The Ultimate Guide to GLP-1s: Semaglutide, Tirzepatide, Brand Names, Dosing and What Actually Works

The American obesity rate was around 40% in 2023, though a 2025 survey found it dipped for the first time in years, possibly in part because of a revolutionary class of medications known as GLP-1s, which you might’ve heard a lot about.

Centers for Disease Control and Prevention (2024). NCHS Data Brief 508

Gallup (2025). U.S. Obesity Rate Declining

The hype exists for a reason, but it’s also created a storm of information which, while largely helpful, can often be overwhelming or even flat-out harmful in some cases.

It’s useful to have all of the facts before making impactful decisions around your body and health: figuring out which brand names relate to which molecules (like semaglutide and tirzepatide), whether pills or shots are more effective, if branded or compounded medication is safer, and what prices actually make sense.

That’s exactly what this complete guide to GLP-1s by Happyglow covers! Obesity impacts so many aspects of life, from health to appearance; it’s OK to want help, and these medications are highly effective.

What changed recently (as of November 2026)

• July 23: Lilly reported more phase 3 results for retatrutide (after TRIUMPH-1 in May) and plans to apply for FDA approval in early 2027. It is not approved.
• July 1: Medicare’s temporary GLP-1 Bridge began: eligible Part D members pay $50 a month for Wegovy, Zepbound KwikPen or Foundayo.
• April 30: FDA proposed removing semaglutide, tirzepatide and liraglutide from the list of drugs outsourcing pharmacies may compound in bulk.
• April 1: Foundayo (orforglipron), the first GLP-1 pill that isn’t a peptide, approved for weight management.
• March 19: Wegovy HD, semaglutide 7.2 mg, approved. The highest semaglutide dose yet.
• January 13: FDA asked for the suicidal-ideation warning to come off the Saxenda, Wegovy and Zepbound labels after a review found no increased risk.

Which GLP-1 Medications Actually Work?

All of the approved GLP-1 medications cause real, meaningful weight loss. The main differences between the options are cost, dosage, delivery mechanism, and slightly different effects. Let’s look at how the main options compare based on core study data:

Medication (brand)	Mechanism	How it’s taken	Average weight loss in its pivotal trial	Placebo in that trial	Beyond placebo, best result in the 2026 review
Tirzepatide 15 mg (Zepbound)	GLP-1 and GIP	Weekly injection	-20.9% at 72 weeks (SURMOUNT-1)	-3.1%	Up to -19.0%
Semaglutide 7.2 mg (Wegovy HD)	GLP-1	Weekly injection	-18.7% at 72 weeks (STEP UP)	-3.9%	Up to -14.8% (injected semaglutide)
Semaglutide 2.4 mg (Wegovy)	GLP-1	Weekly injection	-14.9% at 68 weeks (STEP 1)	-2.4%	Up to -14.8% (injected semaglutide)
Oral semaglutide 25 mg (Wegovy pill)	GLP-1	Daily tablet	-13.6% at 64 weeks (OASIS 4)	-2.2%	Up to -14.3% (oral semaglutide)
Orforglipron 36 mg, trial formulation (Foundayo)	GLP-1, non-peptide	Daily tablet	-12.4% at 72 weeks (ATTAIN-1)	-0.9%	Up to -12.4%
Liraglutide 3 mg (Saxenda)	GLP-1	Daily injection	-8.0% at 56 weeks (SCALE)	-2.6%	Up to -5.8%

The last column is the fairest comparison: the best result beyond placebo for each medication across the trials in a 2026 systematic review. Individual trial numbers are higher because the placebo group also gets diet and exercise counseling.

Moiz et al. (2026). Annals of Internal Medicine

What the Trials Agree On

That 2026 systematic review of the randomized trials that pulled all of the medications together reached a clear conclusion: GLP-1-based medications reliably produce substantial weight loss. Options are quickly expanding to oral pills, less frequent injections, and medications that act on multiple hormone pathways.

The newest medications are approaching the results of bariatric surgery.

The authors say treatment should be individualized because things like effectiveness and tolerability, as well as secondary effects like blood-pressure benefits, vary between medications. Longer-term safety data is still needed.

Headline numbers can also differ because of how results are reported (people who stayed on the medication vs. everyone who started it), trial length, and preexisting conditions: people with type 2 diabetes consistently lose several percentage points less than people without it.

GLP-1 Brand Names Explained

There are so many names for GLP-1s: molecule names, brand names, upcoming products and fake products. If you’re confused, this chart will help you digest them all.

Molecule	Name for weight loss	Name for diabetes	Form	Made by
Semaglutide	Wegovy (shot), Wegovy pill	Ozempic (shot), Rybelsus (pill)	Weekly shot or daily pill	Novo Nordisk
Tirzepatide	Zepbound	Mounjaro	Weekly shot	Eli Lilly
Orforglipron	Foundayo	Not yet	Daily pill	Eli Lilly
Liraglutide	Saxenda	Victoza	Daily shot	Novo Nordisk, generics available

Is GLP-1 the Same as Ozempic?

GLP-1 is a medication category, and Ozempic is one product within that category.

You can think about this in three layers: GLP-1 is the natural hormone your gut releases after eating, and “GLP-1s” is the broad name for the class of medications overall that mimic that gut hormone.

Semaglutide is one specific molecule in that class of medication, and Ozempic is the brand name Novo Nordisk sells semaglutide under for type 2 diabetes.

