Best GLP-1 for weight loss: every medication compared (2026)
The best GLP-1 for weight loss depends on your goal. On average, tirzepatide (Zepbound) produced the most: 20.2% of body weight versus 13.7% for semaglutide (Wegovy) at 72 weeks in SURMOUNT-5. Wegovy has proven heart-risk reduction, Zepbound treats sleep apnea, and Foundayo or the Wegovy pill avoid needles.
How we compared
Weight-loss figures come from each drug's FDA label, using the highest approved dose and the trial named in that label, always shown next to the placebo result. Discontinuation is the share who stopped because of adverse reactions, also from the label. The diabetes-only drugs have no weight-loss trial on their label, so we show the weight change from their diabetes trials and say so. Prices are the makers' own self-pay pages or Temi's product pages, all read on 5 October 2026. Different trials enrolled different people over different lengths of time, so only SURMOUNT-5 is a true head-to-head.
Prices checked on October 5, 2026
Side by side
| Medication | Molecule | Form | How often | Approved for | Weight loss on the label | Stopped for side effects | Starting price |
|---|---|---|---|---|---|---|---|
| Zepbound | tirzepatide | Pen, vial or KwikPen | Weekly | Weight management; obstructive sleep apnea with obesity | 20.9% vs 3.1% placebo on 15 mg, 72 weeks (SURMOUNT-1) | 4.8–6.7% by dose vs 3.4% placebo | $299/mo at 2.5 mg; $449 at 7.5–15 mg (zepbound.lilly.com/savings, checked 5 Oct 2026) |
| Wegovy HD | semaglutide 7.2 mg | Single-dose pen | Weekly | Weight management in adults | 18.8% vs 3.9% placebo, 72 weeks (STEP UP) | 5.4% vs 1% placebo | $399/mo; $199 for a new patient's first two fills through 31 Dec 2026 (NovoCare Pharmacy, checked 5 Oct 2026) |
| Wegovy injection | semaglutide 2.4 mg | Single-dose pen or syringe | Weekly | Weight management (12+); heart-attack and stroke risk with heart disease; MASH F2–F3 | 14.9% vs 2.4% placebo, 68 weeks (STEP 1) | 6.8% vs 3.2% placebo | $349/mo all doses to 2.4 mg; $199 intro for two fills (NovoCare Pharmacy, checked 5 Oct 2026) |
| Wegovy pill | oral semaglutide 25 mg | Tablet, empty stomach | Daily | Weight management in adults; heart-attack and stroke risk with heart disease | 13.6% vs 2.4% placebo, 64 weeks (OASIS 4) | 6.9% vs 5.9% placebo | $149/mo at 1.5 mg; $299 at 25 mg (NovoCare Pharmacy, checked 5 Oct 2026) |
| Foundayo | orforglipron | Tablet, with or without food | Daily | Weight management in adults | 11.1% vs 2.1% placebo on 17.2 mg, 72 weeks (ATTAIN-1) | 8% vs 3% placebo | From $149 per 30 days of 0.8 mg via LillyDirect (usetemi.com/medications/foundayo, checked 5 Oct 2026) |
| Saxenda | liraglutide 3 mg | Multi-dose pen | Daily | Weight management (12+ over 60 kg); being discontinued | 7.4% vs 3.0% placebo, 56 weeks (label Study 1) | 9.8% vs 4.3% placebo | No self-pay price listed; last shipments late Jan 2027 (NovoCare Saxenda page, checked 5 Oct 2026) |
| Mounjaro | tirzepatide | Pen, vial or KwikPen | Weekly | Type 2 diabetes (10+); heart risk in high-risk type 2 diabetes | Diabetes trial: −11.2 kg on 15 mg vs −5.7 kg on semaglutide 1 mg, 40 weeks (SURPASS-2) | GI-related: 3.0–6.6% vs 0.4% placebo | As low as $499/mo with savings card if insured without coverage (mounjaro.lilly.com, checked 5 Oct 2026) |
| Ozempic | semaglutide | Multi-dose pen | Weekly | Type 2 diabetes; heart risk with heart disease; kidney risk with CKD | Diabetes trial: −5.6 kg on 1 mg, −6.4 kg on 2 mg, 40 weeks (label) | GI-related: 3.1–3.8% vs 0.4% placebo | $349/mo to 1 mg, $499 at 2 mg; $199 intro for two fills (NovoCare Ozempic price guide, checked 5 Oct 2026) |
| Ozempic tablets / Rybelsus | oral semaglutide | Tablet, empty stomach | Daily | Type 2 diabetes; heart risk in high-risk type 2 diabetes | Diabetes trial: −3.7 kg on Rybelsus 14 mg vs −1.4 kg placebo, 26 weeks (label) | GI-related: 4–8% vs 1% placebo | Ozempic pill $149/mo at 1.5 mg (NovoCare Ozempic price guide, checked 5 Oct 2026) |
