While injectable medications have dominated the weight loss space for years, most people aren’t exactly pumped to stick a needle in their stomach on a weekly basis. Now, a potential game-changing medication has entered the weight-loss space: a Wegovy pill.
As you probably know, Wegovy is an FDA-approved injectable semaglutide weight loss medication for adults with obesity or overweight and with one weight-related condition. It’s the cousin of Ozempic (which is FDA-approved for blood sugar management) and can deliver impressive weight loss results.
The new Wegovy pill isn’t the first semaglutide oral medication—that honor goes to Rybelsus, which was approved in 2019. But Rybelsus is FDA-approved for blood sugar management in people with type 2 diabetes. The Wegovy pill is the first oral GLP-1 medication for weight loss.
Many patients have been waiting for this. “I’ve had a couple people on injectable semaglutide who have said, ‘When is the oral form coming out?’” Richard Siegel, MD, an endocrinologist and codirector of the Diabetes and Lipid Center at Tufts Medical Center, tells SELF.
“We want as many tools in our tool kit as possible to help people,” Carolynn Francavilla Brown, MD, a family physician and member of the Obesity Medicine Association Board of Trustees Executive Committee, tells SELF. “Any new addition is exciting, but I’m most excited for my patients who are really needle-phobic.”
Diana Huang, MD, family physician at Swedish Downtown Primary Care, tells SELF that she’s “very excited” about this new option for patients. “I have a number of patients who have been on the fence about starting these medications,” she says. “They say, ‘If there’s a shot, I don’t want to do that. But if there’s a pill, sign me up.’ I expect some will reach out about this.’”
It’s hard to ignore all the chatter out there about these weight loss medications, no matter what form they come in. As a result, it’s easy to be an armchair expert about GLP-1 receptor agonists and similar medications. But an oral GLP-1 for weight loss is new. With that in mind, we tapped three physicians who work with people with obesity to answer the biggest questions surrounding this new Wegovy pill. Here’s what they want you to know.
1. Who is it FDA-approved for?
The Wegovy pill is FDA-approved to reduce excess body weight and maintain weight reduction long-term in adults who have obesity or are overweight. In order to qualify for the medication, these patients should also have one weight-related condition, like type 2 diabetes or high blood pressure.
Also worth noting: The medication can help to reduce the risk of major cardiovascular events like heart attack, stroke, or death in adults with heart disease and obesity or overweight.
2. How does it compare to the shot?
The Wegovy pill uses the same active ingredient as the Wegovy injectable—semaglutide—and the way it works in the body is the same, according to Dr. Siegel. Meaning, the medication mimics a protein in your body called glucagon-like peptide 1 (GLP-1). It helps reduce feelings of hunger and slows down the transit of food in your gut to help you feel fuller for longer.
The hope is that pill form will make this medicine easier to take, W. Timothy Garvey, MD, signatory investigator on the clinical trials and a professor at University of Alabama at Birmingham, tells SELF. “Even with these transformational new medicines, we don’t treat this very well,” he says. “After a year, over half of people stop taking them. We just need formulations that patients will adhere to over a long period.”
There are a few key differences between Wegovy in pill and injectable form besides the obvious way you take each. For starters, the pill is taken in a much larger dose of 25 milligrams. (By comparison, people who take the injectable form of Wegovy have a maximum dose of 2.4 milligrams.)
Why the big difference in dosage? It comes down to how your body processes it, Dr. Siegel explains. When you take an oral form of semaglutide, your stomach acids start to break down the medication before it can be absorbed by your body, he explains. “The amount absorbed is fairly low, so you need pretty high doses,” Dr. Siegel says.
During clinical trials, people who took the Wegovy pill lost about 16.6% of their body weight. There have been several clinical trials to measure weight loss with the injectable form of Wegovy, but people typically lose about 15% of their body weight on this medication. “It was surprising that, in the clinical trials, it’s just as effective as the injectable,” Dr. Brown says.
There are other FDA-approved weight loss pills out there, including Contrave, Qsymia, and Orlistat. They just tend to lead to people losing 5% to 10% of their body weight, which is less than what the Wegovy pill offers, Dr. Huang points out.
It’s important to flag that Eli Lilly, which makes fellow weight loss medication Zepbound, also has a weight loss pill in the works called orforglipron. In a recent phase 3 clinical trial, orforglipron lowered patients’ body weight by an average of 12.4% (or 27.3 pounds) compared to 0.9% (2.2 pounds) in study participants who took a placebo. So expect more options to come in the near future.
3. How much does it cost?
The Wegovy pill will cost $149 a month for a starting dose. “That’s a heck of a lot better than the $1,500 a month for the injectable,” Dr. Siegel says.
There is a big caveat here, though: That’s the cost for the starting dose. “The cost tends to go up as you get to higher doses,” Dr. Huang says.
“Pills are cheaper to manufacture, so hopefully they’ll be cheaper for patients,” Mir Ali, MD, medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, tells SELF. “They’re also easier to store.”
Dr. Siegel says he hopes that the cost of the oral medication will go down even more from here. “We will have to see what insurance companies do with this, but the cost may end up lower,” he says. Because this medication is more affordable at baseline than injectable versions, he anticipates that insurance companies may urge patients to use this form before injectables.
4. Do I have to take it forever?
Because obesity is a lifelong condition, many medications are designed to continuously treat it, Martin Binks, PhD, professor and chair of the department of Nutrition and Food Studies at George Mason University, tells SELF. “Medicines for obesity are correcting a metabolic deficit experienced by people with excess weight,” he says. “They are intended and approved for long-term use, similar to many other medicines for other chronic diseases.”
Not everyone wants to be on a medication forever, but it’s common to regain the weight when you stop taking these drugs. “The majority of people stopping injectable semaglutide regain about two thirds of their weight within a year,” Dr. Siegel says. That’s why he says it’s important for people to have a plan in place to try to keep the weight off if they plan to stop using these medications.
“People need help beyond a pill,” Dr. Siegel says. That can include lifestyle counseling and dietary changes, he says. (Ultimately, if you want to try this medication and don’t want to be on it forever, it’s important to have a conversation with your health care provider about your goals.)
5. What are the side effects?
Side effects from the Wegovy oral medication are the same as they are for the injectable version. “We’re not escaping the side effects,” Dr. Garvey says. Those include:
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Stomach pain
- Headache
- Fatigue
- Upset stomach
- Dizziness
- Feeling bloated
- Belching
- Low blood sugar in people with type 2 diabetes
- Gas
- Stomach flu
- Heartburn
- Runny nose or sore throat
“Side effects happen, but people shouldn’t have to grin and bear it,” Dr. Siegel says. He points out that cutting back on dosage may help but, in some cases, people may need to try a different medication.
This is all a lot to navigate. If you’re interested in trying the Wegovy pill or any weight-loss medication, it’s important to have a conversation with a health care provider. They should listen to your goals and help you come up with a path forward from there.
Related:
- The Science on Weight and Health Is More Complicated Than You Think
- Here’s Exactly How Much Protein to Eat If You’re on a GLP-1
- Can You Ask If Someone’s Taking a GLP-1?
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