Modern Metabolic Health with Dr. Lindsay Ogle, MD

Oral Wegovy, Explained

• Lindsay Ogle, MD

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0:00 | 21:29

We unpack the new FDA‑approved oral semaglutide for obesity and cardiovascular risk reduction, explaining how it compares to injections, how to take it correctly, and who should or should not choose the pill. We also cut through supplement hype, detail pricing access, side effects, and practical routines that drive results.

• Indications and differences from prior oral semaglutide
• Why SNAC matters and supplements fail
• Access pathways, insurance notes, and current pricing
• Oral vs injectable efficacy and serum levels
• Exact instructions for timing, water volume, and spacing
• Stepwise dosing from 1.5 mg to 25 mg
• Expected weight loss ranges and response rates
• Managing nausea and constipation with simple tactics
• Who benefits from oral therapy and who should avoid it
• Consistency, adherence, and environmental considerations

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Dr. Lindsay Ogle, MD:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, body liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Have you heard of the new oral GLP1 medication that was just approved by the FDA in December for the treatment of overweight and obesity? You've probably heard of WeGOV and OZIMPI. These are brand name versions of injectable semaglutide. These are once-a-week injections. And now there's an oral uigovy that's available for adults with the indication to treat overweight and obesity and prevent the major adverse cardiac events for adults who have cardiovascular disease. We currently do not have the fatty liver disease indication for oral uigovy, but that may be coming here very soon. I want to talk all about dosing and how to take it appropriately and who this might be right for. But first, I want to acknowledge that there previously has been another oral version of semaglutide that was FDA approved for the treatment of type 2 diabetes. This oral semaglutide's brand name is Rebelsis, and it is still currently available, although it is not as commonly used for a couple of reasons. But I want to highlight this because although both rebelsis and oral wigobi are oral versions of semaglutide, there are some important distinguishing factors. So one is their FDA approval. So rebelsis is only approved for the treatment of type 2 diabetes. The other thing is that their doses are different. So the Ouroby GOV has slightly higher doses that are available for treatment and for maintenance of obesity as well as prevention of cardiovascular disease complications. And then the other thing is that the way that the semaglutide is created is slightly different. And this gets into the weeds a little bit, but the important thing is that the version of oral semaglutide that is put together and packaged for the brand name Rebelsis is not as readily absorbed in humans as the version that is packaged into oral weigobi. And the indicators are there's an R1 is related to the Rebelsis, an R2 is related to the oral Wigobi. R2 is better absorbed, so it actually becomes more like activated in the body and more effective compared to rebelsis. And the reason I'm bringing this up is because many doctors, providers, and maybe even patients have some experience with the brand name Rebelsis and may not have the most positive things to say about it because, on average, it is not as effective as the once-a-week injectable version of semaglutide for type 2 diabetes, which would be ozempic. But for Weigovi, the oral version in our trials, we are seeing that the oral version of Weigovi is very similar to the once-a-week injectable version of Weigovi. And we see pretty similar, although a little bit less, just a percentage or two less of total body weight loss, but it's much more comparable than Rebelsus was to Ozimbic on the diabetes side of things. So that's just a brief overview of Oral Weigobi, which is the first and only FDA-approved oral GLP1 medication. I also want to take the time now to emphasize the difference between this FDA-approved version of semaglutide, the oral Wigobi, compared to what you may see marketed to you on social media or online in other spaces as an oral GLP1. It's really important to make this difference because GLP1, glucagon-like peptide, is naturally created in our body after we eat food or taking calories. And our body responds to it and then it rapidly degrades it. And that is what happens if you were to take an typically if you were to take an oral version of semaglutide, if you're going to take a GLP1 supplement. And this SAC will help to prolong the life of GLP1 and keep it in your system so that you continue to have elevated levels of GLP1 rather than, like I said, with your body naturally degrading it pretty quickly. I'm gonna read here because I don't have it memorized, but SNAC stands for sodium in 82 hydroxybenzyl amino caprolate. So it's a very specific, very technical molecule that will help to prolong GLP1 medications. This SNAC is not included in over-the-counter GLP1 supplements. And so when you see those marketed to you, know that they are not very effective. If they were, that would be great, and you know, we would have more options, probably less expensive options to treat overweight and obesity. But