If you’re on a weight loss journey, you now have an arsenal of medications at your disposal. And while injectable medications have dominated the space for years, GLP-1 weight loss pills are now on the table. As of this week, you have your choice of two: Wegovy (semaglutide) or Foundayo (orforglipron).
If you know you want to try a weight loss medication, but can’t get behind the idea of sticking yourself with a needle, it makes sense to narrow the field to these two options. How can you make a choice? It’s important to know the ins and outs of each before making a decision with the help of a health care professional. Here’s how doctors recommend navigating this.
What is the Wegovy pill?
The Wegovy pill, which is made by Novo Nordisk, is an FDA-approved oral semaglutide medication for adults with overweight or obesity. It’s the sister medication to the injectable form of Wegovy, which is also used for weight loss. Like the injectable form, the Wegovy pill is designed to be taken in smaller doses, before ramping up to a larger dose.
“Semaglutide has the longest real-world track record of any GLP-1 agent,” Tony Yang, DSc, MPH, professor in the Milken Institute School of Public Health in the Department of Health Policy and Management and associate dean for Health Policy and Population Science at George Washington University, tells SELF. “Physicians have years of experience managing its side effects, drug interactions, and dosing nuances.”
The Wegovy pill works by mimicking a protein in your body called glucagon-like peptide 1 (GLP-1). It helps to reduce feelings of hunger and slows down the transit of food in your gut to help you feel fuller for longer. The Wegovy pill is designed to be taken once a day in the morning on an empty stomach with up to four ounces of water. Users need to wait 30 minutes before eating, drinking, or taking other oral medications after taking the Wegovy pill.
What is Foundayo?
Foundayo, a.k.a. orforglipron, is also a GLP-1 medication—it’s made by Lilly. Patients are also started on a lower dose before increasing to higher doses of the medication. “Orforglipron mimics GLP-1, a hormone your gut naturally releases after eating—the one that tells your brain, ‘Okay, we’re done here,’” Dr. Yang says.
“What makes it genuinely novel is its chemistry: It’s a small molecule, not a peptide,” he continues. “That distinction matters enormously.” Peptide-based GLP-1s like semaglutide—again, the active ingredient in Wegovy—get broken down by stomach acid, which is why they’ve historically required injections or very strict fasting protocols in the pill form to survive digestion, Dr. Yang explains.
“Orforglipron’s small molecule structure lets it pass through the gut intact regardless of what you’ve eaten or when,” Dr. Yang says. “No fasting window, no timing your coffee. You just take it.”
How effective are these medications?
Each of these pills have been through extensive clinical trials and deliver similar numbers when it comes to how much weight participants lost.
Lilly noted in a press release announcing Foundayo’s FDA approval that adults on the highest dose of the medication lost an average of 27 pounds or 12.4% of their body weight over a period of 72 weeks. The Wegovy website states that adults in one clinical trial lost an average of 33 pounds or about 14% of their body weight over a 64-week period.
There is a comparison of the two medications, but the results are complicated. On the heels of Foundayo’s FDA approval, Novo Nordisk issued a press release touting unreleased findings of a trial that pitted the 25-milligram dose of the Wegovy pill against 36 milligrams of Foundayo. (The FDA just approved doses of Foundayo up to 17.2 milligrams, although Novo Nordisk says this is equivalent to the 36-milligram capsules used in phase 3 clinical trials.) In it, Novo Nordisk noted that people on the Wegovy pill had “significantly greater weight loss” than those on Foundayo. Novo Nordisk also noted that people on Foundayo were about four times more likely to stop taking the pill due to side effects.
But there are a few major caveats to keep in mind: This was a comparison of data from separate clinical trials of both medications—not a head-to-head comparison. With that, it’s hard to draw too many conclusions. The study was also conducted by the makers of the Wegovy pill and seems to have more favorable results for that medication. “An indirect treatment comparison is a method to compare treatments in the absence of a head-to-head randomized controlled trial,” a Novo Nordisk spokesperson tells SELF. The analysis adjusted for differences in patient characteristics like baseline weight, glycemic status, and sex, the spokesperson says.
“While indirect cross-trial comparisons can be hypothesis-generating, they are no replacement for the gold standard of randomized head-to-head clinical trials,” a Lilly spokesperson tells SELF. “Our clinical trial program gives us strong confidence in how Foundayo will perform in the real world, which is what ultimately matters. Combined with its convenient profile—taken any time of day without food or water restrictions—Foundayo was built for how patients actually live. Our focus is on making sure every patient has the best possible experience with Foundayo,” the spokesperson says.