So, Ozempic is a GLP-1, but not every GLP-1 is Ozempic.

Tirzepatide (Mounjaro, Zepbound) and orforglipron (Foundayo) are GLP-1 medications too, just different molecules made by different companies.

Semaglutide and Ozempic are the same medication. Wegovy is semaglutide too, just at a different dose range and approved specifically for weight management.

Ozempic became famous first, so people often say “Ozempic” when they mean any GLP-1, like how people say “Kleenex” for any tissue.

Why Does the Same Medication Have Two Names?

The FDA approves a medication for a specific use, not just per molecule overall, so when a company wants the same molecule approved for something new, a new set of trials is done, and the product is usually launched under a new, different brand name.

That’s why semaglutide is both Ozempic and Wegovy, and tirzepatide is both Mounjaro and Zepbound. The differences are the approved use (diabetes vs. weight management), the label and instructions, and the dose range (weight-loss versions sometimes go higher).

Why Is Tirzepatide Called a GLP-1 When It’s a Dual Agonist?

Tirzepatide gets called a “GLP-1” because the term has become shorthand for the entire family of medications built on gut hormones, but technically, tirzepatide is a dual GIP/GLP-1 receptor agonist: it activates two hormone receptors, not one.

GIP (glucose-dependent insulinotropic polypeptide) is basically GLP-1’s lesser-known sibling. Both are released by your gut after you eat, and both tell your pancreas to release insulin when blood sugar is high.

Hitting both seems to add up: in the only head-to-head trial, tirzepatide produced about 6.5 percentage points more weight loss than semaglutide, a GLP-1-only medication.

Is There a Generic?

There is no FDA-approved generic available for semaglutide or tirzepatide; key US patents run into the early 2030s for semaglutide and the mid-2030s for tirzepatide.

There are generic versions of liraglutide available now, making it the cheapest GLP-1 route for some people, though it’s a daily medication and noticeably less effective than the newer medications.

Compounded medications are not generic medications. A generic has been reviewed and approved by the FDA, contains the same active ingredient as the branded version, and has been shown to work the same way in the body. Compounded medications are mixed by a pharmacy and aren’t FDA-approved.

That doesn’t mean compounded medications are bad, but it does mean they’re a different thing. We break down the details in our section on compounded vs. brand-name GLP-1s.

What Is GLP-1?

Glucagon-like peptide-1 (GLP-1) is a peptide hormone your gut (and, to a smaller degree, your brain) releases naturally after every meal, meaning it is essentially a food-triggered signal.

This signal does three main things:

1. Optimizes blood sugar function.
   1. Promotes insulin secretion in a glucose-dependent manner.
   2. Decreases glucagon.
2. Acts on appetite and reward pathways in the brain.
3. Delays gastric emptying.

In practice, digestion slows so you stay full longer, the hormone telling your liver to dump sugar into your blood gets turned down, your pancreas releases more insulin, and your brain is told directly that you’re full, killing hunger and cravings at the source.

You naturally eat less, your blood sugar stabilizes, and your body starts burning more than it takes in. The weight loss follows.

The problem is that the natural GLP-1 your body makes disappears within minutes of being released. Your body produces it, uses it briefly, and destroys it almost immediately after. Not exactly useful as a medication.

So scientists knew GLP-1 was remarkable, but without a way to make it last, it was clinically useless, which is where the research and engineering began, leading to GLP-1 receptor agonists: a class of medications that aim to mimic our natural GLP-1.

Müller et al. (2019). Molecular Metabolism

The Hormone, the Gila Monster, and 40 Years of Engineering

If you’re interested in more GLP-1 history, you can learn about John Eng, a researcher studying the Gila monster, a lizard that may eat only a few large meals a year.

This lizard’s venom contained a peptide remarkably similar to human GLP-1 (same receptor, same signal); it just lasted way longer.

That discovery led to exenatide, the first GLP-1 medication, approved in 2005 and derived directly from Gila monster venom. But scientists didn’t stop there. If a lizard could do it, surely they could engineer something even better from scratch.

Which is exactly what they did: first liraglutide, then semaglutide and tirzepatide, all thanks to a lizard.

Eng et al. (1992). Journal of Biological Chemistry

How Do GLP-1 Medications Work?

GLP-1 medications are engineered copies of the natural hormone, built to resist the enzyme that breaks GLP-1 down within minutes. Instead of lasting a few minutes, semaglutide and tirzepatide last about a week, so one shot keeps the signal on all week.

That steady signal works in four places:

1. The pancreas, insulin side: beta cells release more insulin, but only when blood sugar is high. That “as needed” aspect is why GLP-1s alone rarely cause low blood sugar.
2. The pancreas, glucagon side: alpha cells release less glucagon, the hormone that tells your liver to push sugar into your blood.
3. The stomach: food leaves the stomach more slowly, so you feel full sooner and stay full longer. This is also where most of the nausea comes from.
4. The brain: GLP-1 acts on the appetite and reward centers, turning down hunger, cravings, and the constant background thoughts about food that many people call “food noise.”

The risk of low blood sugar shows up mainly when a GLP-1 is combined with insulin or a sulfonylurea, which is why those doses are often lowered when a GLP-1 starts.

GLP-1, GIP, Glucagon and Amylin: The Hormones Behind the Medications

GLP-1 isn’t the only hormone that affects appetite and blood sugar. Newer medications target two or three hormones at once.

