Wegovy pill and orforglipron: what GLP-1 pills really change

For years, GLP-1 obesity medicines came as a weekly injection. At the end of 2025, that changed. On 22 December 2025, the US Food and Drug Administration (FDA) approved the Wegovy pill, an oral form of semaglutide taken once a day. On 1 April 2026, it approved Eli Lilly’s orforglipron, sold as Foundayo, after a review that took only 50 days.

The two drugs are not built the same way. Semaglutide is a peptide, a kind of small protein that the stomach breaks down easily: it needs a special formulation and an empty stomach for enough of it to reach the bloodstream. Orforglipron is a small synthetic, non-peptide molecule that switches on the same receptor without those constraints. Either way, the goal is the same: less hunger, feeling full sooner and, in the end, eating fewer calories.

The UK and the European Union followed a few months later. Here is where approvals stood on 21 October 2026.

A licence does not put a medicine on pharmacy shelves overnight. Each country then sets a price and decides whether to fund it. In October 2026 the picture therefore varies a lot from one country to the next, and orforglipron is not yet sold anywhere in the European Union.

In the UK, both pills can be prescribed privately. Lilly launched Foundayo on 24 August 2026 and expected it to cost about £100 to £120 a month privately, while private providers charge roughly £74 to £129 a month for the first, lower doses of the Wegovy pill. Neither pill is available on the NHS yet: the National Institute for Health and Care Excellence (NICE) is still assessing orforglipron, and no NHS route has been announced for oral semaglutide.

Germany was the first EU country to sell the Wegovy pill, from 1 September 2026, with patients paying the full price: German law excludes weight-loss medicines from statutory health insurance. In France, press reports expect the pill in early November 2026, without reimbursement at launch; French reimbursement currently covers only Wegovy and Mounjaro injections, since 15 June 2026, under strict BMI conditions.

Two large phase 3 trials, published in the New England Journal of Medicine in September 2025, underpin the approvals. OASIS 4 followed 307 adults with overweight or obesity and no diabetes for 64 weeks: on the semaglutide pill they lost 13.6% of their body weight on average, against 2.2% on placebo. ATTAIN-1, far larger, enrolled 3,127 adults in nine countries for 72 weeks: at the highest dose, orforglipron led to 11.2% weight loss, against 2.1% on placebo.

You will also see higher figures, 16.6% for oral Wegovy and 12.4% for orforglipron. They are not wrong: they only count people who took their treatment as planned. The lower figures include everyone, including those who stopped along the way, and are closer to real life.

Be careful with quick comparisons: the two trials did not test the drugs against each other, and their participants, length and methods differ. To date there is no head-to-head obesity trial that shows which pill leads to more weight loss.

In substance, not much changes: the Wegovy pill contains the same molecule as the pen, and the EMA considers its safety profile similar to that of the weekly injections. On effectiveness, the OASIS 4 results are close to those of STEP 1, the trial of the Wegovy injection (14.9% weight loss against 2.4% on placebo over 68 weeks). To get there, however, the pill has to contain a much higher daily dose than the weekly injection, because the gut absorbs semaglutide poorly.

The real difference is practical. The injection is once a week. The Wegovy pill is taken every day on an empty stomach, after at least eight hours without food, with a sip of water, and you then need to wait at least 30 minutes before eating, drinking or taking other medicines. Orforglipron is also taken daily, but at any time, with or without food. For some people, avoiding needles matters a lot; for others, one dose a week is simpler than a daily routine.

One last thing they share, and it matters: whatever the format, part of the weight lost is not fat. We explain what the scale does not show in our guide to GLP-1 and weight loss.

Side effects are mainly digestive, as with the injections: nausea, diarrhoea, constipation, stomach pain, indigestion and vomiting. In OASIS 4, 74% of people on the pill had at least one digestive side effect, against 42% on placebo. These are usually mild to moderate and mostly appear at the start of treatment or when the dose goes up, which is why the dose is increased gradually, in steps of at least a month.

The labels also list rarer but serious risks shared by this drug class: acute pancreatitis, gallbladder problems, dehydration that can harm the kidneys after heavy vomiting or diarrhoea, and low blood sugar in people taking other diabetes medicines. In the US, the labels rule these medicines out for anyone with a personal or family history of medullary thyroid cancer. Severe, persistent stomach pain, repeated vomiting or signs of dehydration mean you should call your doctor straight away.

These symptoms also have a direct effect on nutrition: when you feel sick, you eat less and drink less. Staying well hydrated becomes a priority. Finally, these medicines are prescription-only: buying them from unregulated websites or social media exposes you to fakes, which European regulators have repeatedly warned about.

This is the blind spot in a lot of coverage of these pills. A GLP-1 does not melt fat by magic: it dampens appetite, so you eat less. For some people the drop is dramatic, to the point of skipping meals without noticing or stopping after a few bites. Yet the body still needs protein, vitamins and minerals, even when the plate shrinks.

Four US nutrition and obesity societies published a joint advisory on this in 2025. They list among the pitfalls of GLP-1 therapy digestive side effects, the risk of micronutrient deficiencies, loss of muscle and bone, and weight regain when treatment stops. Their priorities: a nutrient-dense, minimally processed diet, preventing shortfalls in micronutrients, enough protein combined with strength training, and nutrition support from the start of treatment.

Three things deserve special attention. Protein, first, because it helps preserve muscle while you lose weight. Fibre, next, because vegetables, fruit and wholegrains are often the first to go when you eat little, even though they help with the constipation that is common on treatment. And water, because you drink less when you are less hungry and feel full quickly.

When your appetite drops, every bite counts for more. The most useful rule is simple: start the meal with the protein, then the vegetables, and leave the rest for the end if you still have room. A 2025 review in Obesity Pillars on getting the most out of GLP-1 therapy cites intakes of more than 1.2 g of protein per kilo of body weight per day, spread through the day, or about 25 to 30 g at breakfast, lunch and dinner. The authors point out that these targets come from studies in people not taking GLP-1 drugs and still need confirming in people on treatment.

In practice, 25 to 30 g of protein is roughly 100 g of cooked chicken breast, a 250 g pot of skyr, or a bowl of lentils with two eggs. Our guide to protein covers the best sources, animal and plant. For fibre, the same review suggests about 14 g per 1,000 kcal: even on a small plate, keep room for vegetables, pulses, fruit or wholegrains.

If nausea is the main problem, go for smaller, more frequent meals, eat slowly, stop at the first sign of fullness and limit very fatty or fried food, which is often harder to tolerate. A registered dietitian or doctor can adapt these targets to you, especially if you have kidney disease or take other medicines.

GLP-1 pills are no longer a promise: the Wegovy pill is authorised in the UK and the European Union, and orforglipron is already prescribed privately in the UK and should follow in the EU after its positive EMA opinion in October 2026. In trials these pills led to average weight loss of 11 to 14%, with mainly digestive side effects similar to those of the injections. They are prescription-only, are not yet funded by the NHS, and whether one suits you is always a decision to make with a doctor. Because these medicines curb appetite, the quality of every meal becomes decisive: protein at each meal, fibre, water and strength training help you lose fat without sacrificing muscle.