A 2026 snapshot of what's approved, how well each drug actually performs in trials, and what it might cost you.
If you've looked into medical weight loss in the last few years, you've probably noticed the landscape shifted fast. A handful of GLP-1 injections turned into a full menu of pills, injections, and drug combinations, each with its own trial data, side effect profile, and price tag. This overview walks through what's currently FDA-approved, what the clinical trials actually showed, not the marketing headlines, and how a doctor typically narrows the list down for an individual patient.
One note before we start: this is educational information, not a treatment recommendation. Only a doctor who knows your health history can tell you which of these, if any, makes sense for you.
The Current Approved Landscape, 2026 Snapshot
As of mid-2026, the FDA has approved medications across three broad categories for chronic weight management.
GLP-1 and dual-agonist therapies, the newest and most studied class: semaglutide (Wegovy, oral and injectable), tirzepatide (Zepbound), liraglutide (Saxenda), and orforglipron (Foundayo).
Older appetite-suppressant and combination pills:
phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), and phentermine alone (Adipex-P, Lomaira).
Non-stimulant, non-hormonal options:
Orlistat (Xenical, and the lower-dose over-the-counter version, Alli).
The GLP-1 class has expanded quickly. In April 2026, the FDA approved Eli Lilly's Foundayo (orforglipron), a once-daily oral GLP-1 medicine for weight loss and maintenance in adults with obesity or overweight, making it the first small-molecule, non-injectable, non-peptide GLP-1 pill on the market. A month earlier, the FDA approved Wegovy HD, a higher-dose 7.2 mg injectable version of semaglutide for patients who've plateaued on the standard 2.4 mg dose.
It's worth being clear about one distinction that trips a lot of people up:
Some well-known GLP-1 drugs, like Ozempic and Mounjaro, are approved for type 2 diabetes, not weight loss. Only four branded GLP-1 medications are FDA-approved specifically for weight management: Wegovy, Zepbound, Foundayo, and Saxenda. The diabetes-indicated versions used for weight loss are prescribed off-label, and insurance coverage typically follows the labeled indication, not the off-label use.
Drug-by-Drug Breakdown
Semaglutide, Wegovy Class: GLP-1 receptor agonist Administration: Weekly subcutaneous injection, standard 2.4 mg or high-dose 7.2 mg, or a once-daily oral tablet Approval history: The FDA approved Wegovy for chronic weight management in June 2021. Wegovy can be used for weight loss in people 12 years and older, and it's also indicated for cardiovascular risk reduction in certain patients with obesity, plus treatment of MASH, a serious liver condition. The high-dose 7.2 mg formulation, Wegovy HD, was approved in March 2026 for patients who've tolerated the 2.4 mg dose for at least four weeks and need additional weight loss.
Tirzepatide, Zepbound Class: Dual GIP/GLP-1 receptor agonist Administration: Weekly subcutaneous injection Approval history: The FDA approved Zepbound in November 2023. It's also approved to treat moderate-to-severe obstructive sleep apnea in adults with obesity, the first prescription treatment FDA-approved for that specific use. It isn't approved for weight loss in children.
Orforglipron, Foundayo Class: Oral, non-peptide, small-molecule GLP-1 receptor agonist Administration: Once-daily tablet, no food or water restrictions Approval history: The FDA approved Foundayo on April 1, 2026, for adults with obesity, or overweight with weight-related medical problems. It's the first oral GLP-1 that doesn't require fasting or timing around meals, which is a real convenience difference from other oral options.
Liraglutide, Saxenda Class: GLP-1 receptor agonist Administration: Once-daily subcutaneous injection Approval history: An earlier-generation GLP-1, approved before the once-weekly formulations existed. It's still prescribed, particularly for patients who want a GLP-1 but don't need or want the higher-intensity dosing of Wegovy or Zepbound.
