By Dr. Asnat Raziel, specialist in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal
Foundayo treatment: a daily pill, with no fasting and no injections
Foundayo treatment offers a new way to treat obesity: one pill a day. It is the first non-peptide pill in the GLP-1 family to win US approval for obesity. You take it once a day, at any hour, with or without food. At the highest dose, it led to an average loss of 11.1% of body weight in people without diabetes.
Foundayo is the brand name of orforglipron, developed by Eli Lilly. The FDA approved it on April 1, 2026 for weight loss and long-term weight maintenance. In October 2026, the scientific committee of the European Medicines Agency also recommended approval, for weight management and type 2 diabetes. In this guide, I have gathered what you should know before you start.
Where does the drug stand in Israel?
According to reports, Foundayo reached pharmacies in Israel on September 15, 2026. It is available by prescription only, at the patient’s own expense. Currently, it is not part of Israel’s national health basket. The published monthly price ranges from about 691 to about 1,146 NIS, depending on the dose. The Israeli importer is Salomon, Levin and Elstein (SLE) Ltd., and patients receive an information leaflet in Hebrew. For more background, see my page on the Foundayo pill.
What is orforglipron and how does it work?
Orforglipron activates the receptor for GLP-1 (glucagon-like peptide-1). GLP-1 is a natural satiety hormone that the gut releases after a meal. Wegovy, Ozempic and Mounjaro also activate this receptor. The difference lies in the structure. Semaglutide and tirzepatide are peptides, meaning chains of amino acids that break down easily in the digestive tract. In contrast, orforglipron is a small molecule designed to absorb well through the gut.
Therefore, you can take it as an ordinary tablet, without an empty stomach and without waiting before you eat. According to the US prescribing information, about 77% of the dose reaches the bloodstream. Its half-life is 29 to 49 hours. The liver breaks the drug down mainly through the enzyme CYP3A4 (cytochrome P450 3A4), which also processes many other drugs.
The drug increases fullness, reduces hunger and quiets “food noise”. In addition, it slows stomach emptying and raises insulin release only when blood sugar is high. However, most of its effect on weight comes from action in the brain’s hunger and satiety centers. I explained this in my article on satiety, hormones and the brain.
Who is Foundayo treatment suitable for?
According to the label, Foundayo is used alongside a reduced-calorie diet and physical activity. It is intended for adults with a BMI of 30 or more. BMI (body mass index) is weight in kilograms divided by height in meters squared. It is also intended for adults with a BMI of 27 or more and at least one weight-related condition. Examples include high blood pressure, sleep apnea or type 2 diabetes.
To be precise: in the United States, the indication is weight management. The FDA is still reviewing a request to approve the drug for diabetes as well. On the other hand, Foundayo is not approved for children and teens under 18.
Doses and gradual titration in Foundayo treatment
Foundayo comes in six doses: 0.8, 2.5, 5.5, 9, 14.5 and 17.2 mg. You start with 0.8 mg once a day, for at least 30 days. Next, you move to 2.5 mg and then to 5.5 mg, each step for at least 30 days. Depending on response and tolerability, the dose can rise gradually to 9, 14.5 and 17.2 mg, the maximum dose.
Gradual titration aims to reduce nausea, vomiting and other digestive effects. Even so, you do not have to reach the maximum dose. The right dose is the lowest one that gives good hunger control, weight loss or maintenance, and good tolerability. I wrote about this principle in my article on treating to target.
Note: the trials used doses of 6, 12 and 36 mg in a research formulation. These doses correspond to 5.5, 9 and 17.2 mg in the commercial tablets.
How to take the pill and what to do if you forget
Take one tablet a day, at a fixed and convenient time, and swallow it whole. Store the drug at room temperature, with no need for a fridge. If you miss a dose, take it as soon as you remember, and do not double the next dose. If you miss seven or more doses in a row, contact your doctor. In that case, you restart at a low dose and titrate up again.
How much weight do people lose with Foundayo treatment?
The two main phase 3 trials lasted 72 weeks. The ATTAIN-1 trial enrolled 3,127 adults with obesity and without diabetes. According to the prescribing information, average weight loss was 7.4% at 5.5 mg, 8.3% at 9 mg and 11.1% at 17.2 mg. With placebo, weight loss was 2.1%.
At the maximum dose, about 72 out of 100 participants lost at least 5% of their weight. In addition, about 55 lost at least 10%, about 36 at least 15% and about 18 at least 20%. For comparison, only 13 out of 100 in the placebo group lost at least 10%.
The ATTAIN-2 trial enrolled 1,613 adults with obesity or overweight and type 2 diabetes. Average weight loss was 5.1%, 7.0% and 9.6% across the three doses, compared with 2.5% on placebo. HbA1c (glycated hemoglobin) reflects average blood sugar over the past three months. At the maximum dose, it fell by 1.7 percentage points. Of course, these are averages: some patients lost a lot, and others lost little.
