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

Announcer:
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:
Oh my gosh, I can hardly believe it. We have a brand new oral GLP medication on the market called Foundayo. I am not responsible for naming it. Nobody asks me. I don’t love the name, but Foundayo is the newest oral GLP. This is generic name orforglipron and oh my gosh, it’s been wild. I feel like the last couple of months, there have just been announcements after announcements in the weight loss space, looking at all of the new medications that are available. And so let’s talk about the Foundayo and what we saw in the clinical trials. What are the side effects that come up with these medications? What can you expect in terms of cost? Who is a good fit for these medications? Because last week we talked about, should you be switching medications, I want you to have the information that you need to decide, okay, what is the best choice for me?

So I’m going to apologize in advance. A lot of these numbers are relatively new to me because we just saw the FDA approval of this medication on April 1st of this year, 2026. So I’ve got a lot of things jotted down and you’ll see me reference that if you’re watching this in the video version. If you were listening on the audio version, thank you for joining me here. I would love to also have you on my YouTube channel. It’s been fun to grow that over the last couple of months. So if you are not already on YouTube or if you are on YouTube, please do like and subscribe. It really makes a big difference, helps to get my content out there for other people who are looking for good evidence-based ways to support their weight loss goals. One of my, or honestly, my biggest goal in this space is to be a great source of evidence-based medicine. We are living in an era where there are a lot of people who have a lot of opinions about how GLP medications should be used or how they are being used. And I want to be someone who is a source of truth for you. So please like, please subscribe, please share this. It really makes a big difference and I so, so, so appreciate your support. So let’s dive in and talk about this medication, brand name, Foundayo, generic name, orforglipron. So this is a medication. It is an oral GLP medication designed to be taken once per day. Now you’ve heard me talk about before probably the oral Wegovy pill. That rolled out early this year in January. So now just a couple of months later, we’re seeing the approval for the Foundayo medication. So for good or for bad, we’re seeing a lot of comparisons between those two different medications.

And we’ll talk about what these two different ones look like. I think one of the top comparisons that we’ll draw is that even though these are oral pills, they actually look very different. The Wegovy pill is a peptide medication, which all of the GLPs until this point have been or are peptide medications. Because of that protein nature of a peptide, it is broken down really rapidly in the acidic environment of the stomach, and it is hard for these medications to be taken orally. So as such, the oral Wegovy pill is formulated in a way that helps to neutralize the stomach environment. It can’t be taken with other foods, with other medications. You have to take it on an empty stomach, at least 30 minutes before other food, other medications, or anything more than four ounces of water. So it has those restrictions in order to help with the absorption.

Now, the Foundayo orforglipron medication addresses this differently. It’s actually the first non-peptide GLP medication. So it is a small molecule, so the absorption looks different and the absorption is easier. So our body is going to absorb this medication more readily without any restrictions around time of day, about restrictions with food or liquids or medication. So the ease of taking this medication is going to be a lot easier for some people. I have a lot of patients who are taking medications like thyroid medications, maybe acid reflux medications, or other medications that have to be taken already first thing in the morning before food or beverage. And so adding something like the Wegovy pill becomes a very complicated morning routine because now you’ve got multiple pills that you’re spacing out at different times in the morning. So the Foundayo is really nice because this can be taken any time of day. You can take it in the evening, you can take it in the middle of the day. You do want to choose a time of day that you can be consistent with it. And so you can play around with that a little bit. You don’t have to stick around. If you decide you’re going to take it breakfast every day and then you want to switch to dinner, no big deal. You could absolutely do that. Go from taking it breakfast every day and then just switch the next day, start taking it dinner would be totally fine. But day-to-day, you do want to have a routine of what is the time of day that you are taking this medication, but it can be with other medications. It can be with food. It doesn’t have any restrictions in that way. So I think this is really going to be exciting because the oral Wegovy is kind of a pain in the butt from that standpoint.

