Medication vs Medication
Wegovy vs Orlistat
A practical UK comparison focused on what is genuinely different — not which brand has the loudest marketing.
Wegovy injection
STEP 1: mean -14.9% at 68 weeks with 2.4 mg; 7.2 mg is now a licensed maintenance option for adults with obesity if needed
Orlistat
Typically produces more modest average loss than GLP-1/GIP medicines; individual response varies
Side-by-side
| Wegovy injection | Orlistat | |
|---|---|---|
| Active ingredient | semaglutide | orlistat |
| Form | Weekly injection | Capsule with meals |
| Frequency | Once weekly | Up to three times daily with fat-containing meals |
| Licence | UK weight management licence | UK weight management licence |
| NHS context | NICE-recommended in specialist weight-management pathways; access depends on pathway | Long-established NHS option; prescribing criteria and local practice apply |
| Evidence | Very strong | Very mature |
| Weight-loss evidence | STEP 1: mean -14.9% at 68 weeks with 2.4 mg; 7.2 mg is now a licensed maintenance option for adults with obesity if needed | Typically produces more modest average loss than GLP-1/GIP medicines; individual response varies |
| Maintenance | Long-term support/treatment matters; weight regain after stopping has been demonstrated | Can be continued where effective/tolerated; diet composition affects tolerability |
| GI considerations | Common GI effects; dose escalation is used to improve tolerability | GI effects are closely related to dietary fat intake |
Reasons to discuss Wegovy injection
- Large evidence base
- Weekly dosing
- Cardiovascular outcome evidence in appropriate populations
- 2.4 mg established; 7.2 mg injectable option now licensed for adults with obesity if needed
Trade-offs
- Injection
- GI effects
- The new 7.2 mg option should not be compared using old 2.4 mg-only trial assumptions
- NHS access remains pathway-limited
Reasons to discuss Orlistat
- Needle-free
- Generic and established
- Different mechanism from incretin medicines
- Usually lower drug cost than branded incretin therapy
Trade-offs
- Lower average efficacy
- Oily stools/urgency and other GI effects can be disruptive
- Must be taken around fat-containing meals
- Fat-soluble vitamin considerations
Which is stronger for weight loss?
Wegovy injection is rated 8/10 and Orlistat 3/10 in our comparison framework. That rating summarises the obesity evidence available for the licensed formulation; it is not a prediction of your result.
Which is easier to live with?
Wegovy injection: Once weekly. Orlistat: Up to three times daily with fat-containing meals. For some people a weekly injection is easier than a daily tablet; for others avoiding a needle is decisive.
NHS vs private reality
NICE-recommended in specialist weight-management pathways; access depends on pathway. Long-established NHS option; prescribing criteria and local practice apply. NICE criteria and NHS availability are related but not identical, so check the current pathway rather than assuming a clinically eligible medicine is immediately available through a GP.
Maintenance matters
Long-term support/treatment matters; weight regain after stopping has been demonstrated. Can be continued where effective/tolerated; diet composition affects tolerability. A treatment comparison that ends at the point of weight loss is incomplete.
Questions to ask a prescriber
- Which option is actually licensed and clinically appropriate for my health history?
- How do the expected benefits compare for someone with my diabetes/cardiovascular history?
- What side effects should make me contact you?
- What will monitoring involve?
- What is the plan if I cannot tolerate the maintenance dose?
- What happens if I stop?
Sources
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