GLP-1 pill offers new weight-loss option
Patients wishing for an alternative to weight loss drug injections now have another option.
The U.S. Food and Drug Administration (FDA) recently approved a daily pill form of Wegovy, making it the first oral GLP-1 available on the market for weight loss. Manufacturer Novo Nordisk called the new once daily Wegovy pill a game-changing alternative to the weekly injections of GLP-1 medication. Oral pill Wegovy not only removes the need for patients to stick themselves with a needle each week, it doesn’t need to be refrigerated and is less expensive to produce. That means it will likely be cheaper for patients to obtain.
The big question is whether insurance carriers will opt to approve coverage for the pill more often than they do for the more expensive injectable version.
Wevogy in pill form is the same as the injectable GLP-1 version, which has been approved for diabetes patients and for weight loss to combat obesity. GLP-1s work by slowing down how food moves through the stomach (delaying stomach emptying) and curbing the appetite. They are designed to mimic the body’s natural GLP-1 hormone to manage blood sugar, stimulate insulin release, suppress glucagon and send satiety signals to the brain. Combined with proper nutrition and exercise, they have shown to be very effective in helping people lose weight and control blood sugar levels.
FDA approval for weight loss use means doctors can prescribe GLP-1s for adults with a body mass index (BMI) of 30 or greater (obesity) or with a BMI of 27 or greater (overweight) with at least one weight-related comorbidity such as high cholesterol or high blood pressure.
So how will the FDA approval of Wegovy in pill form change the landscape for patients wanting to use GLP-1s for weight loss?
“It is too early to tell right now,” says Dr. George Eid, chair of the AHN Bariatric & Metabolic Institute. “Historically, patients have expressed interest in oral pill format rather than injections. It tends to be more convenient. As far as affordability, it looks like it is going to be a little bit cheaper than the injectables.”
And Wegovy may not be the only GLP-1 drug available in pill form for long. Drug manufacturer Lilly also has another weight-loss drug in pill form up for approval by the FDA this year. If approved, it could be on the market by the end of 2026.
Eid said the GLP-1 drugs has lessened the demand for surgical weight loss procedures such as gastric bypass.
“GLP-1 drugs have affected the number of bariatric surgeries being performed. For obvious reasons, patients tend to prefer medication over surgery,” says Eid. “However, there is growing evidence showing the benefit of bariatric surgery over medications in many areas, for example, in patients with severe level of obesity such as BMI above 50, patients with obesity and diabetes or metabolic syndrome. We have to keep in mind that obesity is a heterogeneous disease and not all patients respond to the same type of treatment.”
Eid was one of the authors of a recent study reported in the Journal of the American Medical Association (JAMA) showing that bariatric surgery offers greater weight loss and lower costs over time compared to GLP-1s. The research shows 40% of U.S. adults are now considered obese, leading to a dramatic surge in the use of the popular but pricey weight-loss drugs. The study concluded that, for obese patients, bariatric surgery achieves greater weight loss at lower ongoing cost when compared to GLP-1’s. The study covered 30,458 patients treated between 2018 and 2023 and found that over two years, bariatric surgery resulted in around 18% lower costs compared to medications, mostly because of sustained high pharmacy costs. In patients with a BMI of 40 or higher, bariatric surgery led to nearly three times as much weight loss compared to medications.
The social stigma attached to people wanting to use these drugs to aid weight loss has been significant, and Eid says that warrants more public education about obesity.
“Bias has always been present and based on perception rather than science,” he says. “There is plenty of evidence showing that obesity is not about poor willpower. Obesity is a physiologic disease that requires treatment similar to other diseases we treat.”
As for whether people see the GLP-1 drugs as an easy fix for weight loss or management, Eid put it into perspective.
“The best way to put it is using the following analogy: Patients who are living with obesity feel like they they are swimming against the current. No matter how strong a person is, at some point they will get tired and pushed back.
“The treatment options we have, being medication or surgery or a combination of both, are meant to stop the current so when patients put the efforts in, those efforts produce good results which can last for years to come,” he said. “Patients still have to swim to shore, but at least this time – with the help of medications or surgery – they have a chance for success.”