But let’s talk about what this looks like then from an effectiveness standpoint. So the clinical trials for this medication are called the ATTAIN trials. There were also the ACHIEVE trials that were looking for this medication more specifically from the diabetes standpoint, but the ATTAIN trials were the trials looking at this medication from a weight reduction standpoint. So we are going to talk about that first. And most importantly here, both ATTAIN one and ATTAIN-MAINTAIN are the two trials that I’m going to be talking about most significantly because those are the ones that address the use of this medication for weight loss and for weight maintenance. So really pretty interesting data. Now, one of the things that I will point out is this medication is available in six different doses. So the doses are available in a 0.8 milligram dose, 2.5 milligram, 5.5 milligram, 9.0 milligram, excuse me, 14.5 milligrams, then 17.2 milligrams.

So you do not have to memorize those. Your doctor can look those up or can learn those doses of medication, but there are six doses of medication and they are designed that people who are starting this medication would start at the introductory dose of medication, the 0.8 milligram dose, and that they would take that medication for at least 30 days before moving to the next dose of medication. So those first two doses, the 0.8 and the 2.5 milligram dose are designed as titration doses. Then after that, the 5.5 milligram dose and higher are designed as treatment doses of medication. Any of those doses, assuming that you are starting this medication from scratch, you should be starting at the beginning and be on a dose for 30 days before moving to the next dose of medication. Now, one of the things that someone who’s paid much attention to the data, or maybe you listen to this episode, and then you go do a little internet search and try to learn more on your own, you’ll notice some discrepancies in the numbers that were reflected in the ATTAIN-1 clinical trial versus what is FDA approved.

So what’s interesting is in the ATTAIN-1, they studied three doses of medication, the six milligram dose, the 12 milligram dose, and 36 milligram dose. And you’ll notice those are totally different doses than what I just described in what is FDA-approved. So what was studied in the clinical trials was these medications in a capsule formulation. So the six milligram, the 12 milligram, the 36 milligram, these were capsule formulations. And then Eli Lilly did pharmacokinetic studies, which are studies looking at the pharmacology of how our body absorbs these medications, what is the peak absorption? How long does it last? How is the dose equivalence between different types of formulations of medication? And so they were able to study, okay, if we do a capsule version of medication versus a tablet version of medication, what are the dose equivalents of that? And that’s actually the exact reason we see these differences.

So the six milligram, 12 milligram, and 36 milligram, those are equivalent to the 5.5 milligram, the nine milligram, and the 17.2 milligram. So no reason that you have to learn that or know that information, but you’ll just hear, as I referenced the trials, those numbers are going to be different compared to what we see in the tablet version of medication. So all the FDA-approved medication is tablets. They’re teeny, tiny tablets, as some of my patients have reported to me, and they do not reflect the exact numbers that were studied in the capsules. So what’s interesting in the ATTAIN-1 trial, this was a 72-week trial, and it was a blinded trial, double-blinded, meaning that both the study participants as well as the people, the doctors and the clinicians administering the study, they did not know what dose of the medication the patient was on or if they were on a placebo.
So they studied the six milligram, the 12 milligram, the 36 milligram compared to a placebo arm of patients. These were all patients who had a BMI of 30 or higher or BMI of 27 or higher with a weight-related comorbidity. They titrated the patients to those doses, then continued them on that for the duration of the 72 weeks. Again, patients did not know if they were on placebo or if they were on the medication. If they were on the medication, they didn’t know which dose of medication that they were on. These were unmarked pills that they were taking, and they continued that for the study duration. And they were studying as the primary endpoint, the change in weight. So patients achieving 5% or more total body weight. And then what were the actual weight numbers achieved and weight loss numbers achieved? They also looked at secondary endpoints of changes in weight circumference, changes in cholesterol and changes in blood pressure.

