If you're researching GLP-1 medications for weight loss, you've probably seen the names: Ozempic, Wegovy, Mounjaro, Zepbound — and now Foundayo and Wegovy HD. But which one works best?
The short answer: tirzepatide (Zepbound) and Wegovy HD (7.2 mg) currently show the strongest weight loss results, with CagriSema potentially joining them soon.
The landscape has changed significantly since early 2026. Here is the updated comparison.
The GLP-1 Options in 2026
GLP-1 medications now fall into more categories than before:
- Semaglutide-based: Ozempic, Wegovy (2.4 mg), Wegovy HD (7.2 mg), Rybelsus
- Tirzepatide-based: Mounjaro, Zepbound
- Orforglipron-based (pill): Foundayo
- Combination (investigational): CagriSema (semaglutide + cagrilintide)
Each has different strengths. Let's compare them.
Comparison Table: GLP-1 Medications for Weight Loss
| Tirzepatide (Zepbound) | Semaglutide (Wegovy 2.4 mg) | Wegovy HD (7.2 mg) | Foundayo (pill) | CagriSema (pending) | |
|---|---|---|---|---|---|
| Drug class | Dual GIP/GLP-1 agonist | GLP-1 agonist | GLP-1 agonist | GLP-1 agonist | GLP-1 + amylin analog |
| Avg weight loss | 20-22% | ~15% | ~20.7% | ~11% | ~20.4% |
| How you take it | Weekly injection | Weekly injection | Weekly injection | Daily pill | Weekly injection (pending) |
| Max dose | 15 mg weekly | 2.4 mg weekly | 7.2 mg weekly | 17.2 mg daily | TBD |
| FDA approved | Yes | Yes | Yes (March 2026) | Yes (April 2026) | No (expected late 2026/early 2027) |
| Nausea rate | ~40% | ~44% | ~40% | ~30% | Similar to Wegovy |
| Needles | Yes | Yes | Yes | No | Yes |
Important: These weight loss numbers come from separate clinical trials with different patient populations. They are not head-to-head comparisons. Individual results vary.
Weight Loss Numbers
Clinical trial results (at maximum dose, ~68-72 weeks):
Tirzepatide (Zepbound 15 mg):
- Average: 20-22% body weight loss
- 30%+ of participants lost 25% or more
Wegovy HD (7.2 mg):
- Average: ~20.7% body weight loss
- For patients who plateaued on standard Wegovy 2.4 mg
- Altered skin sensation reported in 22% of HD patients vs. 6% on 2.4 mg
- See our Wegovy HD guide for full details
Standard Semaglutide (Wegovy 2.4 mg):
- Average: ~15% body weight loss
- About half of participants lost 15% or more
Foundayo (orforglipron 17.2 mg):
- Average: ~11% body weight loss over 72 weeks
- First GLP-1 pill with no food or water restrictions
- See our Foundayo vs Wegovy and Foundayo vs Zepbound comparisons
CagriSema (semaglutide + cagrilintide):
- Average: ~20.4% body weight loss over 68 weeks (REDEFINE 1 trial)
- Not yet FDA-approved; decision expected late 2026 or early 2027
- See our CagriSema guide for trial details and timeline
Your results will vary. Genetics, starting weight, diet, and exercise all play a role.
Why Tirzepatide and Wegovy HD Lead
Tirzepatide targets two hormones: GIP and GLP-1. Semaglutide only targets GLP-1. This dual action may explain why tirzepatide produces more weight loss. You get a stronger effect on appetite and blood sugar control.
Wegovy HD takes a different approach: it is the same drug as standard Wegovy (semaglutide) but at triple the dose (7.2 mg vs. 2.4 mg). The higher dose delivers roughly comparable weight loss to tirzepatide — about 20.7% on average — but it is only available to patients who have been on standard Wegovy 2.4 mg for at least 4 weeks and are tolerating it well.
Foundayo trades maximum weight loss for convenience. As a daily pill with no food or water restrictions, it is the simplest GLP-1 to take. But the weight loss numbers are lower than injectable options.