Phentermine-Topiramate, Qsymia Class: Sympathomimetic amine, an appetite suppressant, plus an anticonvulsant Administration: Once-daily oral capsule Approval history: Approved in 2012, one of the earlier chronic weight-management drugs on the market. It's dispensed only through a restricted program because of birth-defect risk with topiramate.
Naltrexone-Bupropion, Contrave Class: Opioid antagonist plus a dopamine/norepinephrine reuptake inhibitor, an antidepressant Administration: Twice-daily oral tablet Approval history: Also approved in 2012. It's used specifically in patients who have at least one weight-related condition alongside obesity, such as high blood pressure or type 2 diabetes.
Orlistat, Xenical or Alli Class: Lipase inhibitor, blocks a portion of dietary fat absorption Administration: Oral capsule, taken with fat-containing meals Approval history: One of the oldest agents still on the market, and the only one available in a lower-dose, over-the-counter form, Alli. It works differently from every other drug on this list, since it doesn't touch appetite hormones at all.
Phentermine Alone, Adipex-P or Lomaira Class: Sympathomimetic amine, an appetite suppressant Administration: Oral tablet, short-term use Approval history: Decades-old and still commonly prescribed, but only approved for short-term use, unlike everything else on this list.
Efficacy Ranges, From the Trials, Not the Marketing
Here's where it's worth separating a company's headline number from what the peer-reviewed trial actually measured. Average weight loss below reflects the percentage of total body weight lost, usually over roughly 68 to 72 weeks, in adults without diabetes.
Zepbound, tirzepatide 15 mg, SURMOUNT-1 trial: 22.5% over 72 weeks. Wegovy HD, semaglutide 7.2 mg, manufacturer trial data: around 20.7%. Zepbound vs. Wegovy head-to-head, SURMOUNT-5 trial: 20.2% for Zepbound vs. 13.7% for Wegovy over 72 weeks. Wegovy, semaglutide 2.4 mg injection, STEP-1 trial: 14.9% over 68 weeks, versus 2.4% for placebo. Wegovy tablet, oral semaglutide, manufacturer trial data: around 16.6%. Foundayo, orforglipron 36 mg equivalent, ATTAIN-1 trial: 12.4% among those who stayed on treatment through 72 weeks, 11.1% including those who discontinued. Qsymia, top dose, CONQUER trial: approximately 9.8% of body weight. Saxenda, liraglutide 3.0 mg, real-world clinical data: approximately 14%, or 9.2 kg, by 52 weeks in a real-world cohort awaiting bariatric surgery. Contrave, naltrexone-bupropion, COR-I trial: approximately 6.1% of body weight; roughly 56% of patients lost more than 5% of body weight, compared to 18% on placebo.
A few honest caveats worth sitting with. These trials weren't all run the same way, so cross-trial comparisons, as opposed to the direct head-to-head SURMOUNT-5 trial, are approximations, not apples-to-apples data. Qsymia and Contrave, for instance, have never been tested against each other directly. And every number above is a group average. Individual results vary quite a bit, which is part of why a doctor looks at your specific history before recommending one over another.
Side Effect Profiles Compared
GLP-1 and dual-agonist drugs, Wegovy, Zepbound, Saxenda, Foundayo: the dominant side effects across this entire class are gastrointestinal, including nausea, diarrhea, constipation, and vomiting. In SURMOUNT-5, adverse events were primarily gastrointestinal and generally mild to moderate, with 6.1% of Zepbound patients and 8.0% of Wegovy patients discontinuing treatment because of them. In an adolescent liraglutide trial, gastrointestinal side effects were reported by 64.8% of the treatment group versus 36.5% on placebo, and about 10% discontinued because of them. These effects tend to ease with gradual dose increases, which is why most of these drugs are started low and titrated up over weeks.
Qsymia, phentermine-topiramate: distinct side effects include mood changes, tiredness, irritability, tingling sensations, and cognitive effects like trouble with concentration or memory. Because it contains a stimulant and a drug linked to birth defects, it's dispensed only through a restricted safety program.
