Foundayo (Orforglipron) vs the Wegovy Pill: Two Obesity Pills Compared

The United States now has two GLP-1 pills approved for weight management. Novo Nordisk’s Wegovy pill (oral semaglutide 25 mg) was approved in December 2025, and Eli Lilly’s Foundayo (orforglipron) followed on 1 April 2026.^1,3 Both are taken once a day. They are not the same kind of drug, and they come with very different instructions on the packet.

The news peg this month is Lilly’s own comparison. At the EASD meeting on 29 September 2026, the company presented an indirect analysis suggesting Foundayo’s top dose produced slightly more weight loss than the Wegovy pill in people with type 2 diabetes.¹⁰ An indirect comparison is not a head-to-head trial, and no trial has yet tested the two pills against each other for obesity.

This page sets out what each pill is, what the trials found, how the side effects and rules differ, and what they cost as of 1 October 2026. It gives no dosing or switching advice. Any change in weight-loss treatment should be made with a prescriber.

At a glance

Property	Foundayo (orforglipron)	Wegovy pill (oral semaglutide)
Maker	Eli Lilly	Novo Nordisk
FDA approval	1 April 2026	22 December 2025
Type of molecule	Small molecule, non-peptide	Peptide with absorption enhancer (SNAC)
Food and water rules	None: any time, with or without food	Empty stomach, up to 4 oz water, wait 30 minutes
Top maintenance dose	17.2 mg once daily	25 mg once daily
Pivotal obesity trial	ATTAIN-1: -11.2% vs -2.1% at 72 weeks	OASIS 4: -13.6% vs -2.2% at 64 weeks
Heart indication	None yet	Cuts major cardiovascular event risk in adults with heart disease
Lowest self-pay price (US)	From $149 a month	From $149 a month
Head-to-head obesity trial	None	None

Two different ways to make a GLP-1 pill

Semaglutide is a peptide, a chain of amino acids that the gut normally breaks down before it can be absorbed. The Wegovy pill gets around this with an absorption enhancer called SNAC (salcaprozate sodium), which protects the peptide in the stomach long enough for a small share to pass into the blood. That is why the label is strict: take it in the morning on an empty stomach with no more than 4 ounces of water, then wait at least 30 minutes before eating, drinking or taking other oral medicines.²

Orforglipron works at the same GLP-1 receptor but is built differently. It is a small, non-peptide molecule, closer to a conventional tablet drug.³ Its label reports an absolute bioavailability of 77% and no clinically relevant food effect, so Foundayo can be taken at any time of day, with or without food.⁴

For many people that practical difference will matter as much as the weight-loss figures. A pill that must be taken fasting, alone, first thing in the morning is harder to fit around other medicines than one that is not. Our explainer on semaglutide vs tirzepatide covers how the injectable GLP-1 drugs compare.

What the trials found

Foundayo: the ATTAIN programme

ATTAIN-1, published in the New England Journal of Medicine in September 2025, enrolled 3,127 adults with obesity or overweight and no diabetes. After 72 weeks, average weight change was -7.5%, -8.4% and -11.2% across the three orforglipron doses, against -2.1% on placebo, using the treatment-regimen estimand that counts everyone randomised.⁵ Lilly’s efficacy estimand, which reflects people who stayed on treatment, put the top dose at -12.4% against -0.9%.³

ATTAIN-2 tested the drug in adults with obesity and type 2 diabetes. At the highest dose, weight fell 10.5% against 2.2% on placebo (efficacy estimand), or 9.6% against 2.5% counting everyone randomised.⁶

Wegovy pill: OASIS 4

OASIS 4 randomised 307 adults with obesity or overweight to oral semaglutide 25 mg or placebo for 64 weeks. Average weight change was about -13.6% against -2.2% on placebo using the treatment-policy approach, and -16.6% if everyone had stayed on treatment.⁷

Why the numbers cannot simply be lined up

It is tempting to read the table above and conclude the Wegovy pill wins. That would be a mistake. OASIS 4 was much smaller than ATTAIN-1, ran for 64 weeks rather than 72, and used a different population and analysis. Cross-trial comparisons like this are a starting point, not a verdict.