Hormone	Where it’s made	What it does	Where it shows up in medications
GLP-1	Gut, after meals	Raises insulin only when blood sugar is high, lowers glucagon, slows stomach emptying, reduces appetite in the brain	Every medication in this guide
GIP	Upper gut, after meals	Raises insulin after meals and acts on fat tissue	Tirzepatide
Glucagon	Pancreas	Tells the liver to release sugar between meals and raises energy use, including fat burning in the liver	Retatrutide
Amylin	Pancreas, released alongside insulin	Slows stomach emptying, adds fullness and lowers glucagon after meals	CagriSema

Adding glucagon sounds backwards, since GLP-1 lowers it. The idea is that glucagon raises energy use while GLP-1 keeps blood sugar in check.

Why Dosing Is Weekly and Why Change Takes Months

Semaglutide and tirzepatide stay in your body for a long time: semaglutide has a half-life of about a week, and tirzepatide about five to six days, so one shot a week is enough.

It also means the medication builds up gradually: after each dose change, it takes about four to five weeks for the level in your body to settle, which is why titration moves in four-week steps, and why the scale lags behind the dose.

Because of this time lag, new doses and protocol changes need time to show results.

Why GLP-1s Work When Diets Alone Often Don’t

Obesity is a chronic, relapsing disease, and the problem usually isn’t willpower but that your body actively fights to get the weight back.

Diets can work: eat less than you burn, and you’ll lose weight. The hard part is keeping it off as your body pushes back by ramping up hunger and dialing down fullness, which is exactly what GLP-1s help with.

This is called metabolic adaptation: when you lose weight, your body responds as if food is scarce, ramping up hunger and turning down fullness. It’s a survival mechanism that made sense for most of human history. In a world of unlimited food, it’s why diets so often fail. You’re not just resisting temptation; you’re resisting your own biology, every day, indefinitely.

GLP-1s work on that exact problem. They act on the appetite and reward pathways in your brain and slow digestion, so you feel full sooner and stay full longer. Instead of fighting constant hunger, you just want less food. That’s why they succeed where willpower alone struggles.

They also don’t do everything. A meaningful share of the weight lost can be muscle, so protein and strength training still matter. And they don’t replace the basics of eating well; they make those basics far easier to stick to.

The best way to think about a GLP-1 isn’t as a diet you finish. It’s a treatment for a chronic condition, like blood pressure medication, that keeps working as long as you keep using it.

But be clear about what they don’t do. They don’t permanently reset your biology. They work while you take them. When people stop, appetite tends to return, and weight tends to come back: in the STEP 1 extension, people who stopped semaglutide regained about two-thirds of their lost weight within a year.

Wilding et al. (2022). Diabetes, Obesity and Metabolism

Semaglutide (Ozempic, Wegovy, Rybelsus)

Semaglutide is a single GLP-1 agonist (activator) made by Novo Nordisk. This is the molecule behind Ozempic, sold under four brands:

• Ozempic: weekly shot for type 2 diabetes, also approved to lower heart and kidney risk in people with diabetes.
• Wegovy: weekly shot for weight management at higher doses (up to 2.4 mg, or 7.2 mg as Wegovy HD), also approved to lower the risk of heart attack and stroke and to treat a form of fatty liver disease called MASH.
• Wegovy pill: a daily 25 mg tablet for weight management.
• Rybelsus: a daily tablet for type 2 diabetes.

Semaglutide has the longest track record out of the modern GLP-1s and the most outcomes data (trials that measured things beyond weight, like heart attacks and kidney failure).

Core evidence:

• STEP 1: about 15% average weight loss at 68 weeks on 2.4 mg, versus about 2% on placebo.
• STEP UP: the 7.2 mg dose pushed average loss to about 21% at 72 weeks among people who stayed on treatment (about 19% counting everyone), which led to Wegovy HD.
• SELECT: in about 17,600 people with heart disease and overweight or obesity, semaglutide cut major heart events (heart attack, stroke, heart-related death) by 20%.
• FLOW: in people with type 2 diabetes and kidney disease, it lowered the risk of serious kidney outcomes by about 24%.
• ESSENCE: in people with MASH, about 63% saw their liver inflammation resolve on semaglutide versus about 34% on placebo.

Wilding et al. (2021). New England Journal of Medicine

Lincoff et al. (2023). New England Journal of Medicine

Happyglow offers GLP-1 care, giving you access to brand-name GLP-1s directly from the manufacturers themselves, like Wegovy from Novo Nordisk’s pharmacy, NovoCare, with a prescription.

Tirzepatide (Mounjaro, Zepbound)

Tirzepatide is made by Eli Lilly and activates both the GLP-1 and GIP receptors, making it a dual agonist (activator), with two brands:

• Mounjaro: weekly shot for type 2 diabetes.
• Zepbound: weekly shot for weight management, and the first medication approved to treat moderate to severe obstructive sleep apnea in adults with obesity.

Tirzepatide produces the highest average weight loss of any approved option.