| Trulicity | dulaglutide | Single-dose pen | Weekly | Type 2 diabetes (10+); heart risk in type 2 diabetes | No weight-loss trial on label; efficacy is reported as HbA1c | GI-related: 1.3–3.5% vs 0.2% placebo | No self-pay price published; $25 card for some insured (trulicity.lilly.com, checked 5 Oct 2026) |
| Compounded semaglutide injection | semaglutide (compounded) | Multi-dose vial, insulin syringes | Weekly | Not FDA-approved; no approved indication | No FDA label; not tested in approval trials | No label data | From $59.99 per 7.5 mg vial in CA, plus $39 service (usetemi.com/medications/compounded-semaglutide-injectable, checked 5 Oct 2026) |
| Compounded tirzepatide injection | tirzepatide (compounded) | Multi-dose vial, insulin syringes | Weekly | Not FDA-approved; no approved indication | No FDA label; not tested in approval trials | No label data | From $104.99 per 8.5 mg vial in CA, plus $39 service (usetemi.com/medications/compounded-tirzepatide-injectable, checked 5 Oct 2026) |
| Compounded semaglutide pill / ODT | semaglutide (compounded) | Tablet or orally dissolving tablet | Daily | Not FDA-approved; no approved indication | No FDA label; not tested in approval trials | No label data | From $85 per 30-count, 60 mg pack in CA (usetemi.com/medications/compounded-semaglutide-pill, checked 5 Oct 2026) |
By goal
| Goal | Consider | Why |
|---|---|---|
| Most weight loss on average | Zepbound (tirzepatide) | It beat Wegovy 2.4 mg head to head, 20.2% vs 13.7% at 72 weeks (SURMOUNT-5). Wegovy HD 7.2 mg averaged 18.8% in STEP UP, but it has not been tested directly against tirzepatide. |
| No needles | Wegovy pill or Foundayo | Wegovy pill averaged 13.6% (OASIS 4) but must be taken on an empty stomach, then 30 minutes before food. Foundayo averaged 11.1% (ATTAIN-1) and can be taken any time, with or without food. |
| Lower heart-attack and stroke risk | Wegovy injection or Wegovy pill | In SELECT, Wegovy cut heart attack, stroke or cardiovascular death to 6.5% vs 8.0% on placebo (hazard ratio 0.80). Both forms carry this indication for adults with heart disease and obesity or overweight. |
| Lowest monthly cost | Wegovy pill 1.5 mg or Foundayo 0.8 mg | Both start at $149 a month (NovoCare and usetemi.com/medications/foundayo, checked 5 Oct 2026), but only at starting doses. Compounded vials cost less and are not FDA-approved. |
| Obstructive sleep apnea | Zepbound | Among GLP-1s, only Zepbound carries a sleep apnea indication (moderate to severe OSA, adults with obesity), at a maintenance dose of 10 mg or 15 mg weekly (Zepbound label). |
| Type 2 diabetes | Ozempic, Mounjaro, Ozempic tablets, Trulicity | All are approved for blood sugar control. Ozempic also lowers kidney risk in chronic kidney disease (FLOW, hazard ratio 0.76). Mounjaro lowered HbA1c more than semaglutide 1 mg at 40 weeks (SURPASS-2). |
| Teenagers aged 12 and older | Wegovy injection or Saxenda | These are the only GLP-1s with a weight-management indication for adolescents aged 12 and older, per their labels. Saxenda is being discontinued, with last shipments in late January 2027. |
| Fatty liver disease (MASH) | Wegovy injection | It has accelerated approval for noncirrhotic MASH with moderate to advanced fibrosis (F2–F3) in adults, based on liver biopsy improvement at 72 weeks (Wegovy label). |
Evidence summary
SURMOUNT-5 is the only direct trial between the two leading molecules. It randomized 751 adults with obesity but without diabetes, at 32 sites in the US and Puerto Rico, to the maximum tolerated weekly dose of tirzepatide (10 mg or 15 mg) or semaglutide (1.7 mg or 2.4 mg). At 72 weeks:
- Body weight fell by an average 20.2% on tirzepatide vs 13.7% on semaglutide, or 22.8 kg vs 15.0 kg.