The only direct comparison so far is ACHIEVE-3, published in The Lancet, which tested orforglipron against the lower oral semaglutide doses used for type 2 diabetes (7 mg and 14 mg), not the 25 mg obesity dose. In 1,698 people with type 2 diabetes on metformin, orforglipron lowered HbA1c by 1.9% and 2.2% against 1.1% and 1.4%, and weight by 6.7% and 9.2% against 3.7% and 5.3% after 52 weeks.⁸

Lilly’s September 2026 indirect analysis went a step further and estimated that Foundayo 17.2 mg produced 1.5 percentage points more weight loss and 0.3 points more HbA1c reduction than oral semaglutide 25 mg in type 2 diabetes. Lilly itself notes that the 25 mg dose is not approved in the US for type 2 diabetes.¹⁰ Company-run indirect comparisons should be read with that in mind.

Side effects compared

Both pills act on the same receptor, so their side effects look alike. Gastrointestinal effects dominate, usually during dose increases.

• Foundayo: on the 17.2 mg dose, the label reports nausea in 35% of people against 10% on placebo, diarrhoea in 25% against 11%, vomiting in 24% against 4% and constipation in 24% against 9%.⁴ In ATTAIN-1, 5.3% to 10.3% stopped because of side effects, against 2.7% on placebo.⁵
• Wegovy pill: in OASIS 4, 74% reported gastrointestinal side effects against 42% on placebo, and about 7% stopped because of side effects against 6%.⁷

In ACHIEVE-3, more people stopped orforglipron for side effects (8.7% and 9.7%) than stopped the lower oral semaglutide doses (4.5% and 4.9%).⁸ That trial used higher orforglipron doses against lower semaglutide doses, so it does not settle which pill is easier to tolerate at obesity doses.

Label warnings

Both labels carry a boxed warning about thyroid C-cell tumours seen in rodents, and both are contraindicated in people with a personal or family history of medullary thyroid carcinoma or MEN 2. The Foundayo label keeps this warning even though orforglipron is not active at rodent GLP-1 receptors.^2,4 Other warnings on the Foundayo label include pancreatitis, severe gastrointestinal reactions, acute kidney injury, gallbladder disease and low blood sugar when combined with insulin or sulfonylureas.⁴

Foundayo also has interaction rules the Wegovy pill does not share in the same form. The label caps the dose at 9 mg with strong CYP3A4 inhibitors and advises backup contraception for 30 days after starting and after each dose increase for people using oral contraceptives.⁴

Heart outcomes

This is where the Wegovy pill currently has the edge on paper. Its approval covers reducing the risk of major adverse cardiovascular events in adults with established heart disease and obesity or overweight.¹

Foundayo has no cardiovascular indication yet. ACHIEVE-4, which compared orforglipron with insulin glargine in 2,749 people, met its goal of showing orforglipron did not raise cardiovascular risk (hazard ratio 0.84, 95% CI 0.59 to 1.20).¹¹ That is a safety finding, not proof of benefit.

Cost and availability as of October 2026

• Foundayo: Lilly lists self-pay pricing from $149 a month at the lowest dose, as little as $25 a month with its commercial savings card, and $50 a month for Medicare Part D patients from 1 July 2026.³ It shipped through LillyDirect from 6 April 2026 and reached retail pharmacies from 9 April.¹⁷
• Wegovy pill: NovoCare lists self-pay prices of $149 a month for 1.5 mg, $199 for 4 mg and $299 for the 9 mg and 25 mg doses.⁹

Uptake has been uneven. Novo reported more than 265,000 weekly US prescriptions for the Wegovy pill in mid-July 2026, while Foundayo’s second-quarter sales were reported at $98 million.^12,13

Outside the US, the European Commission approved the Wegovy pill on 15 July 2026, and it launched in the UK in July.^12,14 The UK’s MHRA authorised orforglipron in August 2026, the first approval in Europe, but it is not available on the NHS while NICE reviews it.¹⁵

Frequently asked questions

Which pill causes more weight loss?

