For years, the most effective weight-loss drugs came only as weekly injections. That changed in the space of a few months: the FDA approved Novo Nordisk’s Wegovy pill (oral semaglutide) in December 2025, and Eli Lilly’s Foundayo (orforglipron) on April 1, 2026. Both are once-daily tablets in the GLP-1 class, and both are approved for adults with obesity, or overweight plus a weight-related health condition. Searches comparing the two have exploded. Here is what actually separates them.
The short answer
In their main trials, the Wegovy pill produced somewhat more weight loss. Foundayo is easier to take, because it has no food or water rules. They cost the same at the starting dose, but Foundayo’s top doses list for more. The two have never been tested head to head for weight loss, so any comparison of results across separate trials should be read with caution.
Two very different molecules
The biggest difference is chemical. Semaglutide, the active ingredient in Wegovy and Ozempic, is a peptide — a small protein that mimics the gut hormone GLP-1. Peptides are normally destroyed in the stomach, which is why semaglutide was first sold as an injection. The Wegovy pill works by pairing a large dose of semaglutide with an absorption enhancer that briefly protects it and helps it cross the stomach lining.
Orforglipron, the drug in Foundayo, is not a peptide. It is a small molecule, like most conventional pills, designed to switch on the same GLP-1 receptor. Because it is not broken down like a protein, it is absorbed normally — which is why it doesn’t come with special instructions. Small molecules are also generally cheaper and easier to manufacture at scale than peptides, one reason the industry sees them as the future of this drug class.
How you take them
This is where daily life differs most. The Wegovy pill must be taken on an empty stomach first thing in the morning with a small sip of water (no more than about 4 ounces), and you then need to wait 30 minutes before eating, drinking or taking other medicines. Taking it with food can sharply reduce how much of the drug is absorbed.
Foundayo can be taken any time of day, with or without food or water. For people who take several morning medicines, work shifts, or simply don’t want to plan breakfast around a pill, that flexibility is a real advantage. Both drugs start at a low dose and step up over several months to reduce stomach side effects.
How much weight people lost
In the OASIS 4 trial, people taking the 25 mg Wegovy pill lost about 14% of their body weight over 64 weeks when everyone was counted regardless of whether they kept taking it, and about 17% among those who stayed on treatment, compared with 2–3% on placebo. That is roughly in line with the weekly Wegovy injection.
In Lilly’s ATTAIN-1 trial, people on the highest dose of orforglipron who stayed on treatment lost an average of 12.4% of their body weight (about 27 pounds) over 72 weeks, compared with 0.9% on placebo; lower doses produced 7.8% and 9.3%. Cross-trial comparisons are imperfect — the studies enrolled different people and measured results slightly differently — but on current evidence the Wegovy pill has the edge on average weight loss, while both clear the bar for meaningful, health-relevant weight loss.
Side effects
Because they act on the same receptor, the two share the familiar GLP-1 side-effect profile: nausea, diarrhea, vomiting and constipation, most common while the dose is being increased and often easing afterward. Both carry the class’s warnings and are not suitable for everyone; people with a personal or family history of certain thyroid cancers, a history of pancreatitis, or who are pregnant or planning pregnancy should talk to their prescriber before starting any GLP-1 drug. Pharmacists can walk through the label warnings for each.
What they cost
At the time of writing, both companies sell the pills directly to self-paying patients. The lowest dose of each lists at $149 a month. For the Wegovy pill, the higher 9 mg and 25 mg doses list at $299. Foundayo’s two highest doses list at $349, or $299 for eligible patients who refill on time through Lilly’s savings offer. With commercial insurance that covers them, both manufacturers advertise co-pays as low as about $25 a month. Prices and programs have been changing frequently, including through the government’s TrumpRx site, so check current pricing before deciding.
Which one might suit whom?
There is no single right answer, and the choice belongs with a prescriber. In broad strokes: someone who wants the most weight loss from a pill and can reliably follow a fasting routine may lean toward the Wegovy pill. Someone whose mornings are unpredictable, who takes other medicines at breakfast, or who has struggled with complicated dosing may find Foundayo easier to stick with — and a drug that is taken consistently tends to work better than one that is not. The Wegovy pill also carries an approval to reduce the risk of heart attack and stroke in people with established heart disease, which may matter for some patients.
Pill or injection?
Many people ask whether a pill works as well as a shot. For semaglutide, the 25 mg pill produced weight loss similar to the 2.4 mg weekly injection in separate trials, though the two have not been directly compared. The trade-off is convenience: a daily pill with no needles and no refrigeration, versus a once-weekly injection with no daily routine. Weekly injections such as tirzepatide (Zepbound) still tend to produce larger average weight loss than either pill.
The bottom line
The arrival of two effective GLP-1 pills in under a year gives people a real choice of format, and competition is already pushing prices down. Wegovy’s pill leads on average weight loss; Foundayo leads on convenience; and the long-term data that will settle how they compare over years are still to come. This explainer is general information, not medical advice. Talk to a doctor or pharmacist about which option, if any, is right for you.