Whether they’re the topic of conversation at a birthday party, popping up on ads during your favorite reality show, or trending on your TikTok algorithm, everyone seems to be talking about weight loss drugs these days.
It makes sense. The ability to quickly and effectively shed pounds using medication is still a pretty new concept. And while buzzy weight loss drugs like Ozempic, Mounjaro, and Wegovy have relied on weekly injections, new oral medication pills made with the same active ingredient, semaglutide, could soon enter the market, once again revolutionizing access to these medications.
Last week, the American Diabetes Association presented two new studies funded by Novo Nordisk, the manufacturer for Ozempic and Wegovy, that showed significant weight loss for subjects taking daily semaglutide pills at 25 and 50 milligrams. Why should you care? These pills could continue to lower the barrier to entry for people interested in using the weight loss drugs. After all, swallowing a daily pill might seem like the easier, less scary choice compared to frequent needle injections.
“There’s something that feels very severe about injecting yourself weekly, and when it comes to weight management, which is such a sensitive issue, the idea of injecting yourself to achieve weight loss carries stigma,” says Rekha Kumar, a board-certified endocrinologist and obesity medicine specialist and head of medical affairs at Found Health. “The idea of a pill definitely lowers the entry barrier and I think these are game changers because of their safety, tolerability, and efficacy.”
Meet the experts: Michael Glickman, MD, is a board-certified family medicine and obesity medicine physician and founder of Revolution Medicine, Health and Fitness. Rekha Kumar, MD, is a board-certified endocrinologist and obesity medicine specialist and head of medical affairs at Found Health. Rocio Salas-Whalen, MD, is a board-certified endocrinologist and obesity specialist.
Curious whether an oral pill is as effective as injectable Ozempic, or when semaglutide pills might be available? Women’s Health has consulted experts, and they broke down everything you need to know about the new oral weight loss medication, including how it works in the body and potential side effects.
What is semaglutide and how does it work?
Semaglutide, the compound found in drugs like Ozempic and Wegovy, is a class of medications called GLP-1 (glucagon-like peptide 1) receptor agonists. GLP-1s work by increasing how much insulin you release after a meal, which plays an important signaling role during digestion, says Dr. Kumar.
When you eat, food goes through your stomach and intestines, and the GLP-1’s job is to send a signal when you’re full. From there, your pancreas is alerted to make insulin, which regulates your blood sugar and reduces your appetite, she explains.
In other words, think about semaglutide as a way to “reset the fullness signals,” adds Dr. Kumar. These medicines help you to naturally feel full by making the “fullness” signal in your brain more sensitive, she explains.
Many people also report that semaglutide actually quiets the urge to think about eating, giving them more control over their food choices, adds Michael Glickman, MD, a board-certified family medicine and obesity medicine physician and founder of Revolution Medicine, Health and Fitness. As a result, the medication can aid in weight loss, but should be paired with regular exercise and a healthy, balanced diet.
“These pills treat the actual underlying cause [of weight gain], and it’s something that people have been judged for their whole life or feel bad about because they think it’s their fault,” Dr. Kumar explains. “Now we’re saying that there is a seemingly straightforward biologic answer that can practically fix this in conjunction with a healthy lifestyle.”
What did the new studies on oral semaglutide pills find?
This is not the first time an oral semaglutide pill has hit the market. A pill at a max dose of 14 milligrams has technically been FDA-approved for type 2 diabetes since 2019, sold under the brand name Rybelsus, explains Dr. Glickman. And, similar to Ozempic, many obesity medicine specialists have already been using oral Rybelsus off-label to treat obesity in prediabetic and diabetic patients, Dr. Glickman adds.
Original studies on oral semaglutide pills (aka Rybelsus) only showed an average weight loss of 8.4 pounds in diabetic patients, explains Dr. Glickman.
But these new studies found that taking an oral pill containing 25 or 50 milligrams of semaglutide can have similar weight loss effects as a weekly Ozempic or Wegovy injection, says Rocio Salas-Whalen, MD, a board-certified endocrinologist and obesity specialist.
For context, after a few months on the max dose of Ozempic or Wegovy, patients typically lose about 15 percent of their body weight. Comparatively, one of the new studies looking at daily use of 50 milligram oral semaglutide pills showed people lost an impressive 15.1 percent of their body weight after 68 weeks.