And so they’re measuring all these things during the clinical trial. And then when they look at the results of the trial, what they saw on average was that patients taking the six milligram dose, so that is equivalent to the 5.5 milligram tablet that’s FDA-approved and available. There was an average of 7.8% total body weight loss over that 72-week period. For patients who are taking the 12 milligram capsule, that’s the equivalent of the nine milligram tablet, there was an average of 9.3% total body weight loss. Then for patients taking the 36 milligram capsule, that’s the equivalent of the 17.2 milligram tablet, there was an average of 12.4% total body weight loss. Now, these are the efficacy estimates, meaning that patients who were both assigned to the medication then continued and stayed on in the clinical trial. You may hear different numbers reflected at times because there’s also a data point where patients, the treatment efficacy estimate or patients who were assigned to take the medication but then discontinued for any reason that those patients are still included in the results.

You can imagine if a patient was assigned to take a medication, but then they didn’t actually take the medication or they stopped the medication early, that that would affect the results of the clinical trial. And so we do see that the efficacy estimates look higher than the treatment efficacy estimates. So you may hear numbers like 11.4% is the total amount of weight that people lost. And that number is also true. It’s just a different calculation. But these efficacy estimates are really the best data because it shows us patients who started and continued the medication during that trial. And patients discontinue for a lot of reasons. Sometimes patients discontinue because of side effects, but patients discontinue clinical trials for other reasons as well. So for example, one of the reasons that patients would be in this clinical trial, there are things saying, okay, you can’t take other weight loss medications when you’re in this trial.

You can imagine maybe a patient has been prescribed Zepbound or they’ve been prescribed Wegovy. It would not be appropriate for them to be in a weight loss trial for a medication like Foundayo. And so let’s say that this person did not have coverage for medications, so they entered this clinical trial, maybe they were even feeling like, “Hey, I’m probably in a treatment arm. I feel some effect of this medication.” Then they change employers and they have phenomenal GLP coverage. They go to see their primary care doctor. They’re like, “Oh, did you know that taking Wegovy or taking Zepbound would be $25 per month.” That patient might look at that medication and be like, “Yeah, of course I want to go take this new medication.” So they might drop out for the trial for reasons like that as well. So reasons that people drop out of the trial are for many, many different reasons. Also just, I don’t want to. It’s a pain in the butt to go to the clinical trial site once a month. I’ve got a busy schedule and it doesn’t make sense for me to do this. I don’t want to be part of the clinical trial. People drop out of the clinical trials for all sorts of different reasons. But all that to say, they saw an average of 12.4% on the 36 milligram dose, the equivalent of the 17.2 milligram tablet for patients who started and continued that medication over the duration of the 72 weeks. Now you might hear those numbers and say, “Okay, well, Dr. Stombaugh, 12.4% doesn’t seem like that much weight loss. Is that really that valuable for me? ” And I think this is a really important question for us to address because you have to remember that these are just the average patients who are taking these medications.

So the average is just the average, but those numbers very broadly of patients who lost significant body weight and then patients who lost less body weight. We do know that this is a less potent option compared to Zepbound or compared to Wegovy. But one of the things I like to point out is that for someone who has less metabolic disease, this may actually be the perfect amount of potent for that person. So the person who has a BMI in the upper 20s or the low 30s, for example, the person who has health related conditions and even a BMI of 25 or 24 where you might not be thinking about it, but maybe really significant polycystic ovarian syndrome, PCOS where you’re like, “Hey, this person has very clear metabolic disease and we want to be able to support this person.” The person who has perimenopausal weight gain and has that A1C that’s starting to creep up into the prediabetes range, sometimes those injectable medications like Zepbound and Wegovy are far too potent for the person who has very mild metabolic disease.

So medication like Foundayo, even though it is slightly less potent than these other medications, may actually be the perfect amount of potent depending on the person. Now, certainly too, there’s that ease of taking a pill every single day. A lot of my patients, I remember the conversations I was having five to 10 years ago where I would mention to someone the idea of taking a injection for their weight goals and they looked at me like I had 10 heads. They were like, “What are you talking about? Why would I take a shot? Isn’t there a pill version available?” And then as we’ve seen, oh my gosh, well, actually these medications are incredibly effective. It’s a teeny, tiny pill. There’s a lot of people who take the injection, they like taking the injection, especially Ozempic, Wegovy, Zeppbound, Mounjaro. These are once per week injections. So it’s really nice to only think about it one time per week as opposed to having to think about it every single day.

