The pharmacological treatment of obesity is a rapidly evolving field, requiring healthcare providers to stay informed. With a growing selection of weight loss medications available, patients often inquire about the most effective options and which one suits them best. The answer is complex, and newer isn't always better. Determining candidacy for weight loss medications begins with BMI, and the doctor and patient should discuss the patient’s current health issues, other medications, and family medical history. While some weight loss medications are FDA-approved only for adults, some-including semaglutide and liraglutide-are approved for children 12 and older with a BMI >/= 95th percentile. It can be easy to overlook first-generation AOMs, but these may be appropriate for some patients, especially when cost is a factor.
Understanding Ozempic and Its Role
Ozempic (semaglutide) is a once-weekly injection approved to treat Type 2 diabetes in adults. It can also lower the risk of major adverse cardiovascular events (heart attack, stroke, or cardiovascular death) if you have both diabetes and heart disease. If you have diabetes, Ozempic works well to lower hemoglobin A1C (HbA1C or A1C) - your average blood glucose levels over 3 months. It also has a low risk of hypoglycemia (dangerously low blood glucose), and it can result in weight loss.
Ozempic belongs to a growing class of medications known as glucagon-like peptide-1 (GLP-1) agonists. Ozempic is a GLP-1 medication that is approved for type 2 diabetes treatment and is frequently prescribed off-label for weight loss, but increasing demand and high prices are making it harder to access. GLP-1s such as Rybelsus, Mounjaro, Trulicity, Victoza, Bydureon BCise and Byetta are all approved for type 2 diabetes treatment. Wegovy, Saxenda and Zepbound are additional GLP-1s that are approved for weight loss.
How Ozempic Works
Ozempic (semaglutide) is one of the most popular prescription medications in the United States. It belongs to a class of drugs known as GLP-1 receptor agonists, which work by mimicking a hormone in your body that affects blood sugar levels, appetite and digestion.
Semaglutide operates by targeting three key physiological processes:
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- Stimulates insulin secretion: When blood sugar levels rise, Ozempic prompts the pancreas to release insulin.
- Suppresses glucagon: It reduces the hormone that causes the liver to release stored glucose into the bloodstream.
- Slows gastric emptying: This delays how quickly food leaves the stomach, leading to a feeling of fullness and more stable blood sugar spikes after eating.
Why Look for Alternatives?
Due to increased demand and coverage challenges, Ozempic (semaglutide) has become increasingly difficult to access. For many people, these situations have become an unfortunate reality, causing distress and uncertainty for those who depend on these vital treatments.
Alternatives exist: Other GLP-1 medications, such as Mounjaro, Trulicity, Rybelsus, and Wegovy, as well as non-GLP-1 options like Metformin, offer comparable or complementary results. Insurance coverage varies and will affect many patients’ choices about going on weight loss medications.
GLP-1 Receptor Agonists as Alternatives
If you’re having difficulty accessing Ozempic, there are several alternatives that work in a similar way that your healthcare team may consider. GLP-1s are not meant to be stopped and restarted at will. The dosing for some of these includes a long ramp-up period-up to five months-to reach full dosage. While GLP-1s have grabbed a lot of headlines, they are only the latest in a long history of evolving weight loss medications.
Rybelsus (Oral Semaglutide)
Rybelsus is an oral version of semaglutide - the active ingredient in Ozempic. Instead of injecting Ozempic once weekly, Rybelsus is a pill that you take by mouth every day. Compared to other Ozempic alternatives, Rybelsus may be one of the easiest switches to make. That’s because their manufacturer provides instructions for how to switch from Ozempic to Rybelsus (and vice versa).
In the PIONEER 4 trial, 14 mg daily doses led to A1C reductions of 1.2%-comparable to Ozempic at standard doses. Avg. weight loss was 8.2 lbs (3.7 kg), closely aligned with injectable GLP-1s. Absorption depends on taking it with water first thing in the morning, followed by a minimum 30-minute fasting period-compliance plays a vital role in effectiveness.
Read also: Transformations with Ozempic
However, there are a few reasons why switching to Rybelsus may not be right for you, such as if:
- You’re taking higher Ozempic doses: You can only switch to Rybelsus if you’re taking the 0.5 mg Ozempic dose. If you’re taking higher Ozempic doses (1 mg or 2 mg), Rybelsus may not be an option since comparable doses aren’t available yet.