Contrave, naltrexone-bupropion: nausea was the most common complaint, with minimal other adverse effects reported in trials. Effects that distinguish it from Qsymia include vomiting, hot flashes, tremor, and elevated blood pressure. It carries a boxed warning around suicidal thoughts and can't be combined with opioids.
Orlistat: because it works by blocking fat absorption, its main side effects are digestive, including oily spotting, gas, and urgent bowel movements, especially after a meal that's high in fat. It doesn't carry the systemic hormonal side effects the GLP-1 class does.
Shared risk to flag: medications in the Qsymia and Contrave category interact with a range of other drugs, including opioids for Contrave and other stimulants for Qsymia, which is one more reason a full medication review with a prescriber matters before starting either.
Cost and Insurance Snapshot
Pricing shifts often, so treat these as a general range rather than a fixed quote.
Foundayo, oral: starting at $25 per month with commercial insurance coverage, or $149 per month for self-pay through LillyDirect, though self-pay pricing can escalate with dose increases, reaching around $299 per month at higher doses.
Wegovy and Zepbound, injectable: manufacturer self-pay programs price these around $299 to $449 per month depending on the drug and retailer, with Costco and Sam's Club offering brand pricing in the $349 to $499 range.
Qsymia: average retail price around $236 per month, though discount programs can bring it closer to $193.
Contrave: average retail price around $310 for a month's supply, with rebate programs bringing it down to roughly $235.
Orlistat, Xenical or Alli: generally the least expensive option on this list, with the over-the-counter version, Alli, available without a prescription.
On insurance: coverage tends to follow the labeled indication closely. Off-label prescribing, such as using a diabetes-approved GLP-1 for weight loss, is legal but typically isn't covered by insurance the way an on-label prescription would be. Many employer plans still exclude weight-management drugs from coverage entirely, so it's worth calling your insurer directly and asking about your specific plan's obesity-medication policy before assuming either way.
How a Doctor Might Choose Among These
There's no single best drug on this list, only a best fit for a given person's health profile. A few of the factors that typically shape the conversation:
Existing conditions. Someone with type 2 diabetes and obesity might be steered toward a GLP-1 already indicated for both. Someone with a seizure history would likely be steered away from Qsymia. Someone with a history of opioid use or suicidal ideation would likely be steered away from Contrave.
How much weight loss is medically indicated. Trial data suggests the GLP-1 and dual-agonist drugs produce the largest average losses, so they're often considered first for patients with higher BMIs or serious weight-related complications.
Tolerance for injections versus pills. Some patients strongly prefer to avoid needles, which makes oral options like Foundayo, Qsymia, or Contrave more appealing even if the average efficacy is lower.
Cost and coverage. A drug that's clinically ideal but entirely out-of-pocket at over $400 a month isn't a realistic long-term plan for many patients, so insurance formularies often shape the final decision as much as the trial data does.
Side effect tolerance. Someone prone to migraines or with a history of gallbladder issues, for example, may be steered toward or away from specific drugs based on documented risk factors in the package insert.
Think of it the way an architect thinks about materials. The strongest material isn't automatically the right one for every build. The choice depends on the load, the site, and the budget. Same idea here. The doctor is matching the tool to the person, not just picking the drug with the biggest headline number.
The takeaway:
The strongest average trial result and the right prescription for you aren't always the same thing, so the conversation with your doctor about your specific history matters more than any single efficacy number on this page.
Sourcing Note
This overview draws on FDA approval announcements and drug labeling from FDA.gov and manufacturer package inserts, peer-reviewed trial publications including NEJM results from the STEP, SURMOUNT, ATTAIN, and CONQUER trial programs, and manufacturer clinical trial disclosures. Efficacy and side-effect figures reflect group averages from specific trial populations and time points; individual results vary. This article is for general education and isn't a substitute for a conversation with a licensed physician about your own health history.