Core evidence:

• SURMOUNT-1: about 21% average weight loss at 72 weeks on 15 mg, versus about 3% on placebo. In the three-year follow-up, people with prediabetes on tirzepatide were far less likely to develop type 2 diabetes.
• SURMOUNT-2 to 4: consistent results in people with type 2 diabetes (who lose somewhat less), after an intensive diet program, and in a trial showing that stopping leads to regain.
• SURMOUNT-5: the head-to-head against semaglutide, covered in the next section.
• SURMOUNT-OSA: cut breathing interruptions during sleep by about half or more, which led to the sleep apnea approval.
• SUMMIT: in people with obesity and a type of heart failure called HFpEF, tirzepatide lowered the combined risk of cardiovascular death or worsening heart failure. This is not an FDA-approved use.

Jastreboff et al. (2022). New England Journal of Medicine

Happyglow offers GLP-1 care with our physicians, allowing you to get brand-name tirzepatide like Zepbound as single-dose pens or vials sold directly through Lilly’s pharmacy, LillyDirect.

The four-dose KwikPen, which was approved in February 2026, is also available.

Tirzepatide vs. Semaglutide: How They Differ

For weight loss alone, tirzepatide wins. Tested head-to-head against semaglutide, it came out clearly ahead, producing more weight loss on average.

But “better for weight loss” and “better for you” aren’t always the same thing! Stronger isn’t automatically better, so tirzepatide isn’t for everyone.

Semaglutide has a completed heart-outcomes trial and the heart-risk indication on the Wegovy label, a daily pill, and no birth-control warning; tirzepatide has a sleep apnea approval and bigger numbers.

Lifestyle-wise, both cause the same family of stomach side effects, mostly relating to dose increases. Things like cost, insurance, needles or not, and how much you need to lose also factor into the decision.

Individual variation is another factor that Happyglow can help with in our GLP-1 care program. Some people just respond better to certain medications than others, and switching is always an option.

The “best” GLP-1 is one that fits with your health, history, budget, and goals, and that you can stay on consistently.

GLP-1 Pills: Wegovy Pill, Foundayo, and Rybelsus vs. Injections

There are currently three daily GLP-1 pill options.

1. Wegovy pill: semaglutide, a peptide, so it needs an absorption enhancer and guidelines around empty-stomach timing. At a 25 mg dose, it produced ~14% weight loss on average, which is close to the Wegovy injectable.
2. Foundayo (orforglipron): a small molecule (a different chemical structure from a peptide), so it can be taken at any time, with or without food. It produced ~11% to 12% weight loss in its trial.
3. Rybelsus: an oral semaglutide for type 2 diabetes. The dosages are not interchangeable with the Wegovy pill.

Injections still offer greater results on average, and there is currently no tirzepatide pill. You may also see things like compounded oral versions of semaglutide, which are available from various pharmacies but are not FDA-approved.

Older GLP-1s: Saxenda, Victoza, Trulicity, and Byetta

First-generation GLP-1s, the medications before semaglutide and tirzepatide, may still have a place in treatment, mostly because of cost and insurance rules.

Some insurance plans require you to try an older or generic medication before covering the latest brand-name treatments like Wegovy or Zepbound, something known as step therapy.

• Saxenda and Victoza (liraglutide): a daily shot.
  • Saxenda (3 mg): approved for weight management and produced ~8% average weight loss in its main trial.
  • Victoza: the diabetes version of the same medication.
• Trulicity (dulaglutide): weekly shot for type 2 diabetes with heart outcome data, but only modest weight loss. Not approved for weight management.
• Byetta (exenatide): the original Gila monster medication, a twice-daily shot for diabetes, largely replaced by newer options.

Generic liraglutide is now available, making it the cheapest GLP-1 route for some. For patients paying cash, it can be less expensive, but it is a daily injection and much less effective than the newer medications.

Moiz et al. (2026). Annals of Internal Medicine

Who Qualifies for a GLP-1?

Adult patients with a BMI of 30 or greater, or those with a BMI of 27 or greater with a weight-related condition like high blood pressure, type 2 diabetes, high cholesterol, or sleep apnea qualify for a GLP-1 for weight management.

That’s the standard on the Wegovy and Zepbound labels for adults. Adolescents 12 and older with obesity are also eligible for Wegovy, based on age- and sex-adjusted BMI charts.

In practice, BMI is a useful starting metric, but good medicine goes deeper. A complete medical analysis considers BMI, waist, medical history, health conditions, goals, and what you’ve tried in the past. Things like muscle, body composition, and ethnicity also play a role.

Looking at your health as a whole is something Happyglow works on with you. Our philosophy looks at whether excess fat may be harming your organ health/function and quality of life, differentiating between preclinical obesity (future risk) and clinical obesity (current impacts).

Baseline Checks Before Starting

Before you start, your medical provider checks markers like A1c, lipids, and kidney function, and reviews your medication list; any personal or family history of medullary thyroid cancer or MEN 2; gallbladder and pancreatitis history; pregnancy plans; and eating disorders.

Thinking about treatment? A US-licensed physician reviews your intake online. See weight care options →

How to Get a GLP-1 Prescription Online

Getting a GLP-1 online is similar to in-person medical care, just without a lot of the inconveniences of going to an office.

A brief overview of the process:

1. Complete a medical intake: you answer questions about your health, weight history, medications, and goals, so the physician can see whether you qualify for a GLP-1 under the guidelines above.
2. A US-licensed physician reviews it: they decide whether a GLP-1 is appropriate for you and which one, or recommend something else.
3. Your prescription is sent to a pharmacy: for brand-name Zepbound or Wegovy, this is usually the manufacturer’s own pharmacy: LillyDirect for Zepbound and NovoCare for Wegovy, where you pay their self-pay price directly. Your physician keeps adjusting your dose and checking in as you go.