- You’re taking Ozempic for its cardiovascular benefits: Rybelsus hasn’t been approved for the same cardiovascular benefits as Ozempic yet. In this case, other GLP-1 agonist medications with these benefits may be a better option.
- You have difficulty taking pills: If you can’t or don’t like to swallow pills whole, Rybelsus may not be a good option for you. You’ll also need to remember to take it first thing in the morning every day, at least 30 minutes before food, drink, or other medications.How to save: If you’re eligible, you could pay as little as $10 for your Rybelsus prescription with a copay savings card from the manufacturer. A patient assistance program is also available.
Trulicity (Dulaglutide)
Like Ozempic, Trulicity (dulaglutide) is a once-weekly injectable GLP-1 agonist. It also works the same way to manage your blood glucose levels. And it has proven cardiovascular benefits, too. Weight loss is also possible with Trulicity.
Trulicity, also from Eli Lilly, is a once-weekly GLP-1 receptor agonist introduced in 2014. It binds to the same receptors as Ozempic but features a simplified pen that doesn't require dose dialing or needle handling. The AWARD trial series demonstrated A1C reductions between 0.7% and 1.6% depending on dosage and patient background. Weight changes were modest, typically between a 2 to 6 pound loss over six months.
The highest Trulicity dose (4.5 mg) appears to have a comparable effect on A1C levels compared to the 1 mg Ozempic dose. But it doesn’t appear to work as well as the highest Ozempic dose (2 mg). And Trulicity may result in less weight loss compared to Ozempic.
Your current Ozempic dose and treatment goals may determine if Trulicity is an option for you. But if you need more help lowering your A1C or losing weight, Mounjaro (covered next) may be a better alternative. The starting Trulicity dose (0.75 mg) should be available. But higher Trulicity doses may be harder to find through May or June 2024 due to an increase in demand. How to save: With a manufacturer copay savings card, you could pay as little as $25 for your Trulicity prescription.
Read also: Ozempic Meal Plan
Mounjaro (Tirzepatide)
Mounjaro (tirzepatide) is a newer once-weekly injection for Type 2 diabetes. It works on the same targets in the body as Ozempic, plus an additional target. This results in greater A1C reduction and weight loss compared to Ozempic. However, Mounjaro hasn’t been approved for the same cardiovascular benefits yet.
Developed by Eli Lilly and approved by the FDA in 2022, Mounjaro operates through dual action: it activates both the GIP and GLP-1 receptors. This dual agonist approach has shown amplified effects in both blood glucose reduction and weight loss when compared to single agonist GLP-1 drugs like Ozempic. In the SURPASS-2 study, Mounjaro 15 mg reduced A1C by 2.3% compared to 1.86% with semaglutide (1 mg) over 40 weeks. Participants lost up to 13.1% of their body weight on Mounjaro 15 mg, versus 6.7% with semaglutide. Weekly injections, similar to Ozempic, and a titration schedule make it familiar to those already on GLP-1 analogs.
It’s possible to switch from Ozempic to Mounjaro. But you may need to start with a lower Mounjaro dose and work your way up to find the best dose to meet your needs. The starting Mounjaro dose (2.5 mg) should be available. But higher doses may be harder to find through June 2024. How to save: If you need help affording Mounjaro, a manufacturer savings card is available. If you’re eligible, you could pay as little as $25 for your Mounjaro prescription.
Victoza (Liraglutide)
Approved in 2010, Victoza was one of the earliest daily GLP-1 receptor agonists. Its longevity in the market gives it a strong record of safety, with consistent data on heart health benefits for people with type 2 diabetes. The LEADER trial showed a 13% reduction in major adverse cardiovascular events over 3.5 years. A1C reduction ranges from 0.6% to 1.5%, depending on dose and baseline glucose levels. Although it requires daily injection, its cardiovascular profile and lower cost make it a contender for long-term management.
Bydureon BCise (Extended-Release Exenatide)
Bydureon BCise delivers exenatide, a synthetic version of a hormone found in Gila monster venom. This once-weekly formulation steadily releases medication and was designed to minimize peak-and-trough effects. Phase 3 trials showed an average A1C drop of around 1.1% over 24 to 30 weeks. Patients typically lost between 2 to 6 pounds, with greater effects in combination with metformin. User-friendly auto-injectors and over a decade of real-world data give Bydureon appeal for individuals seeking a stable option with minimal daily decision fatigue.