- Waist circumference fell by 18.4 cm vs 13.0 cm.
- Stopping because of gastrointestinal side effects: 2.7% on tirzepatide vs 5.6% on semaglutide.
(Aronne et al., NEJM 2025; summarized by the American College of Cardiology.)
Everything else is cross-trial. Placebo-controlled label trials put Zepbound 15 mg at 20.9% (SURMOUNT-1), Wegovy HD at 18.8% (STEP UP), Wegovy 2.4 mg at 14.9% (STEP 1), the Wegovy pill at 13.6% (OASIS 4), Foundayo 17.2 mg at 11.1% (ATTAIN-1) and Saxenda at 7.4%. The trials ran for 56 to 72 weeks in different populations, so a gap of a point or two between them is not a reliable ranking. These are averages; some people lose far less.
Side effects compared
Gastrointestinal effects dominate for every option, mostly while the dose is rising. Label nausea rates: Wegovy 2.4 mg 44% (placebo 16%), Zepbound 25% to 29% (placebo 8%), Foundayo 26% to 35% (placebo 10%).
Stopping because of side effects was lowest on Zepbound 5 mg (4.8%) and highest on Saxenda (9.8%), with Wegovy injection at 6.8%, the Wegovy pill at 6.9% and Foundayo at 8%. In SURMOUNT-5 fewer people quit tirzepatide than semaglutide for gastrointestinal reasons (2.7% vs 5.6%).
The warnings are shared: thyroid C-cell tumor boxed warning, pancreatitis, gallbladder disease, dehydration-related kidney injury and aspiration under anesthesia. Compounded products have no label data at all. Ask your prescriber: "Which side effects should make me call you before my next dose?"
Cost compared
Self-pay prices, checked 5 October 2026, put the starting doses of the two pills cheapest among brands and higher-dose injections near $349 to $449.
- Wegovy pill and Foundayo start at $149 a month, but rise with dose: the Wegovy pill reaches $299 at 25 mg (NovoCare Pharmacy).
- Wegovy injection is $349 for every dose up to 2.4 mg; Wegovy HD is $399 (NovoCare Pharmacy).
- Zepbound is $299 to $449 by dose, if refilled within 45 days (zepbound.lilly.com/savings).
- The diabetes brands have no comparable cash price except Ozempic at $349 to $499 (NovoCare Ozempic price guide).
- Compounded semaglutide starts at $59.99 per vial in California (usetemi.com/medications/compounded-semaglutide-injectable), but it is not FDA-approved.
See the GLP-1 cost calculator to price a full year at your dose.
All comparisons
- Tirzepatide vs semaglutide
- Zepbound vs Wegovy
- Mounjaro vs Ozempic
- Zepbound vs Mounjaro
- Wegovy vs Ozempic
- Compounded tirzepatide vs compounded semaglutide
- Compounded semaglutide vs Wegovy
- Compounded tirzepatide vs Zepbound
- Compounded semaglutide vs Ozempic
- Oral semaglutide vs injectable semaglutide
- Rybelsus vs Ozempic
- Compounded semaglutide vs brand-name semaglutide
- Compounded tirzepatide vs brand-name tirzepatide
- Foundayo vs Zepbound
- Foundayo vs Mounjaro
- Wegovy vs Mounjaro
- Zepbound vs Ozempic
- Semaglutide vs tirzepatide for diabetes
- Oral semaglutide vs oral Wegovy
- Compounded semaglutide vs Rybelsus
- Metformin vs Ozempic
- Phentermine vs semaglutide
- Ozempic vs Trulicity
- Semaglutide vs liraglutide
- Saxenda vs Wegovy
- Wegovy HD vs Zepbound
- Oral Wegovy vs Foundayo
Frequently asked questions
Which GLP-1 is most effective for weight loss?
On trial averages, tirzepatide. Zepbound 15 mg produced 20.9% average weight loss at 72 weeks in SURMOUNT-1, and in the SURMOUNT-5 head-to-head tirzepatide averaged 20.2% against 13.7% for semaglutide. Among semaglutide products, Wegovy HD 7.2 mg averaged 18.8% in STEP UP. These are averages; ask your prescriber which dose suits your health history and tolerance.
Is Zepbound better than Wegovy?
For average weight loss, yes: 20.2% vs 13.7% at 72 weeks in SURMOUNT-5 (NEJM 2025), with fewer people stopping for stomach side effects. Wegovy has things Zepbound lacks on its label: proven reduction of heart attack and stroke (SELECT), approval for adolescents 12 and older, a MASH indication and a daily pill version. Which matters more depends on your situation. See Zepbound vs Wegovy.