With Happyglow, the GLP-1 care program’s monthly fee covers your medical care (physician, prescription, dose adjustments, and check-ins); the medication cost itself is paid to the manufacturer’s pharmacy. You won’t be charged unless a licensed physician approves you.

A legitimate telehealth service always involves a real medical review and a licensed pharmacy. Our guide to whether telehealth is safe covers how to check.

How Much Do GLP-1s Cost?

Prices have dropped a lot since 2024 because manufacturers now sell directly to patients at self-pay prices. This is great because now the legitimate, branded medications are becoming more widely accessible at lower prices. This makes risky options like gray-market products much less appealing.

You mainly just need a physician to get a prescription, which is what Happyglow’s GLP-1 care program provides.

Here are the latest self-pay prices directly from the manufacturers (as of November 2026):

Medication	Where you buy it	Monthly self-pay price
Wegovy pen (0.25 to 2.4 mg)	NovoCare	$349 (new patients: $199 for the first two starter-dose fills, through Dec 31, 2026)
Wegovy HD (7.2 mg)	NovoCare	$399
Wegovy pill	NovoCare	$149 to $299, depending on dose
Zepbound vial or KwikPen	LillyDirect	$299, $399 or $449, depending on dose (the $449 price needs a refill within 45 days)
Foundayo	LillyDirect	$149 to $299, depending on dose ($349 on the top doses if a refill is late)

NovoCare (2026). Wegovy pricing

LillyDirect (2026). Zepbound pricing

With Insurance

Coverage for GLP-1 medications for weight loss depends on your insurance plan. Many plans cover them with prior authorization, while others require you to try older medications first. Some exclude these medications entirely.

Ozempic and Mounjaro are often covered, but mainly for type 2 diabetes. Since July 1, 2026, a temporary Medicare program lets eligible Part D members get Wegovy, Zepbound KwikPen or Foundayo for a $50 monthly copay. Things like savings cards, Medicaid, and HSA/FSA will be covered in a future article.

What Happyglow Charges

Happyglow GLP-1 Care is $99 a month for your physician, prescription, dose adjustments, and check-ins.

For brand-name medication, you pay the manufacturer’s pharmacy directly at its self-pay price, and Happyglow doesn’t charge you for the medication itself.

You aren’t charged unless a licensed physician approves you.

Compounded vs. Brand-Name vs. Gray-Market GLP-1s

The exact medication supply chain that went through all of the trials and has all of the official data is brand-name Wegovy, Zepbound, the Wegovy pill, and Foundayo.

These come from the manufacturer directly under FDA oversight and are the default choice.

When Compounding Still Has a Role

Compounded GLP-1s are mixed by a licensed pharmacy and have a role when physicians identify a reason for them, such as when a patient has an allergy to the branded medications or needs a strength that isn’t made commercially.

Unfortunately, price (affordability) has been rejected by the FDA as a clinical need.

Compounded products are not FDA-approved or FDA-reviewed for safety, effectiveness, or quality, and they are not the same as the branded versions. They are still a legitimate path to GLP-1s: licensed, regulated compounding pharmacies are legitimate, and compounded medications still require supervision by a licensed medical provider.

U.S. Food and Drug Administration (2025). FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize

Gray Market

On the other hand, the gray market is when things start to get really bad, really quickly. This is the third supply chain beyond brand-name and compounded GLP-1 products, and one to strictly avoid!

These are GLP-1s sold online as “research peptides,” usually labeled as “not for human consumption,” often using counterfeit pens and compounds that haven’t been approved at all.

As an example, retatrutide (reta) is one of the most promising medications in development, with a phase 2 trial showing ~22% more weight loss over placebo at the highest dose, but it’s not yet approved and cannot be legally compounded.

So while some of these things have a ton of hype, anyone selling this stuff is selling unregulated, unofficial products, and when you buy from these sources, you get none of the usual protections that make these medications safe to use, like verification or responsibility.

• Verification: you have no way of confirming you’re actually getting what the source claims they’re providing to you, let alone whether the product itself is of high quality, or anywhere near safe to put into your body.
• Responsibility: if something goes wrong, who takes responsibility? There’s no medical provider looking after you, adjusting your dose, or watching for adverse reactions or side effects.

And just because something has promising data in trials doesn’t mean it’ll be fully approved either.

U.S. Food and Drug Administration (2025). FDA’s concerns with unapproved GLP-1 drugs used for weight loss

The Happyglow Difference

With Happyglow, you can rest easy knowing you’re getting quality, reputable care. You’ll work only with licensed physicians and legitimate, regulated pharmacies. We’re here every step of the way.

Happyglow’s core GLP-1 products are its branded care package products: Zepbound Care, Wegovy Care, Wegovy Pill Care, and Foundayo Care, at $99 a month, with the medication bought and shipped directly from LillyDirect or NovoCare and prescribed by US-licensed physicians.

Compounded semaglutide and tirzepatide are also offered for patients who choose them, though they are case-dependent and not FDA-approved.

GLP-1 Dosage Charts: Titration, Maintenance, and mg vs. Units

With GLP-1s, everyone starts at a low dose and slowly works their way up in increments, so that the body, specifically the gut, is able to adjust well. The goal is to reach the lowest dose that keeps working for you, not the highest possible. This is done with your medical provider.