Weight Loss Specific Medications
Ozempic isn’t approved for weight loss, but it can cause weight loss as a side effect. Because of this, Ozempic is often prescribed off-label for people without diabetes to help them lose weight. Currently, there are three medications that work in a similar way that are approved for weight loss.
Wegovy (Semaglutide)
Wegovy (semaglutide) is a higher-dose version of Ozempic that’s approved for weight loss in adults and adolescents ages 12 and older. If you’ve been prescribed Ozempic off-label for weight loss, switching to Wegovy may be a logical choice. And if you also have heart disease, Wegovy has proven cardiovascular benefits. Currently, most Wegovy doses may be more difficult to find since Wegovy is also in shortage. How to save: If you’re eligible, you could pay as little as $0 for your Wegovy prescription with a manufacturer copay savings card.
Wegovy uses the same active compound as Ozempic but at higher doses (up to 2.4 mg weekly) and is specifically indicated for chronic weight management in adults with obesity or overweight plus a comorbidity. Wegovy was also approved by the FDA in 2022 for obesity and overweight. The STEP 1 trial revealed a mean weight loss of 14.9% over 68 weeks in non-diabetic participants. Significant reductions in waistline and blood pressure were recorded, alongside improved glycemic parameters in prediabetic subjects. Though its use hinges on weight-focused outcomes rather than glucose, individuals managing both weight and metabolic health see dual benefits.
Saxenda (Liraglutide)
Saxenda (liraglutide) is another injectable GLP-1 agonist approved for weight loss. Instead of injecting your dose weekly like with Ozempic, you’ll need to inject Saxenda every day. And compared to Wegovy, you may not lose as much weight with Saxenda. Depending on product availability and your treatment plan, your healthcare team can determine if Saxenda is a potential option for you. Currently, Saxenda is also in short supply. How to save: A manufacturer savings card is currently available for Saxenda. If you’re eligible, you could pay as little as $25 for your Saxenda prescription.
Saxenda is a GLP-1 medication that is prescribed for weight loss. It has the same active ingredient (liraglutide) as the diabetes drug Victoza, but at a higher dose - the maximum dose for Saxenda is 3 mg per day, while the maximum dose for Victoza is just 1.8 mg per day. Patients on Saxenda lost between 5-10% of their body weight during a 56-week clinical trial.
Zepbound (Tirzepatide)
Zepbound (tirzepatide) is a once-weekly injection that contains the same active ingredient as Mounjaro. Zepbound, though, is specifically approved for weight loss in adults. Because of how it works, Zepbound may result in greater weight loss than Ozempic (or Wegovy). But it hasn’t been approved for the same cardiovascular benefits yet. The starting Zepbound dose (2.5 mg) should be available. But higher Zepbound doses may be more difficult to find through June 2024. How to save: A manufacturer savings card is currently available for Zepbound. If you’re eligible, you could pay as little as $25 for your Zepbound prescription.
Zepbound is a higher-dose version of Mounjaro, but is prescribed for weight loss instead of type 2 diabetes. It can also treat obstructive sleep apnea (OSA) in people with obesity. Like Ozempic, Zepbound is injected once weekly. Unlike Ozempic (which is a GLP-1 receptor agonist), Zepbound targets both GLP-1 and GIP receptors. Typical dosing for Zepbound starts at 2.5 mg and may increase depending on how the patient responds to the medication.
Other FDA-Approved Anti-Obesity Medications (AOMs)
FDA-approved anti-obesity medications (AOMs) are safe, evidence-based therapies that target specific physiology to improve the disease and are most effective when used as part of a comprehensive treatment plan. The average weight loss varies from 5% to 21%, with some people losing more and some people losing less. Most people regain weight if AOMs are discontinued.
Phentermine and Phentermine-Topiramate
Phentermine is the oldest and most widely used weight loss medication. It was originally used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor. Topiramate can be combined with phentermine to decrease appetite and cravings. Adults with migraines and obesity are good candidates for this weight-loss medication. Some patients may lose an average of 5-10% of body weight. Daily doses with four strengths start at 3.75 mg/23 mg to 15 mg/92 mg. Side effects include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth.
