Medical specialists treating obesity across the nation report that patients beginning weight-loss treatment are increasingly drawn to pill-form medications due to their affordability and ease of use, according to interviews with seven physicians in the field.
Novo Nordisk’s oral Wegovy became available in January, and Eli Lilly’s newly-approved Foundayo enters the market this week, creating competition in what experts predict will become a $100 billion annual obesity treatment industry within the next ten years.
The Danish pharmaceutical company Novo Nordisk first introduced injectable Wegovy in 2021. Both the pill and injection forms contain semaglutide, the same active component found in diabetes medication Ozempic.
Since receiving approval three months ago, the tablet version has attracted patients seeking lower costs and simpler administration, physicians report.
Dr. Christina Nguyen, who practices obesity and family medicine in Atlanta, explained that tablets offer several advantages: they don’t require refrigerated storage, provide discretion, and eliminate needle use.
“One person said I’d rather stay fat than ever use a needle. That’s a true fear,” she said.
Lilly’s Foundayo tablets, containing the active compound orforglipron, will start shipping Monday.
All seven medical professionals interviewed have begun prescribing oral Wegovy, with three reporting that approximately 10% of their patients now receive the pill form.
Most patients choosing pills are beginning GLP-1 treatment for the first time rather than switching from injections, and haven’t yet reached maximum dosages, doctors noted.
Dr. Stefie Deeds, who specializes in internal and obesity medicine in Seattle, said the oral option is “expanding access to people who are not sure that an injectable is something they would feel comfortable doing on themselves, might be leery of needles, and they’re excited to have an option that is easier and more familiar to take.”
Physicians typically avoid switching patients from injections to pills if the injectable treatment is working effectively.
Dr. Louis Aronne, who directs the Comprehensive Weight Control Center at Weill Cornell Medical College, explained: “The patients we see who are taking medicines, whether it’s Wegovy or (Lilly’s) Zepbound, we’re not telling them to switch to oral Wegovy if they’re doing well.” Aronne has provided consulting services to Lilly, participated in orforglipron clinical trials, and serves on advisory boards for both companies.
Zepbound, which contains tirzepatide, has demonstrated weight reduction of 20% or more in clinical studies, making it the preferred choice for severe obesity cases, particularly complex situations.
“For somebody who is in the lower end of the weight spectrum, people who are more likely to be seen by primary care physicians, they would be more likely to use the orals,” Aronne noted.
Clinical trials showed Foundayo achieved 12% body weight reduction while oral Wegovy resulted in approximately 14% weight loss.
Multiple physicians expressed enthusiasm for Lilly’s orforglipron approval, anticipating greater flexibility in patient treatment options.
Oral Wegovy requires specific timing: patients must take it on an empty stomach with minimal water, waiting 30 minutes before consuming food, beverages, or other medications. Foundayo can be taken at any time without dietary or fluid restrictions.
Nguyen indicated that if Lilly’s pill matches oral Wegovy’s pricing, “most likely everyone will go with the orforglipron.”
Novo spokesperson Liz Skrbova stated that company surveys suggest most patients wouldn’t find the timing requirements disruptive.
Clinical research has also identified additional health benefits from semaglutide, including reduced cardiovascular risks.
Dr. Michael Weintraub, an endocrinologist at NYU Langone Health, expressed caution about the new Lilly medication: “I can’t guarantee that this totally different type of molecule is going to carry the same benefits.”
A Lilly representative said the company continues studying Foundayo and noted that many clinical trial participants showed improved cardiovascular risk markers.
Cost remains the primary consideration for patients selecting GLP-1 medications, according to all physicians interviewed.
Pills offer financial advantages, with both oral Wegovy and Foundayo starting at $149 monthly for initial doses, compared to $299 for Zepbound and $349 for Ozempic and injectable Wegovy.
Insurance coverage restrictions for GLP-1 medications require doctors to spend considerable time helping patients navigate affordability options. When insurance covers treatment, patient costs may drop to $25-50 monthly.
Dr. Catherine Varney, an obesity medicine physician and associate professor at the University of Virginia School of Medicine who participates in Lilly’s speakers bureau and advisory board, said: “I feel more like a financial planner these days than a physician.”
Despite lower-cost pill options, Varney and colleagues worry that weight-loss medications remain financially out of reach for many Americans.
“This still is a market for upper-middle-class and above,” Varney concluded.