Weekly Shots: Zepbound, Mounjaro, Wegovy and Ozempic

Medication	Starting dose	Steps up	Maintenance dose	Maximum
Zepbound (tirzepatide)	2.5 mg for 4 weeks	+2.5 mg after at least 4 weeks on each dose	5, 10 or 15 mg (10 or 15 mg for sleep apnea)	15 mg
Mounjaro (tirzepatide, for diabetes)	2.5 mg for 4 weeks	+2.5 mg after at least 4 weeks on each dose	Set by blood sugar response	15 mg
Wegovy (semaglutide)	0.25 mg for 4 weeks	0.5, 1 and 1.7 mg (4 weeks each)	2.4 mg, or 1.7 mg	2.4 mg
Wegovy HD (semaglutide)	After at least 4 weeks on 2.4 mg	None	7.2 mg	7.2 mg
Ozempic (semaglutide, for diabetes)	0.25 mg for 4 weeks	0.5 mg, then 1 and 2 mg if needed (at least 4 weeks each)	0.5, 1 or 2 mg	2 mg

Missed a weekly dose? For Zepbound and Mounjaro, take it within 4 days; after that, skip it. For Wegovy, take it if your next dose is more than 48 hours away; otherwise skip it. After two or more missed doses in a row, ask your provider before restarting, since you may need to step back down.

Daily Options: Wegovy Pill, Foundayo, Rybelsus and Saxenda

Medication	Starting dose	Steps up	Maintenance dose	Maximum
Wegovy pill (semaglutide)	1.5 mg	4 mg, then 9 mg (30 days each)	25 mg	25 mg
Foundayo (orforglipron)	0.8 mg	2.5 mg, 5.5 mg, then 9, 14.5 or 17.2 mg if needed (at least 30 days each)	Set by response and tolerability	17.2 mg
Rybelsus (semaglutide, for diabetes)	3 mg	7 mg after 30 days, 14 mg if needed	7 mg or 14 mg	14 mg
Saxenda (liraglutide shot)	0.6 mg	1.2, 1.8, 2.4 mg (1 week each)	3 mg	3 mg

U.S. Food and Drug Administration (2026). Drugs@FDA prescribing information

mg vs. mL vs. Units on Vials

Brand-name pens are dialed or pre-set in mg, so those don’t need conversions.

Vials are different, though: you draw the dose with a syringe, and some vials, often compounded ones, are measured with an insulin syringe marked in units, where 100 units equal 1 mL.

The mg dose is universal, but the number of units isn’t, because it depends on how concentrated that specific vial is, and compounded vials vary from pharmacy to pharmacy.

Here is the conversion math:

mL = dose (mg) ÷ concentration (mg/mL). Units = mL × 100.

And an example for a 0.25 mg dose of semaglutide:

Vial concentration	mL to draw	Units on an insulin syringe
2.5 mg/mL	0.1 mL	10 units
5 mg/mL	0.05 mL	5 units

This is the same dose with twice the units, which is why instructions must be followed with care. Always follow the pharmacy’s label and ask if you have any questions.

What to Expect: Timeline, Results and Plateaus

When	What usually happens
Weeks 1 to 4	Appetite and “food noise” drop; mild nausea is most common at this point. Weight will take time to drop.
Months 2 to 6	The dose steps up, and weight loss is at its steepest.
Months 6 to 18	Loss slows and then levels off into a plateau.
After that	The goal shifts to holding the new weight on a maintenance dose.

Months 6 to 18: The Plateau

In major trials, weight loss slowed after about six months and leveled off between 1 year and 18 months, which is expected: your body finds a balance point at a lower weight. It doesn’t mean the medications stop working, and stopping often brings weight back.

Jastreboff et al. (2022). New England Journal of Medicine

Responders and Non-Responders

In the trials, some people lost 25% or more of their body weight, but a smaller group lost less than 5%.

If you’ve been on a full dose for several months with little change, that is something to discuss with your medical provider. Checking adherence and other medications, adjusting the dose, or switching medication can help.

Fat vs. Muscle

Not all the weight you lose is fat either; around 20% to 40% of the total weight lost on these medications is lean mass, which includes muscle.

Getting adequate protein intake and working out, specifically resistance training, helps protect it, which we discuss in the lifestyle section.

Dubin et al. (2024). Diabetes, Obesity and Metabolism

GLP-1 Side Effects and Safety

Every medication has trade-offs, and GLP-1s are no exception: many people who use one will experience side effects, usually mild and in the gut. Serious events are uncommon but real, so it’s important to see the full picture before starting.

We’ll go over what’s common vs. rare, how long it lasts, and what helps, as well as scenarios when GLP-1s might not be a fit for someone in the first place.

The Common Side Effects

Common side effects are largely gastrointestinal (about 76% of people on a GLP-1 vs 40% on placebo) and include:

• Nausea
• Diarrhea
• Constipation
• Vomiting

Most of these cases are mild to moderate and temporary.

How Long Do GLP-1 Side Effects Last?

For most people, side effects follow a common pattern:

• Onset: GI symptoms usually show up in the first few weeks, and often flare again in the days after each dose increase.
• Duration: individual episodes of nausea often last days.
• Long term: side effects are most common during titration (dose increases) and fade for most people once they’ve been on a steady dose for a while.

Only around 10% to 11% of people stopped a GLP-1 in trials due to side effects, vs about 3% on placebo.

