The GLP-1 pills take off 11% to 14% of body weight, and they held most of the loss for people who switched from a shot

Evidence check, October 3, 2026

The claim: "The new GLP-1 pills work as well as the shots, so you don't need the needle anymore."

Our grade: Promising. In randomized trials the two approved pills cut weight by 11% to 14%. That is close to the Wegovy shot (15%) and well short of Zepbound (21%), and no trial has tested a pill against a shot directly. A pill is a real option, but it is not the strongest one.

Tom is 50. A year and a half on Zepbound took him from 250 pounds to 200. He is glad of it, and he is tired of the weekly needle and of keeping pens cold when he travels. Now there are two pills on the pharmacy shelf.

Can he swap the shot for a pill and keep the weight off?

It matters because most of the health gain from these drugs comes from keeping the weight off for years, and a drug you can stay on is worth more than a stronger one you quit. Four trials of the pills are out, plus a new heart-safety trial published September 30.

Where the claim came from

There are two pills. The Wegovy pill is semaglutide, the same drug as the Wegovy shot, in a 25 mg daily tablet. The FDA approved it on December 22, 2025 [1]. Foundayo (orforglipron) is a new drug from Eli Lilly, the maker of Zepbound. It was approved on April 1, 2026 [2].

Both launched at $149 a month for the lowest dose if you pay yourself [1, 2]. Novo Nordisk's announcement led with "about 17%" weight loss [1]. The Wegovy shot's well-known number is 15% [6]. Put those side by side and the pill looks as good as the shot, or better. That is where the claim comes from.

The two numbers aren't measured the same way, though. The 17% counts only people who stayed on the pill. The 15% counts everyone who started.

What the studies found

Both pills work

ATTAIN-1 randomly assigned 3,127 adults with obesity and no diabetes to orforglipron or a placebo (a dummy pill) for 72 weeks, double-blind (neither they nor their doctors knew who got what) [3]. Counting everyone who started, the top dose cut weight by 11.2%, against 2.1% on placebo. That was about 25 pounds [2]. More than half, 54.6%, lost at least 10%, and 18.4% lost at least 20% [3]. People who stayed on the pill lost 12.4% [2].

OASIS 4 did the same for the Wegovy pill in 307 adults over 64 weeks [5]. Counting everyone, weight fell 13.6%, against 2.2% on placebo. For those who stayed on it, 16.6% [1].

As with the shots, people with type 2 diabetes lose less. In ATTAIN-2, 1,613 of them lost 9.6% on the top orforglipron dose, against 2.5% on placebo [4].

Against the shots

No trial has put a pill against a shot for weight loss. The best we can do is line up each drug's main trial, counting everyone who started.

The Wegovy pill lands within about a point of the Wegovy shot. That makes sense: it is the same drug. Foundayo is about 4 points behind the Wegovy shot and 10 points behind Zepbound. For someone who starts at 230 pounds, 10 points is 23 pounds (10 kg). These were separate trials with different people, so treat the gaps as estimates.

Switching from a shot to the pill

This is the trial that answers Tom's question. ATTAIN-MAINTAIN took 376 people who had just finished 72 weeks on a shot and randomly gave them orforglipron or a placebo for a year, double-blind [8].

People coming off the Wegovy shot kept 79.3% of their weight loss on the pill. On placebo they kept 37.6%. People coming off Zepbound kept 74.7% on the pill, against 49.2% on placebo [8].

So the pill didn't hold everything, but it held most of it, and stopping with nothing gave back half or more within a year. The trial had no group that stayed on the shot, so we don't know how much the shot itself would have held [8].

So back to Tom: if his results match the average, he would keep about 37 of his 50 pounds and give back about 13. That is the price of dropping the needle.

The heart, and the side effects

ACHIEVE-4, published September 30, followed 2,749 adults with type 2 diabetes and heart or kidney disease for a median of two years [9]. Half took orforglipron, half took insulin, and everyone knew which. Heart attacks, strokes and heart deaths hit 4.2% on the pill and 5.0% on insulin. That shows the pill is at least as safe for the heart. It does not yet prove it protects the heart.

Semaglutide has gone further. As a shot it cut heart events from 8.0% to 6.5% in 17,604 people with heart disease [12]. As a lower-dose pill it cut them from 13.8% to 12.0% in 9,650 people with diabetes [11]. The Wegovy pill is approved to lower heart risk; Foundayo is not [1, 2].

The side effects are the same as the shots: nausea, vomiting, diarrhea, constipation. In ACHIEVE-4, 62.1% on orforglipron had stomach or gut trouble, against 14.2% on insulin [9]. In ATTAIN-1, 5.3% to 10.3% quit because of side effects, against 2.7% on placebo [3].

Our grade

The case for the other side: the drug makers paid for every trial here. The Wegovy pill's trial had only 307 people. When orforglipron was tested against low-dose semaglutide pills in 1,698 people with diabetes, it lowered blood sugar more, but more people quit it for side effects (10% against 5%) and pulse rose by about 5 beats a minute [10]. And a daily pill is 365 chances a year to forget, against 52.