So a lot of people have really gotten into the routine and now they’re like, “Oh my gosh, a pill, should I or would I take a pill?” And of course it’s a conversation that you should have with your own physician, but that once a day pill option for someone who’s not interested in taking injections, someone who is looking for a little bit more cost affordable option, we’ll talk about that. This is a great choice of medication, and so might be the perfect amount of potent for the right patient. Now, side effects do come up for these medications or did come up for these medications similar to honestly what we’ve seen with a lot of the other GLP medications. So the ones that we see all the time like nausea, constipation, diarrhea, abdominal pain, dyspepsia, GERD or acid reflux, sometimes regurgitation where you feel food coming up, burping or belching, vomiting can come up, the hair loss, dizziness, some of these side effects that we see across other medications as well were common and fairly similar across Foundayo to some of the other medications that we’ve seen.

And so these are ones that you could anticipate headache one I didn’t mention. So ones that we see, but ones that are generally mild, generally well managed. And if it’s not working well for you, if you have a severe side effect, definitely make sure to bring that up with your physician to talk about if you should make a dose adjustment or consider a different medication depending on the side effect that you’re having. But overall, the side effect profile of these medications was generally pretty tolerable and overall mild and improving over time.

Now let’s talk a little bit about cost because this is a question that people have as well. We have seen that we are expecting to see these medications well covered by insurance for people who do have coverage for weight medications. Again, unfortunately that’s not always the case. We do know that many insurers will exclude weight loss medications, which is incredibly frustrating.
We are going to see that change though. Medicare is going to be starting to cover these medications in July of this year, 2026, which is really, really, really exciting. And we’re hoping to see that other commercial insurers follow suit, that this will be part of the standard medical benefit and not an opt-in or opt-out program, which is what it is right now. These medications are available as cash pay starting at $149 for the starting dose of medication, which is 0.8 milligrams, going up to $199 for the next dose of medication at 2.5. Then all of the 5.5 milligram doses and higher are $299 per month. There is an asterisk on those top two doses of medication that they do need to be refilled every 45 days in order to maintain that $299 pricing. So we see, and if you’re familiar with these medications, these prices look very similar or the same right now as what is available for the oral Wegovy pill.

If you’re listening to this way after the fact, any of these numbers may not be relevant. We have seen a lot of price changes across all of the GLP medications over the last couple of years. So I do anticipate that over time we’ll see these come down and down, but these are the prices as of April of 2026. And what we do know is these prices are a little bit more affordable compared to the injectables. So when you talk about Zepbound, when you talk about Wegovy, even at the top dose that $299 is going to show a difference of $50, $150 depending on whether we’re talking about Wegovy, whether we’re talking about Zepbound. And so for the person who is taking Wegovy, the person who is taking Zepbound, they might be thinking, “Okay, well, is this a better, more cost-effective choice for me? ” And this was actually something they studied in the ATTAIN-MAINTAIN trial, which is where they had patients who were in, there was a trial called Sermount-5 where they studied Zepbound versus Wegovy.

Patients were randomized to either of those two medications. They were brought up to the maximum tolerated dose. So for Zepbound, that was 10 or 15 milligrams. For Wegovy, that was 1.7 or 2.4 milligrams. It was open label. So patients did know if they were taking Zepbound or if they were taking Wegovy. They were titrated up to that maximum tolerated dose, then continued on that for the duration of a 72-week trial. Then what they did in the Attain, I keep wanting to say ATTAIN, but ATTAIN-MAINTAIN trial is that patients who finished that SURMOUNT-5 trial were continued if they desire to into the ATTAIN-MAINTAIN trial or patients who were taking that top dose of Zepbound, taking that top dose of Wegovy were brought over to the top dose of Foundayo orforglipron at the 36 milligram dose. Again, that’s the equivalent to the 17.2 milligram tablet.
And they continued on that orforglipron/Foundayo medication for a total of 52 weeks to see, okay, were patients able to maintain the weight loss that they had had during that initial 72-week trial. So I want to share that data from the trial with you. So in this trial, patients who were starting out had an average weight of 250 pounds in the Wegovy arm, an average weight of 255 pounds in the Zepbound arm. So that was before they started Wegovy or before they started Zepbound. At the end of the 72-week trial, patients who were taking Wegovy had an average weight of 209 pounds. Patients who were taking Zepbound had an average weight of 200 pounds, which is what we saw in the trial was that patients taking Zepbound had more significant weight loss compared to patients taking Wegovy. So again, Wegovy was 209. At the end of that 72 weeks, Zepbound was 200 at the end of that 72 weeks.