What is the cheapest GLP-1 without insurance?
Among FDA-approved brands, the starting doses of the Wegovy pill (1.5 mg) and Foundayo (0.8 mg) both cost $149 a month (NovoCare Pharmacy; usetemi.com/medications/foundayo, checked 5 Oct 2026). Prices climb at higher doses. Compounded semaglutide vials start lower, from $59.99 in California (usetemi.com/medications/compounded-semaglutide-injectable, checked 5 Oct 2026), but compounded drugs are not FDA-approved.
Is the GLP-1 pill as effective as the shot?
Not on average in the trials so far. The Wegovy pill 25 mg averaged 13.6% weight loss at 64 weeks (OASIS 4) and Foundayo 17.2 mg averaged 11.1% at 72 weeks (ATTAIN-1), while the weekly shots reached 14.9% (Wegovy 2.4 mg) and 20.9% (Zepbound 15 mg). The trials differ in length and population, and none compared a pill with a shot directly.
Does Ozempic or Mounjaro cause more weight loss?
Mounjaro, in people with type 2 diabetes. In SURPASS-2, Mounjaro 15 mg lowered body weight by an average 11.2 kg vs 5.7 kg on semaglutide 1 mg (the Ozempic molecule) over 40 weeks (Mounjaro label). Neither is approved for weight loss; their weight-loss counterparts are Zepbound and Wegovy. See Mounjaro vs Ozempic.
Which GLP-1 has the fewest side effects?
None is clearly free of them; nausea, diarrhea, vomiting and constipation are common across the class. By the share who stopped because of adverse reactions, Zepbound 5 mg (4.8%) was lowest and Saxenda (9.8%) highest in their label trials. In SURMOUNT-5, gastrointestinal dropouts were 2.7% on tirzepatide vs 5.6% on semaglutide. Slow dose increases are the main way the labels manage tolerance.
Can I switch from one GLP-1 to another?
Yes, people switch for cost, supply or side effects, but the starting dose on the new drug is a prescriber decision, not a direct milligram swap. Rybelsus and Ozempic tablets, for example, are not substitutable mg for mg (label). Ask your prescriber: "Which dose of the new medicine matches where I am now, and when should I take it?"
Sources
- Aronne LJ et al. Tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5). N Engl J Med 2025;393:26-36 (checked October 5, 2026)
- SURMOUNT-5 journal scan, American College of Cardiology (checked October 5, 2026)
- Zepbound (tirzepatide) prescribing information, Eli Lilly, revised 08/2026 (checked October 5, 2026)
- Wegovy (semaglutide) injection and tablets prescribing information, Novo Nordisk, revised 06/2026 (checked October 5, 2026)
- Foundayo (orforglipron) prescribing information, Eli Lilly, revised 07/2026 (checked October 5, 2026)
- Saxenda (liraglutide) prescribing information, Novo Nordisk, revised 02/2026 (checked October 5, 2026)
- Mounjaro (tirzepatide) prescribing information, Eli Lilly, revised 08/2026 (checked October 5, 2026)
- Ozempic (semaglutide) injection prescribing information, Novo Nordisk, revised 05/2026 (checked October 5, 2026)
- Rybelsus and Ozempic (semaglutide) tablets prescribing information, Novo Nordisk, revised 01/2026 (checked October 5, 2026)
- Trulicity (dulaglutide) prescribing information, Eli Lilly, revised 03/2026 (checked October 5, 2026)
- Wegovy self-pay prices, NovoCare Pharmacy (checked October 5, 2026)
- Ozempic pill and pen price guide, NovoCare (May 2026) (checked October 5, 2026)
- Zepbound savings and self-pay pricing, Eli Lilly (checked October 5, 2026)
- Mounjaro savings and resources, Eli Lilly (checked October 5, 2026)
- Trulicity savings and resources, Eli Lilly (checked October 5, 2026)
- Saxenda patient page and discontinuation notice, NovoCare (checked October 5, 2026)
- Foundayo (orforglipron), Temi (checked October 5, 2026)
- Compounded semaglutide injection, Temi (checked October 5, 2026)
- Compounded tirzepatide injection, Temi (checked October 5, 2026)
- Compounded semaglutide pill, Temi (checked October 5, 2026)
Compounded semaglutide and compounded tirzepatide are not FDA-approved generics of the brand-name products. A licensed 503A compounding pharmacy prepares each one for a single prescription.
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