Episode #159: With So Many GLP Options, How Do You Know Which One to Choose?

With so many GLP-1 medications available today, it’s no wonder people feel overwhelmed. Ozempic or Wegovy? The weekly injection or the daily pill? Zepbound? And how do you know which option actually fits your body, goals, lifestyle, and budget?

In this episode of Conquer Your Weight, Dr. Sarah Stombaugh breaks down the most commonly prescribed GLP-1 medications in a clear, practical, and judgment-free way. Instead of hype or headlines, you’ll get real-world guidance to help you understand what matters when choosing a medication and why there’s no single “best” option for everyone.

In this episode, you’ll learn:

• The key differences between popular GLP-1 medications, including Ozempic, Wegovy (injection vs pill), Zepbound, and more
• How effectiveness, side effects, dosing, and cost compare — and what those differences actually mean for you
• Why the “right” medication depends on your medical history, preferences, and long-term goals
• How to think about GLP-1s as part of a comprehensive, sustainable weight-management plan — not a one-size-fits-all solution

If you’ve ever wondered, “Which medication would be best for me?” — this episode is for you.

Ready to get started on your weight loss journey? We’re now enrolling patients for in-person visits in Charlottesville, Virginia and for telemedicine throughout the states of Illinois, Tennessee, and Virginia. Learn more and get started today at https://www.sarahstombaughmd.com

Transcript

Dr. Sarah Stombaugh 0:00

This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer 0:09

Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician, and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh 0:30