Serious but Uncommon Risks

Serious adverse events overall were uncommon in the trials: about 6.5% on medication vs. 5.2% on placebo in pooled data.

Moiz et al. (2026). Annals of Internal Medicine

Who Should Not Take a GLP-1

You should not take a GLP-1 if you have:

• A personal or family history of medullary thyroid cancer or MEN 2
• A previous serious allergic reaction to the medication or its ingredients
• A current pregnancy, or plans to become pregnant soon
• Type 1 diabetes (these medications are not a substitute for insulin)

Those with a history of pancreatitis, gallbladder disease, severe gastroparesis, diabetic eye disease, kidney problems, or eating disorders require caution and closer monitoring. These don’t automatically rule you out, but your medical provider will need to be aware of them.

U.S. Food and Drug Administration (2026). Drugs@FDA prescribing information

Contact your medical provider immediately for severe or persistent stomach pain, especially spreading to the back; pain under the right ribs with fever or yellowing skin; vomiting that stops you keeping fluids down; a lump in the neck or trouble swallowing; swelling of the face or throat; or a sudden change in vision.

Lifestyle on a GLP-1: Protein, Muscle, Alcohol and Sleep

Protein and Resistance Training

As you eat less overall, protein becomes extremely important, since it helps your body maintain muscle.

A 2025 joint nutrition advisory for people on GLP-1s recommended protein at the center of every meal, alongside regular resistance training (think weights, bands or bodyweight exercises, a few times weekly).

Ask your medical provider for a daily protein target; experts often suggest about 1.2 to 1.6 grams per kilogram a day while losing weight, or roughly 80 to 120 grams a day.

Mozaffarian et al. (2025). American Journal of Clinical Nutrition

Alcohol

There’s no direct interaction on the labels, but alcohol can worsen nausea and dehydration, add calories without nutrition, and in people with diabetes can raise the risk of low blood sugar. From an overall health perspective, it might be best to avoid it or drink in moderation.

Interestingly, many patients find they want to drink less while on a GLP-1, and early research is looking at whether these medications could help with alcohol use disorder.

Sleep

Short or poor sleep makes hunger harder to manage and makes it harder to hold on to muscle. Sleep is part of the plan, and if you snore heavily or wake up unrefreshed, ask about sleep apnea, which tirzepatide is approved to treat.

Sleep is such an important aspect of overall health, not just weight. Books like The Circadian Code by Dr. Satchin Panda are great introductions to improving sleep!

Beyond Weight Loss: Heart, Kidneys, Liver and Sleep Apnea

Approved Uses Beyond Weight

• Heart: Wegovy is approved to lower the risk of heart attack, stroke and heart-related death in adults with heart disease and overweight or obesity, based on the SELECT trial’s 20% reduction.
• Kidneys: Ozempic is approved to lower the risk of kidney failure and kidney-related death in people with type 2 diabetes and chronic kidney disease, based on the FLOW trial.
• Liver: Wegovy is approved to treat MASH (a serious form of fatty liver disease) with moderate to advanced liver scarring, based on the ESSENCE trial.
• Sleep apnea: Zepbound is approved for moderate to severe obstructive sleep apnea in adults with obesity, based on SURMOUNT-OSA.

Lincoff et al. (2023). New England Journal of Medicine

These approvals point to something bigger: excess weight affects the heart, kidneys, liver, joints and breathing together, and treating it can improve several of them at once.

Under Study

• Alcohol and addiction: a small 2025 trial found low-dose semaglutide reduced drinking in people with alcohol use disorder. Larger trials are underway.
• Alzheimer’s disease: the large EVOKE trials of oral semaglutide were negative; it didn’t slow cognitive decline.
• PCOS: early studies show improvements in weight, insulin resistance and cycles; not an approved use.
• Asthma and cancer risk: observational studies hint at possible benefits, but these haven’t been confirmed in trials.
• Other health measures: BMI and waist circumference fell roughly in proportion to weight loss. Blood pressure changes were much less consistent between trials.

What’s Next: Emerging, Overhyped and Unproven

Emerging: Retatrutide, CagriSema and the Pipeline

Type	Medication (brands)	Hormones it targets	US status
Single agonist	Semaglutide (Wegovy, Ozempic, Rybelsus)	GLP-1	FDA-approved
Dual agonist	Tirzepatide (Zepbound, Mounjaro)	GLP-1 and GIP	FDA-approved
Dual combination	CagriSema (cagrilintide plus semaglutide)	GLP-1 and amylin	Filed with the FDA, not approved
Triple agonist	Retatrutide	GLP-1, GIP and glucagon	Phase 3 reported, not approved

Liraglutide (Saxenda) and orforglipron (Foundayo) are also single GLP-1 agonists. CagriSema is two separate medications combined in one injection, while tirzepatide and retatrutide are single molecules that hit several receptors.

Overhyped: GLP-1 Patches, Gummies and Supplements

Because of the popularity of GLP-1s, other products have tried to steal the show or take credit for the name, but they often aren’t effective.

Things like GLP-1 patches and gummies sound exciting, but there are no approved versions of these because GLP-1s are peptides: fragile molecules that don’t pass through skin and are broken by your digestive system quickly.

The approved pills only work because they were specifically engineered for it: the Wegovy pill with an absorption enhancer and specific rules for taking it, and Foundayo as a small molecule instead of a peptide.

