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Three GLP‑1 pills are now on the market. None of them matches the best injection — and the one everyone calls the breakthrough is not even the strongest pill. Here is the trade you are actually making.
Every weight-loss figure below is tied to the trial it came from. If a number appears anywhere without a trial name next to it, do not trust it.
| Drug | Form | Weight loss (trial) | Empty stomach? |
|---|---|---|---|
| Wegovy pill (oral semaglutide 25 mg) semaglutide, oral 25 mg | Pill | 13.6% at 64 weeks (16.6% among people who stayed fully adherent)OASIS 4 | |
| Foundayo (orforglipron) orforglipron | Pill | 11.1% at 72 weeks (17.2 mg dose)ATTAIN-1 | |
| Rybelsus semaglutide, oral 3/7/14 mg | Pill | ~4-5% on the 14 mg dose — a diabetes drug, not a weight-loss onePIONEER programme | |
| Zepbound tirzepatide | Shot | ~21% at 72 weeksSURMOUNT-1 | N/A |
| Wegovy (injection) semaglutide 2.4 mg | Shot | ~15% at 68 weeksSTEP 1 | N/A |
A cross in the last column means the drug demands an empty stomach and a 30-minute wait before food. Injections have no food rule, which is the part people forget when they imagine a pill is simpler.
The strongest oral on trial data — and, against expectations, stronger than orforglipron. The catch is the dosing rule: empty stomach, half a glass of water, then nothing for 30 minutes. Every single day. That rule is why the adherent-population figure (16.6%) is three points above the average one.
The first small-molecule oral GLP-1 — not a peptide, so no food-timing rules and no absorption tricks. On paper it loses to the Wegovy pill by about two and a half points, same measure (all patients randomized) both ways. Among people who stayed on treatment the full 72 weeks, Foundayo averaged 12.4% — a different, more favorable measure, not the one to compare against the Wegovy pill's 13.6%. In practice, a drug you can take with breakfast may beat a slightly stronger one you keep taking wrong. Note that Lilly's ACHIEVE trials (often miscited for weight-loss figures) are its DIABETES programme; ATTAIN-1 is the obesity trial.
The original oral semaglutide, and the one people confuse with the Wegovy pill. Its dose ceiling is 14 mg against the pill's 25 mg — which is most of why its weight-loss numbers are a third of them. Best T2D insurance coverage of the group.
You cannot swap dose-for-dose. Oral bioavailability is a different problem entirely, so a 2.4 mg weekly injection has no milligram equivalent in a pill. Most prescribers restart near the bottom of the oral range and titrate over about 16 weeks. Expect weight loss to stall — or tick back up — during that window. That is the transition, not the drug failing, and people quit at exactly this point for exactly this reason.
What the injection is actually like →·Every weight-loss peptide, ranked·Full switching guide·Is there a tirzepatide pill?·Cheapest way to get each one
No, and be wary of anyone who says otherwise. The best oral result is 13.6% average weight loss at 64 weeks for the Wegovy pill (oral semaglutide 25 mg, OASIS 4). Injected Wegovy reaches about 15% at 68 weeks (STEP 1), and Zepbound about 21% at 72 weeks (SURMOUNT-1). So a pill costs you roughly a point and a half against the same molecule injected — and around seven points against the strongest injection available. Whether that trade is worth avoiding a weekly needle is a real question with a real answer, and the answer is personal.
The Wegovy pill — 13.6% at 64 weeks (OASIS 4) against 11.1% at 72 weeks for orforglipron/Foundayo (ATTAIN-1), same measure both ways: all patients randomized, per the FDA labels. That will surprise people, because orforglipron gets written up as the more advanced drug. It is more convenient, not more powerful. (Among patients who stayed on treatment the full 72 weeks, Foundayo reached 12.4% — a different, non-comparable measure.) Watch out for sites quoting a 14.7% figure for orforglipron from "ACHIEVE-2": ACHIEVE is Lilly's diabetes programme, and ACHIEVE-2 compared orforglipron against dapagliflozin in type 2 diabetes. It is not an obesity trial.
For the semaglutide pills, yes, and it is stricter than it sounds: nothing to eat, no more than about 4 oz of water, and then nothing at all for 30 minutes. Every day. This applies to the Wegovy pill and to Rybelsus. Orforglipron (Foundayo) is a small molecule rather than a peptide, so it has no food rule — take it whenever. If your mornings are chaotic, that single difference matters more than the one-point efficacy gap.
Needle avoidance, and it is a legitimate reason — a medication you will actually take beats a better one you will not start. The pill also removes cold-chain storage and travel hassle. What you give up: roughly a point and a half of weight loss versus the same molecule injected, a daily ritual instead of a weekly one, and (for semaglutide pills) the empty-stomach rule. There is no honest survey number we can quote you on how many people prefer pills, so we do not quote one.
Yes, but expect to re-titrate rather than swap dose-for-dose — oral bioavailability is completely different, so a 2.4 mg weekly injection does not map onto a milligram figure in a pill. Most prescribers restart near the bottom of the oral range and climb over roughly 16 weeks. Weight loss commonly stalls or reverses slightly during that window; that is the transition, not the drug failing.
Every efficacy figure on this page names the trial it came from — OASIS 4 (oral semaglutide), ATTAIN-1 (orforglipron), STEP 1 and SURMOUNT-1 (the injections). We do not publish a weight-loss number we cannot attribute.