What are my options for losing weight? Where GLP-1 medicines fit

Which options are for you?

It depends mostly on your BMI and your health. Lifestyle changes are for everyone. Medicines come in at a lower BMI. Procedures and surgery are for much higher weights.

So if your BMI is in the high 20s, the choice is usually between lifestyle changes alone and lifestyle changes plus a medicine. At 170 cm (5 ft 7 in), a BMI of 27 is about 78 kg (172 lb). Surgery usually starts around a BMI of 35 to 40, about 101 to 116 kg (223 to 256 lb) at the same height.^9,15

Approval and payment are separate questions. The Health Canada label says who a medicine is approved for: for Wegovy and Zepbound, a BMI of 30, or 27 with a condition such as high blood pressure.^10,13 The Canadian guideline uses the same numbers and asks doctors to adjust them with ethnicity-specific measures.⁹ Who pays is a different matter: as of 12 Oct 2026, no provincial drug plan covers these medicines for weight management, so it comes down to private insurance or paying yourself.³⁰ See why no province covers Wegovy or Zepbound.

These are points where you and a doctor can start a conversation, not rules that you must or must not have something. The guideline also looks at your health, not just your weight.⁹

How do the options compare?

In trials, surgery led to the most weight loss. GLP-1 medicines came next, but only while people kept taking them. Lifestyle programs and pills led to less.

The numbers below come from different trials, with different people. So treat them as rough guides. They are not a direct comparison. "Weight lost" is the average share of starting body weight.

Each option in detail. Weight lost is the average share of starting weight.

We show only official or list prices, with their source and date. Pharmacies and clinics set their own prices, and we don't list or compare them. Savings-card or promotional prices are not the list price. GLP-1 and pill costs repeat every month.

In the medicine trials, the dummy-injection groups lost 2.4% and 3.1%, or about 2–3 kg.^4,5 These are averages, and results vary from person to person. In those trials, about 14 in 100 people on semaglutide and 9 in 100 on tirzepatide lost less than 5% of their weight.^4,5

Can food and activity changes alone help?

Yes, for many people. Structured programs helped people lose around 6–9% of their weight, and cut their risk of diabetes.

One large trial, Look AHEAD, followed 5,145 adults with type 2 diabetes.¹ The program set a calorie target and about 3 hours of activity a week, with frequent group and one-to-one sessions.¹ People lost 8.6% of their weight in the first year, against 0.7% with usual care.¹ After about 10 years, they were still 6.0% lighter, against 3.5%.¹

In the US Diabetes Prevention Program, 3,234 people with high blood sugar (prediabetes) took part.²⁶ The lifestyle group lost 5.6 kg (about 12 lb) on average over about 3 years, against 0.1 kg on a dummy pill.²⁶ Their rate of new diabetes was 58% lower: 4.8 cases per 100 people a year, against 11.0.²⁶

Food: how much to cut

The Canadian guideline says there is no one-size-fits-all eating pattern. Several approaches work, including calorie-reduced diets with more or less carbohydrate, Mediterranean, vegetarian and DASH-style eating, and replacing one or two meals a day with meal replacements. The best one is the one you can keep up.¹⁷ US guidelines put a number on the calorie cut: about 500–750 calories a day less than your body uses.²⁸ That's a cut from what you need, not a daily total. Someone whose body uses 2,200 calories a day would eat about 1,450–1,700.

The Canadian guideline warns that strict calorie cutting can work in the short term but often isn't kept up past a year, and that restrictive eating can leave you short of vitamin D, vitamin B12 and iron.¹⁷

Protein: the part most people miss

When you lose weight, some of it is muscle. Too little protein makes that worse, and a smaller appetite on a GLP-1 medicine makes protein harder to get.²⁹

The same advisory says to pair protein with strength exercise at least 3 times a week, plus at least 150 minutes of moderate activity like brisk walking.²⁹ If you have kidney disease, ask your doctor before raising your protein.

What to put on the plate

The Canadian guideline uses Canada's Food Guide as the base for healthy eating, at any body size.¹⁷ The Food Guide's main advice:¹⁹

Activity and support

Activity. The Canadian guideline suggests building up to 30 to 60 minutes of moderate to vigorous activity, like walking or biking, on most days, adding up to at least 150 minutes a week. It adds strength (resistance) exercise at least 2 days a week, and less time sitting.¹⁸ Exercise alone leads to about 2 kg of long-term loss on average, but it helps keep weight off and protects muscle during weight loss.¹⁸ For people on a GLP-1 medicine, the US advisory above suggests strength exercise at least 3 times a week.²⁹ Speak to your doctor first if you haven't exercised for a while or have a medical condition.