unfortunately, that is just marketing right now, and the supplements are not going to be worth your investment at this time. So, as I mentioned, Oral Wagobi was FDA approved in December and it has hit the market as of January 2026. And your insurance may cover this medication if your insurance includes treatment of obesity with anti-obesity medications. But if it is not a covered benefit, then you can get this medication through Novo Care. And they're currently selling this medication for the first two months at$149 per month. And then the price increases to$199 per month. So as of right now in January 2026, this is the least expensive way to get brand name FDA-approved GLP1 medications, is through NovoCare if your insurance does not cover GLP1 medications for the treatment of obesity. Now, I'm not going to go over the details of how GLP1 medications work because I have talked about this in prior videos, and I will link here so you can take a look at those videos and you know have a refresher. But a common question that comes up is how does the oral version of Wigovi compare to injectable version of Wigovi? And as I mentioned earlier, the studies are actually very positive. And when the levels are actually tested for the serum concentrations of the semi-active ingredient, semi-glutide in participants' blood levels, the highest dose of oral Wicovi, which is 25 milligrams, is very equivalent to the highest dose of injectable Wicovie, which is 2.4 milligrams. This is great. The maximum concentration typically occurs about an hour after you take your oral Wicov compared to one to three days after you do your injection of Wicov. It's important to know that there is some variation of absorption of the oral Wicovi, and it is extremely important to know how to correctly take oral Wicov. So I'm going to go over that right now. So this is one of the most important parts of the video or podcast if you're listening on a podcast platform. But to take Wikovi appropriately and to have it actually absorb and become active in your system, you need to take this on an empty stomach. So best to take it first thing in the morning. And it's also important that you only take it with a little bit of water, two to four ounces at a maximum. The more water that you take with it. So if you wake up and have a whole glass of water with your oral weigovi, it'll actually decrease the absorption. So start with a very small amount of water, swallow your weekovy, let it absorb in your empty stomach. You also cannot take other medications with oral weakovi. You need to wait a half an hour before you consume any more fluids, eat any food, or take any other medications. If you do not follow these instructions, then you are not going to get the maximum absorption of your medication and essentially, you know, wasting your money, especially if you're paying out of pocket for this medication. There are four strengths of Ouro Vigobi available. You start at 1.5 milligrams and you're on that dose every day for a month. Then, as long as you're tolerating it well, you will increase to a four milligram tablet, which you were also on for a month. And then, same thing, if you are tolerating it well, then you can go up to a 9 milligram tablet. And then if you're tolerating that well, you can then increase to the maximum dose, which is 25 milligrams. And again, that 25 milligram oral vigovi has been found to be fairly equivalent to the max dose of injectable Wigovi, which is 2.4 milligrams. Expected weight loss of oral Wigovi is about 14 to 16% total body weight, which is very comparable to injectable Vigovi. The people who tend to have a little bit more weight loss are typically the ones who are following those instructions on how to take it more consistently. So that again, that's really important that you take on an empty stomach and avoid eating and drinking or taking other medications for half an hour after you take your oral W. And also some people just respond to medications differently. So there are definitely hyper responders and hyporesponders, but that average is right around that 15% that we had previously seen with injectable W. If we break it down even further, about 80%, so four out of five patients lost at least 5% of their initial body weight, which is what us as obesity medicine physicians deem to be an effective response. So 80% is pretty great there. And then about 30% have been able to achieve 20% or more of their total body weight loss. So about three out of 10 are what we would call hyper responders and lost more than 20% total body weight loss with oral VKOV. The side effects are really, you know, on par with the injectable VGOV, although we don't have to worry about injection site reactions with the oral version. But by far most common is going to be nausea. It's a little bit even more common with the oral version. So very important that you reach out to your doctor if you are dealing with a nausea side effect. The you know main things to do to help mitigate that is starting at that initial dose, staying on the initial dose until you're tolerating it well, very slowly titrating, making sure you're staying well hydrated and avoiding an empty stomach. So after that 30 minutes of time after taking your oral week over, have a breakfast and that'll help um prevent nausea later in the day. And avoiding greasy