By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Weight loss pills: why everyone is talking about them
Weight loss pills are the topic I hear about most in my clinic these days. “Can I finally skip the injection?” “Which pill is right for me?” “What if I’m only 16?” This year, two new pills from the GLP-1 family arrived: the Wegovy pill and Foundayo. Both make hunger and “food noise” much easier to handle. However, they are not magic. In this article, I have gathered the questions you ask me most, along with my honest answers.
What weight loss pills do for patients
Weight loss pills work like GLP-1 (glucagon-like peptide-1), the natural satiety hormone that the gut releases after a meal. They increase fullness, reduce hunger and quiet the constant thoughts about food. My patients tell me they suddenly “forget” about their evening snack. As a result, they eat less without a daily struggle.
The benefit goes far beyond the number on the scale. Blood pressure drops, waist size shrinks and blood sugar levels stabilize. In addition, patients report better physical function and a better quality of life.
What is new about them
Until recently, the most powerful treatments came only as injections. Now, for the first time, we have pills that truly work. For people who fear needles, travel often or struggle to keep pens in the fridge, that is a real change.
The second change is one of scale. Making and distributing a pill is much simpler than producing an injection. Therefore, pills may eventually reach many people who have never received medication for obesity. In the United States, for example, the Wegovy pill passed three million prescriptions in its first months, and according to the company, most went to new patients.
How the two weight loss pills differ
The Wegovy pill: semaglutide in a tablet
The Wegovy pill contains semaglutide, the same active ingredient found in Wegovy and Ozempic injections. In the OASIS 4 trial, people who stayed on treatment lost an average of 16.6% of their body weight, compared with 2.7% on placebo. What’s more, about a third of them lost 20% or more.
The trade-off is a strict morning routine. You take the pill on an empty stomach with only a little water, up to about 120 ml. Then you wait at least 30 minutes before eating, drinking coffee or taking other medications.
Foundayo: a small, flexible molecule
Foundayo, known scientifically as orforglipron, is a small molecule rather than a peptide. As a result, you can take it at any time of day, with or without food, and with no waiting period. In the ATTAIN-1 trial of 3,127 adults without diabetes, the highest dose led to an average weight loss of 11.2% after 72 weeks, compared with 2.1% on placebo.
Put simply, the Wegovy pill leads on average effectiveness, while Foundayo leads on convenience. An indirect analysis of the trials found a 3.16 percentage-point difference in weight loss in favor of the Wegovy pill. For a full comparison, see my article Wegovy pill vs. Foundayo: what’s the real difference.
Weight loss pills vs. injections
Weekly injections still lead on effectiveness. For example, Mounjaro (tirzepatide) produced an average weight loss of 20.9% at the highest dose in the SURMOUNT-1 trial. Meanwhile, Wegovy injections and the Wegovy pill lead to similar weight loss. By comparison, weight loss with Foundayo is more modest.
Still, the comparison isn’t only about numbers. A review by the American College of Cardiology (ACC) noted that Foundayo improves heart and metabolic markers about as much as semaglutide, despite slightly smaller weight loss. That is why even a 10% loss of body weight is a meaningful medical achievement.
How do I know which weight loss pills suit me?
There is no single “best drug.” Instead, there is the drug that suits you. To choose, I ask my patients a few simple questions:
- How much weight do you need to lose to improve your health?
- Do you have diabetes, heart disease, fatty liver or sleep apnea?
- Is it easy for you to keep a fixed morning routine?
- Are you afraid of needles, or do you travel abroad a lot?
- Which medications do you take regularly?
- What is your monthly budget for treatment?
How your doctor chooses the best medication
The choice starts with a full medical assessment. First, I check weight, waist circumference, blood pressure and blood tests. Next, I review related conditions and family history.
Another important step is a medication review. Foundayo is broken down in the liver by the enzyme CYP3A4, which also breaks down many other drugs. Consequently, some antibiotics and epilepsy medications interact with it. For example, with simvastatin you should not exceed 20 mg a day. The Wegovy pill, by contrast, is barely affected by other medications.
Finally, I match the treatment to your lifestyle. If you wake up at the same time every morning, you will do well on the Wegovy pill. On the other hand, if you work shifts or find a fixed routine hard, you will benefit from the flexibility of Foundayo.
At what age can you take weight loss pills?
Parents ask me this almost every week. The answer is clear: both pills are currently approved for adults only, from age 18.
- Wegovy pill: according to the US prescribing information, the safety and effectiveness of the tablets have not been established under age 18.
- Foundayo: it is not approved for children or adolescents, and its safety under age 18 has not been established.
- Wegovy injection: the FDA has also approved it for teenagers with obesity from age 12.
What about teenagers?
Obesity in adolescence is a real disease, and no one should dismiss it. However, doctors do not currently give teenagers the new generation of weight loss pills. When a teen needs medication, the doctor prescribes an injection approved for this age group, under specialist supervision and with the whole family involved. In addition, nutrition, sleep, movement and emotional support form the foundation of care for teenagers.
And for older adults?
There is no upper age limit for treatment. In the Foundayo trials, about 13% of participants were 65 or older, and researchers found no differences in safety or effectiveness in this group. Interestingly, in the United States, 38.3% of people starting Foundayo were 60 or older. With older adults, I pay special attention to protein and strength training to preserve muscle.
Are weight loss pills magic?
