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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 | 12.4% at 72 weeks (highest 36 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 a point. 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 eight 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, narrowly — 13.6% at 64 weeks (OASIS 4) against 12.4% at 72 weeks for orforglipron (ATTAIN-1). That will surprise people, because orforglipron gets written up as the more advanced drug. It is more convenient, not more powerful. 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.