Battle of the diet pills: Everything you need to know about the new daily tablets – from side effects to cost. And crucially… which one will help you lose the most weight

An estimated 2.6 million people in the UK currently use fat grafting to tackle weight problems.

However, this may be eclipsed by the demand for new versions of the drugs in pill form.

The first of these, an oral variant of the Wegovy vaccine, was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) earlier this month and is available privately for around £100 a month. In the US, where the Wegovy pill was given the green light earlier this year, three million prescriptions were written in the first five months alone.

Meanwhile, another slimming pill version of fat injections, Foundayo (made by the company that produces Mountjaro), is expected to be available in the UK later this year.

Wegovy Pill

What’s inside?

It contains semaglutide, the same drug used in the Wegovy vaccine. Made by Novo Nordisk.

How do you get this?

Once a day on an empty stomach with some water and at least 30 minutes before a meal. You start with a dose of just 1.5 mg, but this can be gradually increased every 30 days up to a maximum of 25 mg, depending on how you respond and only as directed by the doctor.

How does it work?

Like the shot, GLP-1 contains semaglutide, a drug that mimics the action of our gut hormones; It tells receptors in the brain to reduce appetite and slow stomach emptying, making you feel full for longer.

However, there is also a special ‘carrier’ molecule called salcaprosate sodium (SNAC) which protects the medicine against the harsh acidic environment of the stomach so that it can be fully absorbed into the bloodstream (the jab version goes into the subcutaneous fat and passes directly into the bloodstream).

How much weight can you lose?

It may vary, but on average it is 16.6 percent of body weight. For example, if you weigh 16 7 lb (106 kg), you can expect to lose about 2 7 lb (17.7 kg) over 64 weeks with the highest dose of 25 mg per day, according to trial data published last September in the New England Journal of Medicine.

This is slightly less than the overall average reported for Wegovy vaccines (19 percent for the 7.2 mg vaccine administered once a week). But one-third of the obese volunteers in the pill trial managed to lose 20 percent or more.

Does it have any other health benefits?

As with the GLP-1 shots, patients taking the Wegovy pill experienced significant improvements in HbA1c (the three-month average of their blood sugar level), lower blood pressure, and a slimmer waist.

For example, blood pressure dropped by an average of 6.8 mm/Hg for systolic (the top number that measures the maximum pressure your blood exerts on the artery walls during a heartbeat) and 2.7 mm/Hg for diastolic (the pressure between beats).

Average waist circumference decreased by 12.2 cm (or almost 5 inches), and fasting plasma glucose (or the amount of sugar in your blood after not eating or drinking for eight hours) decreased by 6.6 mg/deciliter.

Meanwhile, total cholesterol scores fell by just over one percent on average, and levels of triglyceride blood fats, which are known to increase the risk of heart disease, also dropped to just under one percent.

Like the shot, the Wegovy pill contains semaglutide, a drug that mimics the action of our GLP-1 gut hormones.

Side effects

Trial data found that 74 percent of those taking the Wegovy pill had gastrointestinal side effects, compared with 42 percent in the placebo group. In most cases these were mild, comparable to injections including Wegovy. Seven percent discontinue Wegovy pills due to side effects such as nausea, sleep disturbances, vomiting, abdominal pain and indigestion. However, the dropout rate was almost the same in the placebo group (six percent).

When will it be available?

Specialty online pharmacies now provide the Wegovy pill. Availability on the NHS will depend on approval from NICE, so the earliest prescription could be 2027.

Cost

Asda’s online pharmacy, for example, charges £98.97 per month for 1.5mg doses and £118.97 for 4mg doses. Higher doses will be coming soon – these will cost £128.97 per month for 9mg and £188.97 for 25mg.

Pros

Greater weight loss with Foundayo (up to 20 percent in 64 weeks, compared with 12.4 percent in 72 weeks with Foundayo).

Cheaper than Wegovy injections.

It lowers blood pressure and glucose levels.

Cons

It should be taken at least 30 minutes before a meal. ‘Otherwise less would be absorbed as food dilutes the SNAC protective layer,’ says Professor Yeo.

It should be taken daily (the vaccine is given once a week).

It is likely to be more expensive than Foundayo due to its production; It is a modified peptide hormone that is more difficult to make; Foundayo is a white powder medicine obtained by chemical reaction, so it is cheaper.

Because it slows gastric emptying, it may also affect other medications that need to pass through the stomach quickly.

Patients who receive the GLP-1 vaccine experience improvements in HbA1c (the three-month average of their blood sugar level), lower blood pressure, and a slimmer waistline.

Foundayo, another slimming pill version of fat injections (made by the company that produces Mountjaro), is expected to be available in the UK later this year.

Foundayo Pill

What’s inside?

Contains orforgliprone. It is made by Mounjaro manufacturer Eli Lilly.

How do you get this?

Once a day and at any time of the day. The starting dose is 0.8 mg but this can be increased every 30 days to a maximum of 17.2 mg.

How does it work?

It mimics GLP-1 like the Wegovy pill or forglipron (the active drug in Foundayo), but unlike Wegovy it is a small-molecule drug that is chemically stable. This means stomach acid doesn’t destroy it, so it doesn’t need a protective coating.

How much weight can you lose?

According to trial data, it averaged 12.4 percent (27.3 lbs) of body weight at 18 months, less than the Wegovy pill. However, those who had previously lost weight with injections but then plateaued were able to maintain 75 to 80 percent of their weight loss for up to 52 weeks by taking Foundayo instead.

Does it have any other health benefits?

It reduced volunteers’ waist size by an average of 4.4 inches (11.1 cm) and lowered systolic blood pressure by an average of 6.7 mmHg (comparable to the Wegovy pill).

Levels of harmful blood fats

triglycerides fell 21.6 per cent and non-HDL cholesterol (which includes ‘bad’ LDL cholesterol) readings fell 8.5 per cent.

Side effects

Five to 10 percent of patients (depending on dose) discontinued the medication due to nausea, constipation, diarrhea, vomiting, indigestion, and stomach pain; but most said the effects were mild to moderate.

Others included headache, fatigue, belching, heartburn, wind, and hair loss (these are similar to Wegovy’s reports).

Professor Yeo says that because there are so few Foundayo users at present, it is not entirely clear whether one pill has more adverse effects than another.

‘I’m not worried for now and time will tell if there are actually more side effects.’

When will it be available?

It is expected to be available exclusively in the UK later this year and is currently being reviewed by the medicines watchdog MHRA.

The drug will need to be evaluated by the National Institute for Health and Care Excellence (NICE) before it is made available on the NHS.

Cost

It is currently only available in the US for around $147 (£111) per month for the lowest dose, 0.8 mg. It is expected to be cheaper than injectable GLP-1s in the UK.

Pros

Professor Yeo says it can be taken at any time of the day and “without food restrictions”, making it more convenient than the Wegovy pill.

Professor Yeo says that being a simple powder means it will be cheaper to make; ‘so when it eventually goes off patent (potentially around 2039) it will cost a few pennies,’ he says.[potentiallyaround2039)itwillcostpennies’saysProfessorYeo[potentiallyaround2039)itwillcostpennies’saysProfessorYeo

It can help those who stay steady with fat injections to maintain most of their weight loss, ‘so I suspect those in better shape will use this as a cheaper method of following injections,’ Professor Yeo says.

Cons

Less weight loss on average than the Wegovy pill

It should be taken daily (unlike weekly injections)

Due to undesirable side effects, the withdrawal rate at higher doses is slightly higher than the Wegovy pill.