Wegovy vs Zepbound: Which Should You Choose?
Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide) are the two FDA-approved once-weekly injections for chronic weight management. They differ in mechanism (Wegovy is a GLP-1 receptor agonist; Zepbound is a dual GIP/GLP-1 agonist), in average weight-loss magnitude in pivotal trials, and in real-world cost.
Reader-supported, we may earn a commission through links on this site. Rankings are editorially independent. Disclosure · Methodology
Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide 15 mg) are the two FDA-approved injectable GLP-1 medications for chronic weight management, and they represent the current gold standard in pharmacological obesity treatment. The STEP 1 trial (NEJM 2021) showed 14.9% mean weight loss with Wegovy; the SURMOUNT-1 trial (NEJM 2022) showed 20.9% with Zepbound. No direct head-to-head trial has been published.
Zepbound's efficacy advantage is real and clinically meaningful — approximately 6 percentage points more mean weight loss in separate Phase 3 trials. Wegovy has the cardiovascular outcomes data: the SELECT trial (NEJM 2023) demonstrated a 20% reduction in major adverse cardiovascular events in adults with obesity and established cardiovascular disease. Zepbound's cardiovascular outcomes trial (SURMOUNT-MMO) is ongoing. For most patients without established cardiovascular disease, Zepbound's efficacy advantage makes it the stronger choice if both are accessible and covered.
SkinnyRx
Clinician-guided GLP-1 platform with both compounded and brand-name access plus overnight shipping.
FuturHealth
GLP-1 weight-loss platform combined with personalised nutrition and fitness coaching.
Other GLP-1 Programs to Compare
These reviewed GLP-1 programs have category-matched supplied destinations. They are not presented as a guarantee of Wegovy or Zepbound availability; confirm the medication, insurance, dose, pharmacy, and current terms directly before enrolling.
WellMedr
A multi-category telehealth platform with compounded semaglutide shown from $49/mo and tirzepatide from $89/mo on 12-month plans, plus a 4.6/5 Trustpilot record.
Side-by-Side Comparison
| Attribute | SkinnyRx | FuturHealth |
|---|---|---|
| Program Fee | Included in monthly plan | Included in monthly plan |
| Medication From | From $149 – $449/mo | From $198 – $499/mo |
| Editor Score | 4.3 / 5 | 4.0 / 5 |
| Primary Category | GLP-1 Weight Loss | GLP-1 Weight Loss |
| FDA Brand-Name Access | Wegovy, Zepbound, Ozempic, Mounjaro, Foundayo | Wegovy, Zepbound, Ozempic, Mounjaro |
| Compounded Options | 4 compounds | 1 compounds |
| Adjacent Categories | GLP-1 Weight Loss | GLP-1 Weight Loss |
What the Studies Actually Show
Percentages below are means from the pivotal Phase 3 trials of each medication. The first direct head-to-head comparison was published in SURMOUNT-5 (NEJM 2025); cross-trial comparisons should still be read as directional. Individual results vary; trial populations differed slightly in baseline BMI and comorbidities.
| Endpoint | SkinnyRx | FuturHealth |
|---|---|---|
| Mean weight loss vs placebo (pivotal trial)1,2 | −14.9% at 68 weeks STEP 1 enrolled adults with BMI ≥30 (or ≥27 with a weight-related comorbidity). SURMOUNT-1 used the same eligibility criteria. Trial-design differences mean these figures cannot be directly compared. | −20.9% at 72 weeks (15 mg dose) |
| Placebo arm weight loss1,2 | −2.4% | −3.1% |
| Proportion losing ≥15% of body weight1,2 | 50.5% of participants | 78.0% (15 mg dose) |
| Most common GI side effects (≥10% incidence)3,4 | Nausea, diarrhea, vomiting, constipation | Nausea, diarrhea, vomiting, constipation |
| Cardiovascular outcomes evidence5 | SELECT trial: 20% MACE risk reduction in adults with established CV disease and overweight/obesity | SURMOUNT-MMO trial ongoing |
| Manufacturer | Novo Nordisk | Eli Lilly |
| FDA approval (chronic weight management)3,4 | June 2021 | November 2023 |
The Verdict
Tirzepatide (Zepbound) produced greater mean weight loss in its pivotal SURMOUNT-1 trial than semaglutide did in STEP 1, though the trials are not directly comparable. Semaglutide (Wegovy) has been on the market longer and has a deeper real-world safety dataset, including the SELECT cardiovascular outcomes trial. Choose based on insurance coverage, GI tolerance, and clinician judgment.
Frequently Asked Questions
- STEP 1 Trial. NEJM 2021 · Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021;384:989–1002.
- SURMOUNT-1 Trial. NEJM 2022 · Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022;387:205–216.
- FDA Prescribing Information. Wegovy (semaglutide) · WEGOVY (semaglutide) injection, for subcutaneous use. U.S. Food and Drug Administration prescribing information.
- FDA Prescribing Information. Zepbound (tirzepatide) · ZEPBOUND (tirzepatide) injection, for subcutaneous use. U.S. Food and Drug Administration prescribing information.
- SELECT Trial. NEJM 2023 · Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med 2023;389:2221–2232.
RxNotebook is an editorial publication. Citations point to peer-reviewed journals, FDA labeling, and clinical society guidelines. We are not affiliated with the studies cited above. This page is for general information and is not medical advice.