable device

30. Anemia defined as either:

    Hgb <11 g/dL for females, <12 g/dL for males

31. Cessation of any nicotine product within 3 months of enrollment or plans to quit use during the study

32. Documented total body weight loss of ≥ 5% anytime 6 months preceding enrollment

33. Residing in a location without access to study site medical resources

34. History of or currently active eating disorders including night eating syndrome (NES), bulimia, or binge eating disorder

35. Unwilling to refrain from any reconstructive and/or cosmetic surgery that may affect body weight during the study such as mammoplasty and lipoplasty

36. Current, or history of, illicit drug use (defined per state law) or excessive alcohol use

37. Enrolled in another investigational study that has not completed the required primary endpoint follow-up period (Note: Subjects involved in a long-term surveillance phase of another study are eligible for enrollment in this study).

38. Current Use (within the last month) of any smoked or non-smoked marijuana products that contain THC or unwilling to abstain from THC containing marijuana products during the trial.

39. Any conditions that, in the opinion of each site investigator, may render the subject unable to complete the study with a likely final outcome, or lead to difficulties for subject compliance with study requirements, or could confound study data.

40. Subject is not of sufficient medical health as determined by the Investigator to participate in the study.

41. Employees/family members of Allurion Technologies or any of its affiliates or contractors

42. Immediate employees/family members of the Investigator, sub- Investigators, or their medical office or practice, or surgical, bariatric or hospital organizations at which study procedures may be performed

43. An immediate family member (by marriage or blood relationship) of another subject already enrolled in the study

44. Positive breath or stool test for H. Pylori

45. History of covid-19 with any residual symptoms

46. Known or suspected allergies to polyurethane

47. Uncontrolled high blood pressure defined as ≥160/100 mmHg with or without medications

48. Uncontrolled high cholesterol or triglycerides defined as LDL ≥190 mg/dL or triglycerides ≥500 mg/dL

49. Inability to swallow Allurion Practice Capsule