There is no head-to-head obesity trial. In separate trials, the Wegovy pill produced -13.6% at 64 weeks and Foundayo’s top dose -11.2% at 72 weeks, but the trials differed in size, length and design.^5,7 Lilly’s indirect analysis in type 2 diabetes favoured Foundayo by a small margin.¹⁰

Can I take Foundayo with breakfast?

Yes. The label allows Foundayo to be taken at any time of day, with or without food.⁴ The Wegovy pill must be taken on an empty stomach with a small amount of water, followed by a 30-minute wait.²

Are these pills the same as compounded or “research” GLP-1s?

No. Both are FDA-approved branded medicines made by their manufacturers. Products sold online as research chemicals are not the same product and are not evaluated by the FDA. Our guide to weight-loss peptides in 2026 covers that market.

Do the pills work as well as the injections?

Neither pill has been compared head to head with injectable semaglutide or tirzepatide in a published obesity trial. Novo has reported real-world data on people switching from injections to the Wegovy pill, but that was not a controlled comparison.¹⁶

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]. 22 December 2025. prnewswire.com
2. Novo Nordisk. Wegovy prescribing information (revised June 2026). novo-pi.com
3. Eli Lilly and Company. 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]. 1 April 2026. investor.lilly.com
4. US Food and Drug Administration. Foundayo (orforglipron) tablets prescribing information (revised July 2026). accessdata.fda.gov
5. Wharton S, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist for obesity treatment (ATTAIN-1). N Engl J Med. Published 16 September 2025. DOI: 10.1056/NEJMoa2511774. nejm.org
6. Eli Lilly and Company. Lilly’s oral GLP-1, orforglipron, is successful in third Phase 3 trial, triggering global regulatory submissions this year for the treatment of obesity [press release]. 26 August 2025. investor.lilly.com
7. American College of Cardiology. OASIS 4: Significant weight loss with oral semaglutide comparable with high-dose, SC versions [journal scan]. 24 September 2025. acc.org
8. Eli Lilly and Company. Lilly’s oral GLP-1, orforglipron, delivered superior blood sugar control and weight loss compared to oral semaglutide in head-to-head type 2 diabetes trial published in The Lancet [press release]. 26 February 2026. prnewswire.com
9. NovoCare Pharmacy. Wegovy self-pay pricing. Accessed 1 October 2026. novocare.com
10. Eli Lilly and Company. Lilly’s Foundayo (orforglipron) 17.2 mg showed greater weight loss and A1C reduction than oral semaglutide 25 mg [press release, EASD 2026]. 29 September 2026. investor.lilly.com
11. Eli Lilly and Company. ACHIEVE-4, the longest Phase 3 study of Lilly’s Foundayo (orforglipron) to date, reaffirmed its cardiovascular and overall safety profile [press release]. 16 April 2026. investor.lilly.com
12. Novo Nordisk. Novo Nordisk reports adjusted operating profit of DKK 33,389 million for Q2 2026 and raises full-year outlook [company announcement]. 4 August 2026. nasdaq.com
13. Fierce Pharma. Lilly’s obesity pill Foundayo ‘disappointed’ in Q2, as injectables continue to boom. 5 August 2026. fiercepharma.com
14. Novo Nordisk. Novo Nordisk receives European Commission approval of Wegovy pill as first oral GLP-1 for weight management in the EU; single, ready-to-use pen for higher dose 7.2 mg also approved [press release]. 15 July 2026. globenewswire.com
15. UK Government. UK first in Europe to authorise orforglipron for weight management and type 2 diabetes. 10 August 2026. gov.uk
16. Quartz. Switching to Novo Nordisk’s weight loss pill helped people keep shedding pounds. 30 September 2026. qz.com
17. Eli Lilly and Company. Foundayo (orforglipron), Lilly’s new oral GLP-1 pill for weight loss, now available at retail pharmacies [press release]. 9 April 2026. investor.lilly.com