Still, “this may not be a fair comparison,” Mir Ali, MD, medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, tells SELF. “There’s no head-to-head data to say those things.”
But doctors stress that both medications can be helpful for patients. “They’re both very good at helping with weight loss,” Andrew Giaquinto, PharmD, clinical assistant professor at the Rutgers Health Ernest Mario School of Pharmacy, tells SELF. “At the end of the day, both will help you lose weight and the amount of weight loss between the two is very similar,” he adds.
Some of the effectiveness of these medications depends on what else you do when you take them, Dr. Ali says. “Patients still have to make the right choices, including eating the right foods,” he says. “Otherwise, none of these medications are going to be effective.”
There is a big difference in how these can be taken.
While the weight loss results are fairly similar, a big difference between these two medications is how they’re taken.
“The real trade-off comes down to convenience versus maximum weight loss,” Geetika Arora, MD, an endocrinologist at Northwell’s Phelps Hospital, tells SELF. “Oral Wegovy must be taken on an empty stomach first thing in the morning with no more than four ounces of water, and you must wait at least 30 minutes before eating, drinking anything else, or taking other medications. Orforglipron can be taken without any meaningful restrictions around meals or water, since food intake does not appear to have a clinically important impact on how the drug is absorbed.”
That’s something people should take into consideration before choosing one pill over another, Grace Spencer, CRNP, a nurse practitioner specializing in endocrinology at UAB St. Vincent’s, tells SELF. Dr. Yang agrees. “Where they diverge is in practical experience, not pharmacology,” he says. “And honestly, that’s where most drugs actually succeed or fail in the real world. The best medication is the one people actually take consistently.”
Spencer says she’s glad she can now offer her patients another choice. “I am excited that there is now an option for an oral GLP-1 receptor agonist that has no food or water restrictions,” she says.
The side effects are pretty similar.
Each medication has a list of potential side effects people can experience while taking them. Naturally, there is plenty of overlap. Both medications list the following as potential side effects:
- Burping/belching
- Constipation
- Diarrhea
- Fatigue
- Gas
- Headache
- Heartburn
- Nausea
- Stomach pain
- Vomiting
Additionally, Foundayo may cause:
- Hair loss
- Indigestion
- Swollen belly
You may also experience these side effects on the Wegovy pill:
- Dizziness
- Feeling bloated
- Low blood sugar in people with type 2 diabetes
- Runny nose or sore throat
- Stomach flu
- Upset stomach
How to choose between the two, according to doctors
There’s so much information floating around out there about these medications, and some information is more accurate than others. “It is a lot of information, even for health care providers in the space,” Dr. Giaquinto says.
When choosing the right medication for you, Dr. Arora says it’s crucial to stop thinking about what might be “best” overall. “Instead, think about what matters most to you personally,” she says.
The oral Wegovy pill may be best if you thrive on structure and want to maximize every percentage of weight loss, Dr. Arora says. “If you have a consistent morning routine and don’t mind setting an alarm 30 minutes earlier to take your medication before breakfast, the extra weight loss potential might be worth it,” she adds. Dr. Arora also recommends considering the oral Wegovy pill if you’ve tried injectable Wegovy and tolerate it well. “Switching to the oral version might feel like a natural progression,” she says. “You’re sticking with a medication that works for you while ditching the needle.”
But Dr. Arora says that Foundayo is helpful for people who have varying schedules. “If you work night shifts, travel frequently across time zones, have an unpredictable schedule, or simply can’t guarantee you’ll remember to take a pill on an empty stomach every single morning, orforglipron’s flexibility could be life-changing,” she says. “The medication is also ideal for people who’ve struggled with adherence to other weight loss medications because of complicated dosing rules. Research consistently shows that the best medication is the one you’ll actually take consistently.”
Ultimately, this comes down to an honest conversation with your health care provider about your goals and what you can manage. “I encourage patients to do their own research, while also consulting their health care provider to ensure the information they find is supported by scientific evidence,” Spencer says.
Related:
- On a GLP-1? This Is the Workout Plan That Helps You Keep Muscle
- How GLP-1s Are Quietly Reshaping Gym Culture
- The Ultimate Grocery List for GLP-1 Users, According to a Dietitian
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