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 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 5 ft 7 in (170 cm), a BMI of 27 is about 172 lb (78 kg). Surgery usually starts around a BMI of 35, about 223 lb (101 kg) at the same height.^10,8

A medicine's label and your insurance plan use different numbers. The label says who the FDA approved it for: a BMI of 30, or 27 with a condition such as high blood pressure. It doesn't lower that for any ethnic group.^10,9 Insurance plans that cover weight-loss medicines usually ask for proof first (prior authorization), and many employer plans don't cover them for weight at all.¹³ Medicare's temporary GLP-1 Bridge starts at a BMI of 35 on its own, or lower with certain conditions.¹⁴ See Guide 6.

These are points where you and a doctor can start a conversation, not rules that you must or must not have something. Guidelines also look at your health, not just your weight.^15,8

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 older 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 prices: the makers' own self-pay prices, with the date we checked them. Clinics, telehealth services and pharmacies set their own prices, and we don't list or compare them. Medicine costs repeat every month.

In the medicine trials, the dummy-injection groups lost 2.4% and 3.1%, or about 5–6 lb from 200 lb.^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 US 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.²² The lifestyle group lost about 12 lb (5.6 kg) on average over about 3 years, against 0.2 lb (0.1 kg) on a dummy pill.²² Their rate of new diabetes was 58% lower: 4.8 cases per 100 people a year, against 11.0.²²

Food: how much to cut

US guidelines from heart and obesity societies suggest eating about 500–750 calories a day less than your body uses.²³ 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 same guidelines say very-low-calorie diets (under 800 calories a day) should only be used in limited cases, with medical supervision.²³

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.²⁴

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.²⁴ If you have kidney disease, ask your doctor before raising your protein.

Activity and support

Activity. The CDC says adults need 150 minutes of moderate activity a week, like brisk walking, or 75 minutes of vigorous activity, like running, plus 2 days of muscle-strengthening activity.²⁵ For people on a GLP-1 medicine, the advisory above suggests strength exercise at least 3 times a week.²⁴ Speak to your doctor first if you haven't exercised for a while or have a medical condition.

Support. The ADA says treatment should be chosen to fit your history, circumstances and preferences, and that approaches can be combined.²⁶ WHO also says diet and activity programs may be offered alongside GLP-1 medicines.²⁷

What about older weight-loss pills and other medicines?

Four older pills are used for weight in the US. They help less than GLP-1 medicines. Some diabetes medicines also lower weight a little.

The American Diabetes Association lists results from trials in people with type 2 diabetes. In each, both groups also had diet and activity advice:³

• Orlistat stops some of the fat in your food from being absorbed. 9.6% of body weight lost over 52 weeks, against 5.6% on a dummy pill. Stomach pain, wind and needing the toilet urgently are common.³ A 120 mg version is prescription-only; a 60 mg version is sold over the counter.¹⁸
• Phentermine is an appetite suppressant approved only for short-term use. 7.4% lost over 28 weeks, against 2.3%. It can raise heart rate and blood pressure, and isn't for people with heart disease.³ It's a controlled substance, unlike GLP-1 medicines.²⁸
• Phentermine–topiramate (a combination pill): 9.8% lost over 56 weeks at the top dose, against 1.2%. It must not be taken in pregnancy.³
• Naltrexone–bupropion (a combination pill): 5% lost over 56 weeks, against 1.8%. It isn't for people with uncontrolled blood pressure, seizures or who take opioid painkillers long term.³

These trials can't be compared with each other or with GLP-1 trials, because they had different people and lengths. In a 4-year trial in people without diabetes, people on orlistat lost 13 lb (5.8 kg), against 7 lb (3.0 kg) on a dummy pill.²

Metformin is a diabetes medicine, not an approved weight-loss one. In the Diabetes Prevention Program it led to 2.1 kg (about 5 lb) of loss on average.²² An international PCOS guideline says doctors should consider it for women with PCOS (polycystic ovary syndrome) and a BMI of 25 or more.²⁹

SGLT2 inhibitors, such as dapagliflozin, lead to modest weight loss. Across 116 trials, people lost about 4 lb (1.8 kg) more than on a dummy pill.³⁰

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-1.¹⁹ 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

Average weight lost in each trial. Pounds are for someone who starts at 200 lb (91 kg).

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.

Pills. The Wegovy pill (oral semaglutide) was approved for weight in December 2025, and Foundayo (orforglipron) in April 2026.^34,35 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.³⁶ Then some were switched to dummy injections. Over the next year, their weight went up by 14% of what they weighed at the switch.³⁶ For someone who weighed 190 lb (86 kg) by then, that is about 27 lb (190 × 0.14 = 26.6). Those who stayed on tirzepatide lost a further 5.5% over the same year.³⁶ Guide 9 covers stopping.

Cost. What you pay depends on who covers you. With an employer or other private plan that covers weight-loss medicines, you pay your plan's copay, usually after prior authorization.¹³ Medicare can't cover medicines for weight loss alone, but its temporary GLP-1 Bridge charges a $50 monthly copay to people who qualify, from July 2026 to December 2027.¹⁴ Without coverage, the makers sell at their own self-pay prices. Guide 6 lists them, with sources and dates, and covers safe ways to get them.

Who it's for. FDA labels allow these medicines from a BMI of 30, or 27 with a weight-related condition.^10,9 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?

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.

Who it's offered to

The 2022 guidance from the American Society for Metabolic and Bariatric Surgery (ASMBS) and its international partner (IFSO) says:⁸

• surgery is recommended at a BMI of 35 or more, whether or not you have other health problems;
• it should be considered at a BMI of 30 to 34.9 with a metabolic disease such as type 2 diabetes;
• for Asian people, it should be offered from a BMI of 27.5.⁸

The ADA's 2026 Standards of Care say to consider surgery for people with type 2 diabetes from a BMI of 30, or 27.5 for Asian Americans, if they are otherwise good candidates.²⁶ Insurance plans set their own criteria.²¹

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

Diabetes. In a US trial, 5 years after surgery, 29 in 100 (bypass) and 23 in 100 (sleeve) had near-normal blood sugar.³⁸ With medicines alone, it was 5 in 100.³⁸ In a Finnish trial, about 1 in 4 to 1 in 3 had diabetes in remission at 10 years.²⁰

Risks

• Death around the time of the operation is rare: between 3 in 10,000 and 2 in 1,000.⁸
• Over 10 years, 16–19 in 100 needed another operation.²⁰
• Acid damage to the food pipe was found in 31 in 100 after a sleeve, against 7 in 100 after a bypass.²⁰
• Lifelong follow-up, vitamins and nutrition checks are part of the deal.⁸

Cost. Medicare Part B covers some bariatric procedures, such as gastric bypass, if you meet conditions related to severe obesity.²¹ Private plans vary. We found no official price.

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.^11,12

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 Nausea (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

Endoscopic sleeve gastroplasty (ESG) reshapes the stomach from the inside.¹² In a trial at nine US centers, 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 build up?

There is no single fixed order. Options can be combined, and diet and activity stay part of every plan.^26,27

The ADA says the first treatment should be chosen to fit the person: lifestyle and nutrition therapy, medicine or surgery, and they can be combined.²⁶ Here is a simple picture of how the options fit:

Questions people ask