Orlistat vs Wegovy: Comparing the weight loss medications

Our bodies don't define us, and we are all much more than just the sum of our parts. That said, feeling comfortable and confident in our own skin can have a huge positive effect on our quality of life.

Not to mention, reaching a healthy weight can help give us more energy to tackle each day, and help protect us from future health issues.

If you've tried to lose weight through traditional avenues like a reduced-calorie diet and exercise to no avail, you may now be exploring the world of weight loss medications.

With an ever-growing amount of pharmaceutical treatments available, it can be difficult to know where to start and which one is going to be right for you.

For example, should you look into an injectable medication like Wegovy, or an oral medication like Orlistat?

To help you wade through the noise and make an informed decision, here's everything you need to know about Orlistat and Wegovy — including the differences, side effects, cost, and effectiveness.

What is Wegovy?

Wegovy is a weight loss medication manufactured by US company Novo Nordisk that's administered via subcutaneous injection (under the skin) once weekly.

As a brand name for semaglutide, it's the same medication as Ozempic. However, while Ozempic is prescribed as a treatment for type 2 diabetes, Wegovy is specifically approved for weight loss.

When combined with healthy lifestyle changes, you can expect to lose around 15% of your body fat within the first year [1].

What is Orlistat?

You've likely heard plenty about injectable medications like Mounjaro and Wegovy. However, one oral weight loss medication that has gone relatively under the radar is Orlistat.

Created by Swiss pharmaceutical company Roche in the 1980s, Orlistat was actually one of the first weight loss medications on the market.

It's derived from a naturally occurring lipase inhibitor found in the body called lipsatin, which helps break down fats in the intestine.

When this enzyme is blocked, around 25-30% of the fat consumed through food passes through the digestive system without being absorbed [2].

Orlistat helps to break this dietary fat into smaller parts, so it can be used or stored for energy — instead of fat. This can help aid fat loss or reduce the risk of gaining body fat after weight loss.

Orlistat vs Wegovy: Which one is more effective for weight loss?

It's important to note that Wegovy and Orlistat work in different ways to encourage weight loss.

Wegovy is part of a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. These mimic the action of the hormone GLP-1 which is released by the pancreas when we consume food [3].

This signals to the brain that we are full and satisfied, regulating appetite and helping to naturally eat fewer calories. Many also report that it helps reduce 'food noise' or the urge to snack.

Meanwhile, Orlistat works on reducing the amount of food that can be metabolised as fat.

This can be particularly helpful if you have a goal to lose body fat while gaining muscle (in other words, tone up), or to maintain your results after losing weight with an injectable medication like Wegovy.

So, which one takes the cake when it comes to promoting weight loss? Research shows that Wegovy leads to more significant weight loss over time than Orlistat.

In head-to-head comparisons, patients have lost 3-4 times as much weight on Wegovy than on Orlistat capsules [4].

In clinical trials, patients lost about 15-20% of their body weight while taking Wegovy, combined with lifestyle intervention [5]. Meanwhile, research shows that Orlistat supports around 4-8% loss of body weight in the same time period [4].

What are the dosing schedules for Orlistat vs Wegovy?

Orlistat is taken as a capsule up to 3 times per day with food, particularly before eating a high-fat meal.

In some cases, a medical professional may recommend patients start with 1 capsule per day, and work their way up.

On the other hand, Wegovy is administered as an injection, at the same time every week. It follows a titrating schedule — meaning you will start with a small dose and then gradually increase it over time to build tolerance and reduce side effects.

Typically, you'll start at 0.25 mg for 4 weeks, then build up to 1.0 mg for 4 weeks, 1.7 mg for 4 weeks — until you reach the maintenance dose of 2.4 mg at the 12-week mark [6].

Orlistat vs Wegovy side effects

Both Wegovy and Orlistat have a range of potential side effects you should be aware of.

Common side effects of Orlistat include gastrointestinal issues such as flatulence, oily stools, and frequent bowel movements, especially when meals high in fat are consumed [7].

With Wegovy, you may experience adverse effects like vomiting, nausea, diarrhea, constipation, indigestion, and abdominal pain [8].

Everyone reacts to medications differently, and you may find that you can tolerate the side effects of some treatments than others.

Are both Orlistat and Wegovy available in the UK?

Yes, both Orlistat and Wegovy are available by prescription in the UK. While Orlistat can be prescribed through a GP, Wegovy must be accessed via the NHS through a holistic weight loss programme like Juniper as per NICE's guidelines.

You may be eligible for Orlistat if you have a BMI of over 30 and at least one weight-related health issue such as prediabetes or type 2 diabetes.

You can also gain access to an over-the-counter version of Orlistat under the brand name Alli through Juniper without a prescription. Our research shows that for every 2 kilos lost through dieting, you can lose 1 extra kilo with Alli.

Meanwhile, Wegovy has been available in the UK for those living with obesity since September 2023. It can be prescribed to those with a body mass index (BMI) over 35, who have a weight-related health condition such as high blood pressure or pre-diabetes.

You can check your eligibility for both medications here.

What are the cost differences?

Apart from their mechanisms for weight loss, one of the key differences between Orlistat and Wegovy is the cost.

While Wegovy starts at around £145 for a 4-week supply, Orlistat will set you back around £55 [9]. You may also be able to access Wegovy or Orlistat through the NHS, which can help reduce your out-of-pocket cost.

Accessing these medications through Juniper's Weight Loss Reset Programme can also give you better value — by providing you with lifestyle coaching and nutritional guidance for lasting results.

In fact, Juniper members are 4.5% more likely to lose weight than those who use prescription medications alone [9].

Can you switch from Orlistat to Wegovy?

Perhaps you're taking Orlistat and have had some good initial results, but have been hearing about the promising results of Wegovy as a weight loss treatment.

The good news is, it is possible to make the switch, so long as you meet the eligibility requirements. However, it's vital to take an intentional approach with the guidance of a healthcare provider.

Never abruptly stop or start a medication without consulting a professional, as there's always a possibility of withdrawal or rebound effects.

Similarly, if you've reached your goal weight on Wegovy and are looking to change to Orlistat to maintain your results, be sure to talk to your doctor about your options.

You may also be wondering if you can take Wegovy and Orlistat together. While there are no direct contraindications between these two medications, there is evidence of moderate interactions [10].

As both medications have gastrointestinal side effects, taking the two simultaneously may exacerbate these symptoms — which can lead to a fairly unpleasant experience.

As Orlistat affects fat absorption, it can also interfere with how well Wegovy works (and vice versa).

Wegovy vs Orlistat: Find the right fit with Juniper

Everyone's weight loss journey is unique, and sometimes it requires some experimentation to find the most effective medication for you.

The good news is, you don't have to go it alone. Your prescriber will take your lifestyle, medical history and preferences into account when evaluating potential weight loss treatments, and will be with you every step of the way as your body adjusts.

Ready to get started? Check your eligibility here.

Image credit: Pexels/Tim Samuel