An Easier Solution for Obesity? High-Dose Oral Pills Offer an Alternative to Wegovy Shots

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Treating obesity may soon become as simple as taking a pill, potentially revolutionizing weight management and garnering support from proponents of broader weight acceptance. Recent studies have revealed promising results for high-dose oral versions of the weight-loss medication found in Wegovy, indicating that these potent tablets could be just as effective as the popular injections in shedding pounds and improving overall health. Furthermore, the oral pills seem to work well for individuals with diabetes, a group known to face difficulties in losing weight.

Novo Nordisk, the drug manufacturer, plans to seek approval from the U.S. Food and Drug Administration later this year for these pills. Dr. Daniel Bessesen, an endocrinology specialist at Denver Health, who treats patients with obesity but was not involved in the research, highlights the preference for pills among individuals when given the choice between a pill and an injection. He emphasizes that the key factors for people are effectiveness, availability, and affordability of the treatment.

While there have been weight-loss pills available on the market, none have achieved the substantial results witnessed with injected drugs like Wegovy. Therefore, the prospect of an oral option that is equally effective has been met with excitement among those with obesity. Dr. Katherine Saunders, a clinical professor of medicine at Weill Cornell Health and co-founder of Intellihealth, a weight-loss center, believes individuals with obesity will be thrilled to have an alternative treatment.

Novo Nordisk already markets Rybelsus, an oral version of semaglutide—the same medication used in the diabetes drugs Ozempic and Wegovy. However, the recently released results of two rigorous trials presented at the American Diabetes Association’s annual meeting focused on higher doses of oral semaglutide (25 milligrams and 50 milligrams) and their impact on weight reduction, blood sugar levels, and other health markers.

In a 16-month study involving approximately 1,600 overweight or obese individuals with Type 2 diabetes already receiving treatment, the high-dose daily pills significantly outperformed the standard dose of Rybelsus in lowering blood sugar levels. Additionally, the higher doses led to weight loss ranging from 15 to 20 pounds, compared to about 10 pounds with the lower dose, starting from an initial weight of 212 pounds.

Another 16-month study with over 660 adults who had obesity or were overweight and had at least one related disease (excluding diabetes) found that the 50-milligram daily pill helped participants lose an average of approximately 15% of their body weight, equivalent to around 35 pounds. In comparison, those who took a placebo lost only about 6 pounds.

The weight loss achieved with the high-dose oral pills was notably consistent with the results observed with the highest dose of injected Wegovy, according to the study authors. However, there were some side effects associated with the oral semaglutide treatment, such as mild to moderate intestinal issues like nausea, constipation, and diarrhea, experienced by about 80% of participants. The obesity trial using the 50-milligram dose also revealed a higher incidence of benign tumors among those taking the drug compared to the placebo group. Additionally, approximately 13% of participants experienced altered skin sensations like tingling or heightened sensitivity.

Medical experts anticipate that the pills will be well-received, particularly among individuals who are eager to lose weight but are wary of injections. Moreover, the convenience and portability of tablets, which do not require refrigeration, offer advantages over injection pens. However, the pills may not necessarily be a superior option for the hundreds of thousands of people who are already receiving injectable treatments like Ozempic or Wegovy. Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital, highlights that many patients appreciate the simplicity of a weekly injection and may not have significant reservations about receiving it.

Paul Morer, a 56-year-old employee of a New Jersey hospital system, lost 85 pounds using Wegovy and intends to continue with the weekly injections, even if pills become available. For him, injecting the medication has become routine, and he hardly notices the needle, making it a non-issue.

Critics express concerns that the availability of a weight-loss pill may exert pressure on individuals with obesity to use it, further fueling social stigma against those who cannot or choose not to lose weight. Tigress Osborn, chair of the National Association to Advance Fat Acceptance, argues that the pill reinforces the narrative that one’s body is wrong and should change.

Nevertheless, Novo Nordisk is betting on the popularity of a higher-dose pill to address both diabetes and obesity. Sales of Rybelsus exceeded $1.63 billion last year, more than doubling the previous year’s figure.

Other companies are also developing oral versions of weight-loss drugs, including Eli Lilly and Co., which expects approval for Mounjaro—an injectable diabetes drug with potential weight-loss benefits. Promising mid-stage trial results have been reported for an oral pill named orforglipron, aimed at treating obesity and overweight individuals with and without diabetes. Additionally, Pfizer has released mid-stage results for dangulgipron, an oral diabetes drug to be taken twice daily with food.

Novo Nordisk officials have not yet disclosed the pricing details for the high-dose oral pills or their plans to ensure sufficient manufacturing capacity to meet demand. Furthermore, due to soaring popularity, the supply of injectable Wegovy doses will remain limited until at least September, as confirmed by company officials.

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• Study Shows High-Dose Oral Pills as Effective as Injections for Obesity Treatment
• Novo Nordisk Plans to Seek FDA Approval for High-Dose Oral Pills
• Comparison of Oral Pills and Injections in Weight Loss and Health Improvement
• Side Effects of High-Dose Oral Pills for Obesity Treatment
• Considerations for Choosing Between Oral Pills and Injectable Treatments