Then all of those patients were switched to the top dose of orforglipron, the 36 milligrams, which is the equivalent of 17.2 milligrams of the Foundayo tablet. They continued on that for 52 weeks. Now, what’s really interesting is that for patients who had previously been taking Wegovy and switched to the oral Foundayo orforglipron, their weight at the end of that next 52 weeks was 211 pounds, so 209 to 211. Interestingly, this statistically is considered the same number, and you can probably imagine this large bowel movement, feeling a little dehydrated, maybe a little swollen. There are reasons that you can have a slight weight discrepancy like this. So 209 to 11 was considered to be able to maintain the weight from switching from Wegovy to the Foundayo medication orforglipron. For patients who are taking Zepbound in the first 72 weeks and then switched to Foundayo orforglipron, they started out at 200 pounds and then were 211 pounds at the end of that 52-week trial.

So there was some slight weight regain, but again, really clinically significant down from their starting weight of 255 pounds on average. So one of the things we’ve really been talking about, and people have been talking about the use of this medication for weight maintenance because people who’ve been taking those weekly injectables may be able to switch to this daily pill as a great way to maintain their weight loss in an ongoing fashion, and especially for the cost-aware consumer that this medication is more affordable. It’s still expensive. And every time I say it’s more affordable, people come after me and they’re like, “It’s so much money.” And I’m like, “Totally.” And two years ago, these medications were 1,200 to $1,500 per month, so we’re seeing over time that the cost of these medications come down. I feel very confident that someone who listens to this episode in the future is going to be like, “What is she talking about?” Maybe these medications are all covered by insurance now or they’re quite a bit more affordable. And so these prices are slowly coming down over time. And certainly 299, which is that 17.2 milligram dose of orforglipron Foundayo, that is definitely cheaper than Wegovy, which at cash pay is 349 for the top dose of medication or Zepbound, which is 449 for the top dose of that medication. So some decent cost savings that is available for this.

Now, if you were listening to this and you’re like, “Huh, I’m really interested in that Foundayo medication,” definitely bring it up, schedule an appointment with your physician. If you were looking for someone who is experienced with these medications, who wants to support you in a really comprehensive way during your weight journey, I would love to be that person. I see patients in person in Charlottesville, Virginia, and by telemedicine throughout the states of Illinois, Tennessee, and Virginia. If you are interested in working with me, reach out to us at www.sarahstombaughmd.com. You can learn more about our comprehensive weight loss program. If you were outside those states and you’re like, “Shoot, I really wish that I could get this type of information from Dr. Stombaugh.” I do have a great online program called The GLP Guide. At this time, it’s only $149 for a full year of access. So this is just a drop in the bucket compared to the cost of money that you are paying for your medications because I want to be able to support you and how do you titrate these medications? How do you address side effects? How do you travel with these medications? How do you think about these medications and feel really supported on your journey? We have videos that address all of those most frequently asked questions. And the best part is if you have a question that I don’t address in the video and you’re like, “Shoot, I bought this thing. I thought it was going to address my question. I have a question that Dr. Stombaugh did not address.” You could reach out to us and we will record a video just for you and add it to The GLP Guide for you and for everybody else who might also have that question. So it is a growing resource and an excellent way to feel supported in your GLP journey. Thank you so much for joining us for today’s episode. We’ll see you all next time.