What would change the grade: a trial of a pill against a shot, a heart trial of orforglipron in people without diabetes, and more than a year of data after switching.

What this means for you

• If needles are what's stopping you, a pill is a real choice now. Expect to lose about 11% to 14% of your weight, not 20% [3, 5].
• If you want the most weight loss, Zepbound is still ahead, at about 21% in its main trial [7].
• If you're on a shot and want to stop injecting, switching to the pill kept three quarters or more of the loss for a year. Stopping with nothing kept half or less [8]. Plan the switch with your doctor.
• Know the rule for each. The Wegovy pill goes down first thing in the morning on an empty stomach, with no more than 4 ounces of water, 30 minutes before food, coffee or other pills [13]. Foundayo can be taken any time, with or without food [2].
• If you have heart disease, ask about semaglutide. It is the one with proven heart benefit [11, 12].
• On any of these drugs, protect your muscle: about 1.6 g of protein per kg of body weight a day, and lifting two or three times a week. See keeping muscle on GLP-1 drugs and our protein target.

What's next

The missing piece is a trial of a pill against a shot, and a heart trial of orforglipron in people without diabetes. More pills are in testing. The shots are getting stronger too: see our check of retatrutide, which reached 25% in its big trial. For more, see keeping muscle on GLP-1 drugs and why vials sold online as peptides aren't the tested drugs.

Sources

1. Novo Nordisk. FDA approves Novo Nordisk's Wegovy pill, the first and only oral GLP-1 for weight loss in adults. Press release, December 22, 2025. Price, approved uses and OASIS 4 on-treatment result. https://www.prnewswire.com/news-releases/fda-approves-novo-nordisks-wegovy-pill-the-first-and-only-oral-glp-1-for-weight-loss-in-adults-302648344.html
2. Eli Lilly. FDA approves Lilly's Foundayo (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions. Press release, April 1, 2026. Price, how to take it and ATTAIN-1 on-treatment result. https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill
3. Wharton S, Aronne LJ, Stefanski A, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist for obesity treatment (ATTAIN-1). N Engl J Med, 2025. 3,127 adults without diabetes, randomized, double-blind, placebo-controlled, 72 weeks. Funded by Eli Lilly. https://doi.org/10.1056/NEJMoa2511774
4. Horn DB, Ryan DH, Kis SG, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist, for the treatment of obesity in people with type 2 diabetes (ATTAIN-2). Lancet, 2025. 1,613 adults, randomized, double-blind, placebo-controlled, 72 weeks. Funded by Eli Lilly. https://doi.org/10.1016/S0140-6736(25)02165-8
5. Wharton S, Lingvay I, Bogdanski P, et al. Oral semaglutide at a dose of 25 mg in adults with overweight or obesity (OASIS 4). N Engl J Med, 2025. 307 adults, randomized, double-blind, placebo-controlled, 64 weeks. Funded by Novo Nordisk. https://doi.org/10.1056/NEJMoa2500969
6. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med, 2021. 1,961 adults, randomized, double-blind, placebo-controlled, 68 weeks. Funded by Novo Nordisk. https://doi.org/10.1056/NEJMoa2032183
7. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). N Engl J Med, 2022. 2,539 adults, randomized, double-blind, placebo-controlled, 72 weeks. Funded by Eli Lilly. https://doi.org/10.1056/NEJMoa2206038
8. Aronne LJ, Horn DB, le Roux CW, et al. Orforglipron for maintenance of body weight reduction: the double-blind, randomized phase 3b ATTAIN-MAINTAIN trial. Nat Med, 2026. 376 adults switched from a weekly shot, randomized, double-blind, placebo-controlled, 52 weeks. Funded by Eli Lilly. https://doi.org/10.1038/s41591-026-04386-7
9. Klein KR, Wysham C, Tuttle KR, et al. Cardiovascular safety of orforglipron versus insulin glargine in adults with type 2 diabetes at increased cardiovascular risk (ACHIEVE-4). Lancet, 2026. 2,749 adults, randomized, open-label, median 2 years. Funded by Eli Lilly. https://doi.org/10.1016/S0140-6736(26)01865-9
10. Rosenstock J, Yabe D, Cox D, et al. Efficacy and safety of once-daily oral orforglipron compared with oral semaglutide in adults with type 2 diabetes (ACHIEVE-3). Lancet, 2026. 1,698 adults, randomized, open-label, 52 weeks. Funded by Eli Lilly. https://doi.org/10.1016/S0140-6736(26)00202-3
11. McGuire DK, Marx N, Mulvagh SL, et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes (SOUL). N Engl J Med, 2025. 9,650 adults, randomized, double-blind, placebo-controlled, about 4 years. Funded by Novo Nordisk. https://doi.org/10.1056/NEJMoa2501006
12. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med, 2023. 17,604 adults with heart disease, randomized, double-blind, placebo-controlled, about 40 months. Funded by Novo Nordisk. https://doi.org/10.1056/NEJMoa2307563
13. US Food and Drug Administration. Wegovy (semaglutide) injection and tablets, prescribing information, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s033lbl.pdf