Now, these supplement products are not always dangerous, just ineffective and overpriced, selling the promise of medication-level results, and that promise doesn’t hold up. While it may be tempting to look at supplements due to cost or more favorable side effect profiles, they just don’t hold up at all efficacy-wise.

Unproven: Gray-Market Retatrutide (GLP-3)

Retatrutide, sometimes referred to as “reta” or “GLP-3”, is not approved as of November 2026: its phase 3 trials have reported, and Lilly plans to apply for FDA approval in early 2027.

Any retatrutide or cagrilintide being sold right now is gray-market and not to be trusted: the FDA says these medications cannot be compounded.

We talk more about this in our telehealth safety article, but the problem with gray-market sellers is that you never know whether the compound you receive is even what they claim it is, regardless of what data currently exists.

Nobody is there to manage your care, answer your questions, and track progress. With Happyglow, you can ask your physician questions, and our physicians are knowledgeable about weight loss. Our software and educational libraries also integrate around you to ensure you have the best care possible at your fingertips.

Alternatives: Other Weight Loss Medications and Bariatric Surgery

GLP-1s are the most effective weight loss medications available, but they aren’t the only option. Older pills and surgery each have a place.

Other Prescription Medications

Medication	How it works	Typical weight loss beyond placebo	Notes
Phentermine	Appetite suppressant (stimulant)	About 3% to 5%	Approved for short-term use; raises heart rate and blood pressure
Qsymia (phentermine + topiramate)	Appetite suppressant + anticonvulsant	About 7% to 9%	Strongest non-GLP-1 pill; birth defect risk requires contraception
Contrave (naltrexone + bupropion)	Acts on appetite and reward pathways	About 3%	Not for people with seizure risk or on opioids
Orlistat (Xenical; Alli over the counter)	Blocks some fat absorption	About 3%	Oily stool and GI side effects common
Metformin (off-label)	Diabetes medication with modest weight effect	About 2% to 3%	Inexpensive; not approved for weight loss

Over-the-counter “fat burners” and weight loss supplements generally have little evidence behind them and aren’t regulated as medication.

Grunvald et al. (2022). Gastroenterology

Bariatric Surgery

Surgery still produces the largest and most durable weight loss. The two most common procedures are:

• Sleeve gastrectomy: removes most of the stomach, leaving a narrow sleeve.
• Gastric bypass: creates a small stomach pouch connected directly to the small intestine.

In a large long-term study, people lost about 25% of their weight five years after gastric bypass and about 19% after sleeve gastrectomy (Arterburn et al., 2018). Current guidelines recommend surgery at a BMI of 35 or higher, and say to consider it at 30 to 34.9 with metabolic disease (Eisenberg et al., 2022).

Combining Surgery and GLP-1s

The two aren’t either-or. GLP-1s are increasingly used after surgery to treat weight regain, and sometimes before surgery to lower risk. As GLP-1s approach surgery’s results, the choice increasingly comes down to how much weight you need to lose, your health, and whether you’d prefer a one-time procedure or ongoing medication.

Building Your GLP-1 Plan

A GLP-1 works best as one part of a plan, not the whole plan. Every good plan has three parts:

1. The medication: the right medication and dose for you, increased at a pace you tolerate.
2. Muscle and nutrition protection: enough protein, resistance training, fiber and fluids.
3. Monitoring and follow-up: regular check-ins on weight, side effects, labs where needed, and how you feel.

What a plan can look like (examples only; ultimately your physician decides):

Situation	A plan might look like
Wants the most weight loss, fine with needles	Weekly Zepbound (tirzepatide), stepped up toward a maintenance dose, plus protein and strength training
Won’t inject	A daily pill: the Wegovy pill or Foundayo
Has heart disease	Wegovy (semaglutide), for its proven heart-risk reduction
Has type 2 diabetes	Mounjaro or Ozempic, often coordinated with other diabetes medications
Has sleep apnea	Zepbound, the only GLP-1 approved for it

Things your physician weighs:

Factor	Why it matters
How much weight you want to lose	Bigger goals may favor tirzepatide; smaller ones may not need the strongest medication
Diabetes, heart disease, sleep apnea or liver disease	Some medications have approvals and outcome data for these
Needles vs. pills	Daily pills are an option if injections are a dealbreaker
Stomach sensitivity	Affects how fast the dose goes up
Birth control pills or pregnancy plans	Tirzepatide and Foundayo affect oral contraceptives; all GLP-1s are stopped before pregnancy
Insurance and budget	Coverage and price can outweigh small differences in results
Age and frailty	Protecting muscle matters more

Troubleshooting, One Thing at a Time

• Side effects: wait a little longer at your current dose, hold a dose, step back down, or switch medication, with your physician.
• Not losing weight: check time on dose first (give a new dose at least four weeks), then consistency, liquid calories and alcohol, and other medications that can cause weight gain. Only then change the dose or the medication.
• Switching: common and reasonable; there’s no official dose conversion, so your physician picks the starting dose on the new medication.
• Stopping: expect appetite to return. In the STEP 1 extension, people regained about two-thirds of their lost weight within a year of stopping semaglutide, and in SURMOUNT-4, people switched to placebo regained a large share while those who stayed on tirzepatide kept losing.
• Maintenance: many people stay on a maintenance dose long term, sometimes a lower one than their top dose, the way blood pressure medication is taken.

Wilding et al. (2022). Diabetes, Obesity and Metabolism