foods, avoiding overly sugar-sweetened beverages, that'll help um prevent some of the nausea that tends to occur. Also, constipation can be very common on these medications. So again, staying hydrated, making sure you're getting adequate fiber, and then talk to your doctor if you are still struggling with this and you can create a plan to help manage this common side effect. I also have another video all about constipation on a GLP1 medication, which I will also link for you to take a look at. So, who is oral Wigovi great for? It is great for somebody who does not want to inject themselves once a week. Um, this will allow you to get the benefits of your GLP1 without having to do your weekly injection. It's also great for people who are worried about the side effects of a GLP1 and the fact that if you give yourself that injection, you have to wait at least a week or more for it to get out of your system. The oral we gove has a much shorter half-life, and so you can start at that very low dose and make sure that you tolerate it, and then slowly increase your GLP1 medication over time. Um so it's great for kind of dipping your toes into treatment with a GLP1 medication. The injectable GLP1 medications come with a lot of packaging. Um, not only the auto injector pins that they are using each week, but also with the packaging of, especially if it's delivered to your house monthly. Um the oral WIGO V is going to just come in a typical pill bottle and is you know gonna have smaller packaging. So you're having less an environmental impact using oral WeakOV. If you are worried about your environmental impact and you are on an injectable TLP1, I'm gonna link in the show notes below a company who is trying to overcome that and meet that need. And so you can learn more about them in the link below. If cost is a concern to you, as I mentioned, Orogobi is currently the least expensive GLP1 option if you are paying out of pocket. It's less expensive by about$50 a month. So that really adds up over time because we know obesity is a chronic medical condition and requires chronic treatment. So if you are treating obesity, you're gonna probably need to take your GLP1 medication indefinitely. Saving$50 a month is going to be really substantial in the long run. Also, if you like a daily reminder, if in the morning having a routine of taking a medication to help treat your obesity reminds you that you are, you know, on this path and dedicated to the healthy changes that you're implementing, then an oral obe goby is a great option. Last, if you have a chronic skin condition and that it the injection is irritating to you, or you have you know scars in your abdomen from prior surgeries or an injury, and it's difficult to do give yourself those injections or find, you know, um a healthy area of skin to do your injection, an oral form helps you bypass that. And while oral vigobi is a great option for many people, there are a few who should, you know, avoid the oral option. The most important one is somebody who has a history of metabolic and bariatric surgery or any other gastric surgeries that alter the anatomy or would alter the absorption of the medication. As we mentioned earlier, one of the most important things is making sure you're taking the medication appropriately so that it actually absorbs and becomes active in your body. So if you have um, you know, atypical anatomy in your stomach, then you would want to definitely talk to your doctor about that. And the injectable form may be a better option to ensure more consistent and reliable concentrations of Wikovy. Also, if you are somebody who has a lot of morning medications that you need to take, especially if you are on a thyroid hormone like lipothyroxine or centhroid, the thyroid medication also needs to be on an empty stomach, Wikovi needs to be on an empty stomach. That'll really complicate your morning routine. And so that's something to consider if you're taking other medications in the morning. Be realistic with yourself. Are you going to take this medication and time it appropriately? Because if not, then it's truly going to be a waste of money and not a great option. Similarly, if you are somebody who is not a routine person, you are not consistent with your wake time, you just don't think you're gonna remember to take a daily medication, then truly the injectable medication is going to be best for you. Of course, we can set um Alarms on our phone and keep the medication by our bed or by our toothbrush. But if you really don't think that you're going to take the medication every day, then I don't recommend it. Because if you're inconsistent with taking the medication, not only is it not going to be very effective, but you're going to increase your chances of having side effects because you're going to fluctuate to the amount of medication in your system, which will then cause more risk for nausea when you do take the medication. And I don't want that for you. So there you have it, a review of our new oral Vicoli. I think it's wonderful to have more options for my patients to treat their overweight and obesity. There are definitely pros there and cons to this medication. What are your thoughts? Please share them with me. I would love to hear it. And we'll see you next week. Take care. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.