CagriSema adds an amylin analog (cagrilintide) to semaglutide for dual appetite suppression through two different pathways. It could rival tirzepatide once approved.
Side Effects: How Do They Compare?
Similar side effect profiles across all injectable GLP-1s:
Most common:
- Nausea
- Constipation or diarrhea
- Decreased appetite
- Stomach pain
Less common:
- Vomiting
- Fatigue
- Dizziness
Wegovy HD specific: Altered skin sensation (tingling, numbness) affected 22% of patients at 7.2 mg vs. 6% at 2.4 mg. This is the main differentiating side effect.
Foundayo: Being a pill, it avoids injection-site reactions. Nausea rates may be slightly lower (~30%), though direct comparison is difficult across separate trials.
Side effects are worst when starting and after dose increases. Most people adjust over 4-8 weeks.
Cost Considerations
List prices (before insurance):
| Medication | Approx. List Price/Month |
|---|---|
| Zepbound | ~$1,060 |
| Wegovy (2.4 mg) | ~$1,349 |
| Wegovy HD (7.2 mg) | ~$1,500 |
| Mounjaro | ~$1,023 |
| Ozempic | ~$968 |
| Foundayo | ~$1,050 |
Your actual cost depends entirely on insurance. Some plans cover one but not others. Savings cards can reduce costs for commercially insured patients. See our full GLP-1 cost comparison for insurance copays, savings card details, and budgeting tips.
Medicare: Starting July 2026, Medicare will cover GLP-1 weight loss medications at $50/month under a new demo program. This includes Wegovy HD.
Which Should You Choose?
Consider tirzepatide (Zepbound) if:
- Weight loss is your main goal
- You want the highest average weight loss
- Your insurance covers it
Consider Wegovy HD (7.2 mg) if:
- You are already on Wegovy 2.4 mg and have plateaued
- You want weight loss comparable to tirzepatide on a semaglutide pathway
- Your doctor recommends stepping up
Consider standard semaglutide (Wegovy 2.4 mg) if:
- Tirzepatide isn't covered
- You prefer a medication with a longer track record
- Your doctor recommends it based on your health history
Consider Foundayo if:
- You want to avoid needles entirely
- Convenience and simplicity are priorities
- You are comfortable with moderate (~11%) weight loss
Consider Ozempic or Mounjaro if:
- You have type 2 diabetes
- Your insurance covers diabetes medications but not weight loss drugs
Watch for CagriSema if:
- You want another high-efficacy option
- You are interested in the dual-pathway (GLP-1 + amylin) approach
- FDA approval is expected late 2026 or early 2027
The Reality Check
The "best" GLP-1 is the one your insurance covers and your doctor prescribes. All GLP-1s require lifestyle changes to work best. They're tools, not magic solutions. You still need to eat well and move your body.
Tips for success:
- Prioritize protein at every meal (protein powder can help you hit targets)
- Stay well-hydrated to reduce constipation (quality water bottle)
- Track your progress to stay motivated (smart scale for trends)
- Use meal prep containers to plan healthy meals ahead
Bottom Line
For pure weight loss potential, tirzepatide (Zepbound) and Wegovy HD (7.2 mg) show the strongest results in clinical trials, both around 20-22% average weight loss. Foundayo offers a needle-free alternative with moderate results (~11%). CagriSema could become another top contender once approved.
The medication that's covered by your insurance and prescribed by your doctor is the best one for you.
Work with your healthcare provider to determine which medication is right for you. Individual results and experiences vary.
Disclaimer: This content is for informational purposes only and does not constitute medical advice. Always consult a healthcare professional before starting or changing any medication.
Related Reading
- Wegovy vs Zepbound: Which Weight Loss Drug Is Better?
- Mounjaro vs Wegovy: Which Is Better for Weight Loss?
- Foundayo vs Wegovy: Pill vs Injection for Weight Loss
- Foundayo vs Zepbound: Pill vs Injection, Results, and Cost
- CagriSema: Trial Results and When It's Coming
- Wegovy HD (7.2 mg): Results, Side Effects, and Cost
- GLP-1 Cost Comparison 2026: What You'll Actually Pay