Support. The Canadian guideline pairs every medicine recommendation with health behaviour changes.⁹ WHO also says diet and activity programs may be offered alongside GLP-1 medicines.³²

What about pills, and other medicines that lower weight a little?

Two older weight-loss pills are approved in Canada: orlistat (Xenical) and naltrexone–bupropion (Contrave). Both are prescription-only, and both help a little. Some diabetes medicines also lower weight a little.

Orlistat (Xenical) stops some of the fat in your food from being absorbed; it passes out in your poo. In Canada it is a prescription medicine.³ The Canadian guideline lists it for adults with a BMI of about 28 to 47.⁹ Over a year, people lost 2.9% more of their weight than on a dummy pill. In a 4-year trial, people on orlistat lost 5.8 kg, against 3.0 kg on a dummy pill.^9,2 It can cut the absorption of some vitamins and other medicines.⁹

Naltrexone–bupropion (Contrave) is a combination tablet, prescription-only, sold in Canada since 2018.³ In its main trial, people lost 4.8% more of their weight than on a dummy pill at 56 weeks, and 48 in 100 lost at least 5%, against 16 in 100 on a dummy pill.⁹ The guideline lists rare risks including seizures and worsening depression.⁹

Metformin is a diabetes medicine, not an approved weight-loss one. In the Diabetes Prevention Program it led to 2.1 kg of loss on average.²⁶ An international PCOS guideline says doctors should consider it for women with PCOS (polycystic ovary syndrome) and a BMI of 25 or more.³³

SGLT2 inhibitors, such as dapagliflozin, lead to modest weight loss. Across 116 trials, people lost about 1.8 kg more than on a dummy pill.³⁴

Where do GLP-1 medicines fit?

They lead to more weight loss than pills or lifestyle alone. But they are a long-term treatment, and most of the weight returns if you stop.

Semaglutide (Wegovy) acts like the gut hormone GLP-1.²⁰ Tirzepatide (Zepbound) acts on GLP-1 and a second gut hormone, GIP.⁵ Guide 2 explains how they work. In every trial below, people also followed a diet and activity plan.^4,5 The Canadian guideline gives semaglutide 2.4 mg and tirzepatide its strongest grade of evidence for weight management.⁹

Average weight lost in each trial. Kilograms are for someone who starts at 90 kg (198 lb).

Only the last trial compared the two medicines directly; the others each tested one medicine against a dummy injection, so don't compare across them.

When to review. The Canadian guideline notes that regulators have traditionally advised stopping if 5% hasn't been lost after 3 months on a full dose. It adds that real health gains can come whatever the amount lost, so the decision is about your goals, not one number.⁹

Tablets. As of 12 Oct 2026, no GLP-1 tablet is approved in Canada for weight management. Rybelsus, a semaglutide tablet, is approved for type 2 diabetes only.³ The trial results on this page are for weekly injections.^4,5

What happens when you stop. A year after stopping semaglutide, trial participants had regained about two-thirds of the weight they lost.⁶ In a tirzepatide trial, everyone first took the medicine for 36 weeks and lost about 21% of their weight.⁴¹ Then some were switched to dummy injections. Over the next year, their weight went up by 14% of what they weighed at the switch.⁴¹ For someone who weighed 85 kg (187 lb) by then, that is about 12 kg (85 × 0.14 = 11.9). Those who stayed on tirzepatide lost a further 5.5% over the same year.⁴¹ Guide 9 covers stopping.

Cost. As of 12 Oct 2026, no provincial drug plan covers Wegovy, Zepbound or Saxenda for weight management.³⁰ Only a small number of private insurers cover them for weight, often with prior approval, BMI rules or step therapy (trying other options first).⁴³ Canada's Drug Agency recommended in 2025 that public plans pay for Wegovy only for people with established heart disease and a BMI of 27 or more, and price talks then failed.^35,30 Otherwise you pay yourself. The official figures we found: Wegovy at $388.64 per 4-dose pen, or about $5,066 a year, the maker's price in Canada's Drug Agency's 2025 review.²² Zepbound's list price from 29 Dec 2025 was reported as $300 per 4 weeks for 2.5 and 5 mg and $420 for 7.5 and 10 mg.²⁵ What you pay at the pharmacy can differ. Prescription medicines can count toward the Medical Expense Tax Credit.³⁹ Guide 6 covers prices, coverage and safe ways to get them.