Weight maintenance and switching from injections to the pill
The ATTAIN-MAINTAIN trial, published in May 2026 in Nature Medicine, tested a question many patients ask me. Can you switch from an injection to a pill without losing what you achieved? The trial enrolled 376 adults who had completed treatment with tirzepatide or semaglutide injections. Those who switched from tirzepatide kept, on average, 74.7% of their weight loss on orforglipron, compared with 49.2% on placebo. Those who switched from semaglutide kept 79.3%, compared with 37.6%.
Foundayo treatment compared with injections and other pills
Foundayo is effective, but the average weight loss in its trials is more modest than with the strongest injections. However, comparing separate trials can mislead, because populations and analysis methods differ. As a result, the choice depends on preferences, other conditions, response to earlier treatments and the ability to persist. For a comparison with Novo Nordisk’s pill, see my article on the Wegovy pill and Foundayo.
What do we know about the heart?
The ACHIEVE-4 trial enrolled 2,749 people with type 2 diabetes, overweight and raised cardiovascular risk. It compared orforglipron with insulin glargine. According to the company’s September 2026 announcement, the drug met its cardiovascular safety goal. The hazard ratio for a major cardiovascular event was 0.84 (95% confidence interval: 0.59 to 1.20). An additional analysis also showed lower mortality, but this analysis did not pass strict statistical correction. In other words, the trial shows heart safety, but it has not yet proven protection.
Common side effects of Foundayo treatment
The common side effects involve the digestive system. They appear mainly during the adjustment period and after a dose increase, and they ease over time. The pooled data from the two trials reported these rates (placebo / 5.5 / 9 / 17.2 mg):
- Nausea: 10% / 26% / 34% / 35%.
- Constipation: 9% / 20% / 27% / 24%.
- Diarrhea: 11% / 21% / 23% / 25%.
- Vomiting: 4% / 13% / 21% / 24%.
About 8 out of 100 patients stopped the drug because of side effects, compared with 3 out of 100 on placebo. In addition, heart rate rose on average by a few beats per minute, as with other drugs in this family. To ease symptoms, eat small portions slowly, cut down on fatty food and drink enough fluids. If symptoms are significant, delay the dose increase together with your doctor. You will find more tips in my guide to the side effects of weight loss drugs.
Important warnings
Acute pancreatitis is rare but important. Across the two trials, doctors confirmed 6 cases among patients on the drug, compared with one patient on placebo. Severe, persistent pain in the upper abdomen, sometimes spreading to the back, requires stopping treatment and urgent assessment. In addition, gallstones occurred in 1% of patients, compared with 0.7% on placebo.
As with all drugs in this family, the label carries a warning about thyroid tumors. Therefore, anyone with a personal or family history of medullary thyroid cancer, or MEN 2 syndrome, should not receive the drug. Furthermore, it is not recommended in severe liver failure or during breastfeeding. You should not combine it with another GLP-1 drug.
Drug interactions, pregnancy and surgery
Unlike the peptide drugs, orforglipron has important drug interactions. So it is worth reviewing all regular medications before starting treatment:
- With strong CYP3A4 inhibitors, such as clarithromycin, the maximum dose is 9 mg a day.
- With strong CYP3A4 inducers, such as carbamazepine and rifampicin, it is better not to combine.
- Alongside simvastatin, do not exceed 20 mg a day of the statin.
- With insulin or a sulfonylurea, consider a dose reduction because of the risk of low blood sugar.
Women who take oral contraceptive pills should switch to a non-oral method, or add a condom. This advice applies for 30 days from the start of treatment and for 30 days after each dose increase. If pregnancy occurs, stop the drug and see your doctor. Also, before surgery, gastroscopy or colonoscopy, let the team know, because the drug slows stomach emptying.
What happens when you stop Foundayo treatment?
Obesity is a chronic disease. It is not laziness; it is physiology. Stopping an effective treatment may bring hunger back and lead to weight regain. That is why it is important to plan ahead: a maintenance dose, a switch to another drug or close follow-up. Meanwhile, enough protein, strength training two to three times a week and good sleep help preserve muscle. Stopping is not a personal failure, but a change in the treatment of a biological disease. My guide to stopping weight loss medication covers this step in detail.
Bottom line on Foundayo treatment
Foundayo is the first non-peptide GLP-1 pill approved in the United States for weight management. You take it once a day, regardless of meals. At the maximum dose, it led to an average loss of 11.1% in people without diabetes and 9.6% in people with diabetes. Moreover, it preserved most of the weight loss in people who switched to it from injections.
Foundayo treatment may especially suit people who prefer a pill to an injection. The keys to success are choosing the right patients, titrating gradually and reviewing interactions. Alongside these, good nutrition, strength training and medical follow-up matter. Drug treatment is not a magic solution, but a medical tool that works best when you do not face it alone.
This article provides general information and is not personal medical advice. For any question about your treatment, please consult your doctor.
References
FOUNDAYO (orforglipron) tablets – US Prescribing Information
Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment
EMA Panel Backs Lilly’s Foundayo for Obesity and Type 2 Diabetes in Europe
Foundayo in Israel: prices and availability (ice, in Hebrew)
Eli Lilly, the maker of the drug, funded the ATTAIN and ACHIEVE trials.