And today we are talking about choosing the best GLP medication for you. I am recording this in January of 2026, and this is definitely one of those videos that I'm like, okay, someone's going to watch this in a year or a couple of years even. And like, what is she talking about? There's so many more options, or their prices are totally irrelevant. So it still may be really great information, even if you are listening to this at some point in the distant future. But just be aware that it may not accurately reflect all of the options that are available in the market because it's really exciting. We do have other things coming down the pike, as well as I am going to be talking about prices today, but we've seen a lot of changes when it comes to the prices of these medications. And so those absolutely may not be relevant even like a month or so from now. But let's dive in and talk about all the different options. How do you know which one is the right one for you? Or, you know, what is the best option? And the reality is there are a lot of great options that are out there and it will depend on your individual needs. Now I am going to say during this conversation, there's going to be a lot of demonstrations as I'm holding up different pens and different options and talking through them. So if you are someone who is listening to this on the audio only version, I think I will do a great job of explaining as best that I can. But if you want to check this out on YouTube, that is going to be the best place to see me do the different demonstrations and to see some of those different options available. So today we are going to be talking about all of the medications Ozempic, Wagovi, the Wagovi injection, the Wagovi pill, Zeppound, Manjaro, Sixenda. So let's dive in and talk about these different ones. So as you've probably heard me say or say, heard from other places, these medications, the GLP medications, have been around for a long time. The very first FD-approved medication for the treatment of type 2 diabetes was a medication called Bayetta. It was a twice-a-day injection and it was specifically for type 2 diabetes. It was relatively effective for diabetes, not used as much from a weight perspective. But we've seen as these medications have gotten better, they've gone from twice a day to once a day, now once a week options, at least for the injections. And we've seen how potent and effective these medications have been. They have just taken off in popularity. So let's talk about the different medications that are available. So there are semaglutide medications. Semaglutide is a generic name for the medications that you know is Ozempic and Wagovi. So I do have a Ozempic pen here. And sorry, let me grab it. So the Ozempic pen is semaglutide that is FDA approved for the treatment of type 2 diabetes. It looks like this. It is a multi-dose pen. So every month, someone who had type 2 diabetes was getting this covered by insurance would get a pen that looks like this. It's designed to give four doses of medication. They have to separately get needles that every week, when you're giving an injection, you'd use a new needle. You would dispose of that in a sharps container when you're done. So Ozempic is available for the treatment of type 2 diabetes. And then a couple years later, we saw it available as Wagovi. So this is the Wigovi pen. These are the exact same medication as one another. So Ozempic, Wagovi, exact same medication. Wagovi, when it's given in the injection form as of right now, is available in single pen doses. There are actually multi-dose pens available elsewhere in the world. And so if you're listening outside of the United States, you might be like, why doesn't she know about these multi-dose pens? They're not available in the states as of January 2026. So people who are using Wagovi in the injection form do get these single dose pens. So that looks like every month, when you're getting the prescription, you would get four of these. You would every week inject one. When you're done with it, you would dispose of it in a sharps container. And the next week you would use a new one. And these are the exact same as one another. Ozempic Wagovi, exact same medication. Now, when we think about these two medications, the Wagovi is FD approved for the treatment of weight. But the reality is they're the exact same. So how do we decide between these two? A lot of times it's going to boil down to insurance coverage. If you are someone who has type 2 diabetes, very commonly the GLP medications are covered. That is not always the case. There still be maybe requirements in terms of trialing other medications first, but it is fairly common that there is coverage for type 2 diabetes with the GLP medications. However, for the weight indication, if you have a BMI of 30 or higher, if you have a BMI of 27 or higher with a weight-related comorbidity, that's when we're thinking about using these medications for the treatment of weight. And the coverage of those continues to be spotty. If you're interested in learning more about coverage, we're actually having an entire episode next week where we're talking about the insurance cost, the prior authorization, cash pay, what you can expect in terms of those different options. But not everybody at this time has coverage for medications. At this time, Medicare does not cover these medications at all, although we are anticipating them being covered as soon as April of 2026, which is really exciting. And then we know that right now, insurance companies, commercial insurance, so you get your insurance through the exchange or through your employer, the employers actually opt into or opt out of the treatment of obesity. So even sometimes people who have really good insurance coverage may not have coverage for these medications. So the Wagovi medication can be a really good option, can be very effective. The average person who uses medication has an average weight loss of 15.6% total body weight over the course of about a year in the clinical trials, and people, some of which had more effectiveness, some of people who had less effectiveness, but a really good option. The cash pay prices of these are $199 for the starting doses and $349 for the higher doses of this medication. So it could be a relatively costly thing, but it's a pretty good medication. Now, sometimes, even for a weight perspective, we will use the Ozempic medication. So as you remember, we'll go V, Ozempic, these are the exact same medication, but Ozempic was the one approved for the treatment of type 2 diabetes. Now, as I was telling you, this is designed as a multi-dose pen, meaning that every month when you, or every week rather, when you are going to inject your pen, you there's a little dial here and you'll dial up to your dose of medication and you would dial all the way up and it's going click, click, click, click, click, click, click, and you would dial all the way up. Now, right now it reads 0.5 milligrams. Sorry, it's probably upside down there, reads 0.5 milligrams because this is a demo pen of the starting dose of medication. But one of the really interesting things we can do is actually prescribe a high dose ozembic pen. So someone who is taking a two milligram ozembic pen, if there's four doses of medication in there, then all of a sudden there's eight milligrams of medication in that pen. The cost of an ozembic two milligram pen is $499 per month. So one thing that we can do is we can prescribe that two milligram pen. Again, it has eight milligrams of medication, and then we can have someone do a partial dose of medication. Now, this is definitely something you want to do under the guidance of a physician. But if your physician is willing to prescribe it to you in this way where you take a partial dose of medication, I do actually have a click counting guide on the GLP guide. My online program, the GLP guide, is a great resource for people who are starting out their GLP medication. And especially if you're doing something like this where you're taking a partial dose of the ozempic medication, you want to make sure that you are doing that properly. The amazing thing is, is we can help people to deliver a partial dose of medication. So all of a sudden, a pen that's designed to take, for example, it's going to last for four injections or over the course of about a month, we may be able to help it last quite a bit longer, like two to even eight months. We do want to be careful about the safety of doing that because these medications are not designed to be used for that long of a period of time, but it becomes a very cost-effective option. If you imagine using this over, let's say four months, a $500 pen, all of a sudden, when used over four months, becomes about $125 per month. So even though it sounds pretty expensive at that higher dose, it becomes a really cost-effective option. So we can switch between these medications, Ozempic will go the exact