Who it's for. The Health Canada labels allow these medicines from a BMI of 30, or 27 with a weight-related condition.^10,13 A family doctor or nurse practitioner can prescribe them. That is a point where you and a doctor can start talking about it. It does not mean you should take one. Guide 4 covers who should and shouldn't take them.

Who is weight-loss surgery for in Canada?

Surgery is for people with a higher BMI, often with a health condition that weight loss could improve. It gives the largest, longest-lasting loss, but it is a major operation.

Canadian thresholds

The Canadian guideline says bariatric surgery can be considered for adults with:¹⁵

• a BMI of 40 or more, or
• a BMI of 35 or more with at least one weight-related disease, such as type 2 diabetes, high blood pressure, sleep apnoea or fatty liver.^15,16

It says surgery should also be considered for people with poorly controlled type 2 diabetes and a BMI of 30 to 35, despite the best medical treatment.¹⁵ Before surgery, a team checks your health, nutrition and sleep, and asks you to stop smoking for good.¹⁶ Newer guidance from US and international surgeons (2022) offers surgery from a BMI of 35, or 27.5 for Asian people.⁸

Getting it. In Canada, surgery is done through publicly funded hospital programs, usually after a referral from your doctor. Places have been limited: a 2014 Canadian paper estimated that fewer than 1 in 100 eligible adults had surgery each year, with waits averaging about 5 years. Waits differ by province and may have changed since.²⁴ Ask your family doctor about the program in your province.

Results

A Swedish study followed over 4,000 people. Gastric bypass led to 32% loss at its peak, and 25% after 10 years.⁷ Gastric banding, which puts a band around the stomach, led to less: 20% and 14%.⁷ People who had surgery were less likely to die during the study than similar people who didn't.⁷ The Canadian guideline lists sleeve gastrectomy, gastric bypass, duodenal switch and gastric banding as procedures done in Canada.¹⁵

Diabetes. In a US trial, 5 years after surgery, 29 in 100 (bypass) and 23 in 100 (sleeve) had near-normal blood sugar.⁴⁴ With medicines alone, it was 5 in 100.⁴⁴ In a Finnish trial, about 1 in 4 to 1 in 3 had diabetes in remission at 10 years.²³

Risks

• Death around the time of the operation is rare: in trials, about 8 in 10,000 within 30 days.¹⁵
• Over 10 years, 16–19 in 100 needed another operation.²³
• Acid damage to the food pipe was found in 31 in 100 after a sleeve, against 7 in 100 after a bypass.²³
• Other risks include leaks, blood clots and gallstones.^15,8
• The Canadian guideline says every surgery needs lifelong follow-up, vitamin and mineral supplements, and lasting behaviour changes.¹⁵

What are gastric balloons and endoscopic sleeves?

Both are done through the mouth with a camera tube (an endoscope), without cutting the skin.^11,12 Neither removes any part of the stomach. The Canadian guideline places them between medicines and surgery for effect and risk.¹⁵

Gastric balloon. A balloon is placed in the stomach using the endoscope. In a US trial, it was removed after 6 months.¹¹ People lost 10.2% of their weight by then, against 3.3% with lifestyle alone.¹¹ By 12 months, loss had eased to 7.6%.¹¹ Feeling sick (87 in 100) and vomiting (76 in 100) were common, and 19 in 100 had it taken out early.¹¹ The trial included adults with a BMI of 30 to 40.¹¹ The Canadian guideline says most people regain weight after the balloon comes out, and there isn't enough evidence that it works long term.¹⁵

Endoscopic sleeve gastroplasty (ESG) reshapes the stomach from the inside.¹² In a trial at nine US centres, adults with a BMI of about 30 to 40 (class 1 or 2 obesity) took part.¹² They lost 13.6% at 1 year, against 0.8% with lifestyle alone.¹² Serious problems happened in 2 in 100 people.¹²

How does care fit together?

There is no single fixed order. Options can be combined, and diet, activity and behaviour support stay part of every plan.^9,42

The Canadian guideline suggests your doctor use Obesity Canada's 5As: ask your permission to talk about weight, assess your health and the causes, advise on risks and options, agree on goals with you, and assist you in getting the right help.⁴⁰ Here is a simple picture of how the options fit:

For example, the Canadian guideline says surgery should be considered at a BMI of 30 to 35 when type 2 diabetes stays poorly controlled despite the best medical treatment.¹⁵ And it recommends medicines to help keep off weight lost through lifestyle changes.⁹

Questions people ask