No. The pill quiets hunger, but it doesn’t choose what you eat. In all the trials, patients also received guidance on nutrition and physical activity. So the results you read about come from medication combined with lifestyle change.
Moreover, obesity is a chronic disease. When you stop treatment, hunger often returns, and some of the weight comes back with it. For this reason, I see the pill as a long-term tool rather than a short-term diet. You can read more in my article what happens when you stop weight loss medication.
Side effects of weight loss pills and how to avoid them
Most side effects affect the digestive system: nausea, vomiting, diarrhea, constipation and heartburn. They appear mainly at the start of treatment and after dose increases, and they fade over time.
- Wegovy pill: in the OASIS 4 trial, 46.6% of patients had nausea, compared with 18.6% on placebo. Only 6.9% stopped treatment because of side effects, compared with 5.9% on placebo.
- Foundayo: at the highest dose, 35% of patients had nausea, compared with 10% on placebo. About 8 in 100 patients stopped because of side effects, compared with 3 in 100 on placebo.
Here are the tips I give every patient:
- Eat small portions slowly, and stop at the first sense of fullness.
- At first, cut back on fatty, fried and heavy foods.
- Drink water throughout the day.
- Don’t rush to increase the dose, because a gradual increase is the key to tolerance.
- Tell your doctor before surgery, a gastroscopy or a colonoscopy.
Severe, persistent abdominal pain, especially pain that spreads to the back, needs an urgent medical evaluation. For full details, see my guide to the side effects of weight loss medications.
Do you need medical and nutritional support?
Absolutely. Medication works best when you don’t go through treatment alone. Your doctor adjusts the dose, follows your blood tests and spots side effects early. Your dietitian, meanwhile, makes sure you eat enough protein, vegetables and fiber, even when your appetite is small.
At our center, I work with a multidisciplinary team of dietitians, psychologists and coaches. Once hunger eases, there is suddenly room to work on habits, emotional eating and sleep. I wrote about this approach in detail in my article on holistic obesity treatment.
Do you need to exercise?
Yes, and strength training matters most. Any significant weight loss also includes some loss of muscle. Yet muscle supports your metabolism, your balance and your independence as you age. That is why I recommend strength training two to three times a week, along with walking and daily movement. This way, you lose fat rather than muscle.
More questions you ask me about weight loss pills
Weight loss pills in everyday life
I’m already on an injection. Can I switch to a pill?
In most cases, yes. In the ATTAIN-MAINTAIN trial, people who switched from injections to Foundayo kept most, but not all, of their weight loss. Your doctor plans the switch, because there is no simple conversion table between the doses.
I forgot to take my pill. What should I do?
With the Wegovy pill, skip that dose and continue as usual the next day. With Foundayo, take the dose when you remember, but never take two doses on the same day.
Can I drink coffee with the pill?
Not with the Wegovy pill. Wait half an hour after taking it, and only then have your coffee. Foundayo has no such restriction.
Pregnancy, diabetes and who shouldn’t take them
I take birth control pills. Does that matter?
With Foundayo, it does. In the first month, and in the month after each dose increase, add a barrier method or switch to a non-oral contraceptive. With the Wegovy pill, there is no need for this.
I’m planning a pregnancy. What should I do?
Intentional weight loss is not recommended during pregnancy. So plan with your doctor when to stop treatment, and stop immediately if you find out you are pregnant.
I have diabetes. Which pill is right for me?
Both pills lower blood sugar. However, combining them with insulin or sulfonylurea drugs raises the risk of low blood sugar. Your doctor may therefore lower the dose of your other medications.
Who can’t take these pills?
People with a personal or family history of medullary thyroid cancer or MEN 2 syndrome (a genetic syndrome that causes tumors in the glands). In addition, you should not take them during pregnancy or together with another GLP-1 medication.
Cost and dosing
How much do they cost, and are they covered?
At present, neither pill is registered in Israel, so neither is included in the national health basket. Patients can obtain them through the 29C pathway (the Israeli route for unregistered drugs), at their own expense. The Wegovy pill costs ILS 760 at the starting doses and ILS 1,261 at the maintenance dose. Foundayo costs between ILS 691.59 and ILS 1,146.46 a month, depending on the dose.
If I have no side effects, does that mean the drug isn’t working?
Not at all. Nausea is not a condition for weight loss. If your hunger is quiet and your weight is going down, the medication is working.
Do I have to reach the maximum dose?
No. The right dose is the lowest one that gives you good hunger control, weight loss and good tolerance. I explain this approach in my article on treating to target.
The bottom line on weight loss pills
Weight loss pills open a new door for many people who have been waiting for a treatment without a needle. The Wegovy pill leads on effectiveness but requires a precise morning routine. Foundayo is flexible, but weight loss with it is more modest, and it interacts with many medications. Both are for adults only. In the end, a pill is a medical tool, not magic. It works best with good nutrition, strength training and close support. If you are unsure which way to go, let’s choose together the treatment that fits you best.
The information in this article is general and does not replace personal medical advice.
References
Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity
Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment
OASIS 4: Significant Weight Loss With Oral Semaglutide Comparable With High-Dose, SC Versions
ATTAIN-1: Oral Orforglipron Significantly Reduces Weight, Cardiometabolic Risk
‘Familiarity’ with oral Wegovy has triggered its quick uptake
Early Foundayo pill uptake after FDA approval
Novo Nordisk funded the OASIS 4 trial, and Eli Lilly funded the ATTAIN trials; both companies manufacture the drugs.