“For the first time in modern history, we have effective treatment options to reverse obesity, and with that, improve all of the metabolic conditions associated with obesity, significantly improving life expectancy,” he says. “Patients that were hesitant about an injectable medication in the past could find that it’s very manageable to take a daily tablet.”
Are oral semaglutide pills available yet?
Nope, these higher-dose “Ozempic” pills aren’t available right now. However, low-dose oral semaglutide, Rybelsus, is out on the market already for use those with type 2 diabetes.
The more powerful drugs were just studied in phase three trials, and will need to be submitted to the Food and Drug Administration for review and approval before they are available to the public, explains Dr. Kumar.
If a drug is chosen to be “fast tracked” after phase three trials are complete, it can still be at least another six to twelve months before it is officially approved and put on the market, adds Dr. Glickman.
“The time it takes for the medication to arrive on the market after FDA approval can be immediate, assuming Novo Nordisk has already completed advanced production of the medication, and established a reliable supply chain,” he explains.
Bottom line? It’s likely going to be another year (or more) before the pills are available to the public.
Is there a difference between the injection vs. the pill?
Not really, since these two medications work the same way, and produce very similar weight loss results, explains Dr. Salas-Whalen. The only practical difference is the method of administration—a weekly injection compared to a daily pill, she adds.
Whether a patient opts for pill or injection will revolve around personal preference. A pill and weekly injection involve different schedules, and it really comes down to your lifestyle, preferences, and accessibility.
The pill would need to be taken in the morning on an empty stomach at least 30 minutes before food, says Dr. Glickman. “If someone eats or drinks prior to the 30-minute window ending, it may not absorb as well and be less effective, so I think the weekly injectable options are going to remain very popular,” he explains.
A semaglutide injection also has to be refrigerated, adds Dr. Salas-Whalen. “Many times patients are constantly on the move or traveling and it becomes a little bit difficult to carry a pen that needs to be refrigerated, so they are good candidates for the oral version,” she explains.
The injectables are also prescribed at higher doses because they’re only taken once a week and absorbed differently in the body since they don’t have to pass through the digestive tract, says Dr. Kumar.
And obviously, if you have an aversion to needles, the oral pill is a much simpler option, (even though the injection itself is typically painless), adds Dr. Salas-Whalen.
What are the risks with a semaglutide pill?
In one of the studies, 80 percent of people taking the semaglutide pill experienced gastrointestinal issues such as constipation, bloating, diarrhea, and an upset stomach. Almost 13 percent also experienced skin tingling sensations. Nausea, vomiting, and dehydration are also common, adds Dr. Salas-Whalen.
But these side effects are actually pretty comparable to the ones that you get with the injection. “In order to achieve the same results of a 2.4 milligram injection, we’re saying you need to swallow 50 milligrams a day to reach the same efficacy,” says Dr. Kumar. “If you’re trying to reach a dose in the pill that is as effective as the injection, then you’re just going to keep increasing the dose of the pill.”
That said, most mild to moderate side effects typically fade over time as your body adjusts to the meds, adds Dr. Glickman.
And while some celebs have talked about wanting to go on Ozempic postpartum, Dr. Kumar says semaglutide should not be taken if you’re pregnant or breastfeeding because it’s unclear if the medication could affect a fetus. You could also have an allergic reaction to the drug, so it’s important you work closely with a doctor, she adds.
Finally, semaglutide pills should be avoided if you have a history (or family history) of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, or thyroid cancer, says Dr. Kumar. If you have any problems with your kidneys, liver, or pancreas, you should also be aware that more serious side effects might develop, she adds.
Of course, you should always make sure you’re talking to a doctor who has experience prescribing these medications, stresses Dr. Salas-Whalen.
“Be wary of who’s giving you this medication, ask the physician how many patients they’ve treated,” she says. “Ideally, see an obesity board-certified physician or a board-certified endocrinologist because those two are the ones that are going to have the most expertise.”
Andi Breitowich is a Chicago-based writer and graduate student at Northwestern Medill. She’s a mass consumer of social media and cares about women’s rights, holistic wellness, and non-stigmatizing reproductive care. As a former collegiate pole vaulter, she has a love for all things fitness and is currently obsessed with Peloton Tread workouts and hot yoga.