same. We can anticipate very similar weight results from them because they are the same medication. And as with any of these medications, we're starting at the lowest dose and we're titrating up over time to effectiveness. Now, the biggest challenge with these semaglutide medications is that they do have some side effects. All of these medications do, uh predominantly nausea and constipation are the ones that I see come up the most commonly with my patients. I do like to really make sure that we have, especially that constipation piece, well managed before we're titrating up to the next dose. And we're making that decision to move to the next dose when we're seeing that weight loss is not progressing. So we're not seeing the movement on the scale, maybe the effectiveness and the way the medication is feeling in your body, as well as from a side effect standpoint, we want to make sure that those are adequately managed before we move up to the next dose of medication. But either Ozempic or Wagovi, great options, a really good option for many, many people. Now, when we look at the Wigovi pill, I did have a great episode on that last week. If you haven't had a chance to check that out, we talk about all about the Wagovi pill, but that is another great option that was just released earlier this month in January of 2026. And the Wagovi pill is now available as a once daily medication. So if instead of taking an injection, you prefer to take a pill, that is a great option as well. And from a side effect standpoint, from an effectiveness standpoint, it's really pretty similar to the Wagovi injection. So whether we're talking about osempic, wagovi injection, or ragovi pill, those are all very similar options to one another. And we can pretty easily switch between those also if we need to do that. As we move on to other medications, next we're going to be talking about Zeppound. Zeppound at this time is the most potent medication on the market. I don't have a demo pen for the Manjaro here with me right now, but Manjaro and Zeppound are the exact same medication. Manjaro is for the treatment of type 2 diabetes, whereas Zeppound is for the treatment of weight reduction, does have a second indication for the treatment of sleep apnea for moderate or severe sleep apnea. I didn't mention for Ragovi, it also has an indication for cardiovascular disease as well as fatty liver disease. So we do see it used for those indications as well. But these are both the Manjaro and Zeppound, are both terzeptide products. A lot of times they're talked about in the same category of medication as a GLP medication, but the reality is these are GLP slash GIP receptor agonists. So it's targeting two different receptors, the GLP and the GIP receptors. And that can be really good in terms of having more potent effect. The GIP, I like to think of it as further potentiating the effects of the GLP. So people will notice more significant appetite suppression. When we look at the average weight loss over the course of 72 weeks, a little bit longer of a trial, patients on average lost 15% on the lowest weight or on the lowest dose, rather, the 5 milligram treatment dose, they lost 19% on the 10 milligram dose, and they lost 20% on the 15 milligram dose of medication. So certainly more potent of a medication. We also generally see that the side effects of this medication are a little bit better. I commonly see that people may still have nausea, they may still have some of that constipation coming up. Diarrhea is a little bit more frequent on this medication, partially because of the effect of that other receptor, but a lot of people find that their side effects from the Zetbound or Monjaro medication are a little bit less compared to if they were on the semaglutide medications like Ozempic or Rogovi. So honestly, the Zet Bound can be a really great choice because it is so potent and it really is a nice option, both in terms of potency as well as in terms of side effects. At this time, the cost of this is a little bit higher. And if you have insurance coverage, you can be looking at getting the pens. If you don't have insurance coverage, they actually have a vials program. So if you look at this, you will notice that this does say Zetbound on us. So this is brand name Zetbound, similar to the injection. These are the exact same medication, but available in two different forms. So when you're thinking about the cash pay Zetbound option, you're thinking about the Vials program. The cash pay option for that is $299 for the starting dose of 2.5 milligrams, $399 for the five milligram dose, and $449 for the 7.5 milligram dose and higher. So this is a great option as well. While it's not recommended, you could in theory split the doses of medication. So there are people who may take a partial dose of medication, which may make it more cost effective. But especially as we're looking at higher doses of medication, we have to be really careful about that because they do require that you refill every 45 days in order to keep the medication coverage at that 449 or at least to maintain that 449 pricing. But zip-bound medication, great option. If it's covered by insurance, that's a great way to go. And then from a cash pay option, really the most effective option, especially if we're looking at someone, maybe they are looking for a good potency medication. WillGovi is maybe covered or more cost-effective option. So we can start them on Willgovi, bring them up to the top dose over time as they respond to it. And then if we need more potency, we can bring them over to an intermediate dose of Zebound and continue to increase their dose from there. So we think of it as a little bit more potent of a medication. Now, on the other hand, are people who don't need as potent of a medication? You hear a lot of conversations around microdosing, for example. And while microdosing with Ozempic or Zipbound or any of these things may absolutely make sense, my favorite option for people who need less potent effect is actually the Succenda medication. So Sixenda is an oldie but goody. This is a once per day injection, which may turn off some people, but the reality is can be a really great fit for the right person. I will very commonly prescribe this for someone who has a much less significant weight loss goal, maybe much less significant metabolic disease. So especially for the person maybe has perimenopausal weight gain, someone who has a BMI in the upper 20s, so in the range of 25 to 29, this can often be a really good option. It is a once per day option. So that can be, you know, have to get into the routine of doing that every single day. But we also don't see any sort of wearing off effect of this medication. So people really like it for that reason. The lowest dose of this medication is 0.6 milligrams, then it can be titrated all the way up to a three milligram dose. Now, the best part about Sixenda is that even though Sixenda is pretty expensive, it has been available in generic form over the last year. So it took a little bit of time for it to really get going. We've seen it available locally in my market just in the last six months or so. But generic lyric lutide, and I'm talking about not compounded medication, I'm talking about going to your CVS, Walgreens, you know, Costco pharmacy, whatever your local pharmacy is, and getting generic lyri glutide, you can get that over the counter starting at about $80 if you're on the starting dose of medication. So people are able to get this at a pretty cost-effective option. And this is my favorite option for people who may not meet traditional criteria for coverage of the medication. Patients who have early metabolic disease, like I was saying, someone who maybe has 20 or 30 pounds to lose, but does have those signs of elevated blood sugar, maybe elevated cholesterol, elevated liver enzymes, this can be a really excellent medication without being too potent. Now it can still have some side effects, nausea and constipation being the most common, but the side effects are less significant because it is that slightly less potent of a medication. So definitely make sure to consider this as an option, either brand name sucenda or generic luriglutide, excellent option for people with less significant metabolic disease. And lots of things that are coming out. So we've got these four different medications that we're talking about today. That's really exciting to see what's coming down the pike. We know there's going to be another oral GLP on the market likely later this year, a more potent medication called Redatru Time coming on the market end of this year, beginning of next year. So this market is just changing all of the time. If you want to get updates, I want to make sure that you follow me. Like and subscribe if you're following me on YouTube. Share this with someone who would benefit from this information. Thank you for joining me for today's podcast. I'll see you all next week.