Naltrexone-Bupropion
Naltrexone-bupropion combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day. The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
Orlistat
Orlistat is a lipase inhibitor that comes in a capsule. Undigested fat is then passed through the body. Some patients may lose about 5% of their body weight. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal. The only over-the-counter medicine for weight loss currently approved by the FDA is Alli (orlistat). Other over-the-counter products are considered supplements.
Setmelanotide
Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders.
Plenity
A medical device rather than a medication, Plenity was FDA-cleared in 2019 for people with a BMI of 25 to 40. It consists of a capsule that releases a biodegradable, super-absorbent hydrogel into the stomach. The gel helps to increase satiety, enabling the person to eat less.
Lifestyle Changes and Natural Ways to Manage Weight
Several healthy habits can help you naturally manage hunger and quiet “food noise” without medication.
Mindful Eating
Consuming small, frequent healthy meals and snacks throughout the day can help you manage hunger cues. She recommends consuming various foods, including starches, proteins, and fats and advises against swearing off things you love within moderation. Honoring cravings also enhances satisfaction at meals from day to day and reduces binges. Mehr says that intuitive eating - tuning into feelings of fullness and eating when you’re hungry - can be helpful.
High-Protein Diet
High-protein diets help manage weight and food noise as proteins keep you feeling full longer and curb cravings. Good ways to add more protein to your diet include:
- Lean meats, like skinless chicken breast
- Eggs
- Beans
- Nuts
Fiber-Rich Foods
Fiber-rich foods naturally slow digestion. Incorporating vegetables, fruits, whole grains, and beans into your diet is beneficial for overall health, including weight management and reducing cravings.
Regular Exercise
Exercise can temporarily suppress your appetite by lowering hunger hormones and boosting the ones that make you feel full. It also helps with stress, which is often a big trigger for food cravings.
Stress Management
The authors of the 2022 review suggested that mindfulness was one possible solution. Mehr agrees. Take some deep breaths. Take a break for a few minutes. Take a mindful walk [and] listen to the sounds around you - birds, leaves, traffic.
Quality Sleep
The authors suggested a possible link between sleep and hormone dysregulation, which can change a person’s metabolic rate and affect weight loss. When you’re tired, your hunger hormones go haywire, making you crave more food. Aim for seven to nine hours of solid sleep, and try to wind down before bed with something relaxing.
The Future of Weight Loss Medications
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026 specifically for obesity. Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. It could provide a welcome alternative for people who do not want injections. Phase 3 results expected soon. at 36 weeks. The other, retatrutide, targets GLP-1, GIP, and glucagon. At this writing, it is in Phase 3 clinical trials. In Phase 2, participants lost up to 24.2% of body weight at 48 weeks. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. The once-monthly injection entered Phase 3 clinical trials in March 2025. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication. Those of interest include not only GLP-1, but also peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK). With more options available, doctors will be increasingly able to personalize treatments.
Important Considerations
- Compounded Medications: Some online healthcare providers claim to sell Ozempic, Wegovy, or Zepbound at reduced prices. However, the FDA warns against buying medications from any source other than a state-licensed pharmacy. In April 2025, they banned the sale of “counterfeit” semaglutide and tirzepatide. These medications are not made or packaged by the original manufacturers. Instead, they are compounded medications. Compounded versions of medications are made by compounding pharmacies, often to tailor a medication to specific patient needs, like an allergy to an inactive ingredient. Compounded medications are not FDA-approved. due to shortages. Some patients have taken these alternatives, which are generally more affordable, without ill effects. has received 520 reports of adverse events associated with compounded semaglutide and 480 reports of adverse events associated with compounded tirzepatide (as of April 30, 2025).
- Medications That Cause Weight Gain: There are many medications that can be obesogenic or cause weight gain. Antidepressants are broken down into categories: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAO inhibitors), and others. In the SSRI group, paroxetine shows the highest associated weight gain. Weight-positive medications in the tricyclic antidepressant category include amitriptyline, doxepin, and imipramine. Bupropion (Wellbutrin), an aminoketone, is considered weight-negative and is prescribed both to assist in weight loss and to treat depression.
- BMI and Health Conditions: The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems. They can also interfere with hormonal birth control. Older AOMs also have indications based on BMI and may be contraindicated for use with certain other medications.