Both Wegovy and Ozempic contain semaglutide, a GLP-1 receptor agonist. The difference is in their dosage and approved use: Wegovy is the 2.4 mg once-weekly version approved for chronic weight management, while Ozempic is 0.5–2.0 mg once-weekly for type 2 diabetes (though it’s often prescribed off-label for weight loss).

Wegovy consistently delivers around 15% average weight loss over 68 weeks in non-diabetic obesity trials. Ozempic, at its standard doses for diabetes, produces 5–8% weight loss, with the main benefit being blood sugar control.

High-dose oral semaglutide pills (25–50 mg daily) have recently shown Wegovy-like weight loss and superior blood sugar control compared to the current 14 mg tablets, indicating that “oral Wegovy” could be a reality in the near future.

Both drugs also have proven cardiovascular benefits: Wegovy reduced major cardiovascular events by 20% in people with overweight or obesity without diabetes, while Ozempic reduced these events by 26% in high-risk type 2 diabetes patients.

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Weekly Shots: How They Compare

Wegovy (2.4 mg weekly)
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• Weight loss: In the STEP-1 trial, participants lost an average of 14.9% of their body weight at 68 weeks versus 2.4% with lifestyle changes alone. More than half achieved at least a 15% loss.
  
  
• Cardiovascular outcomes: In the SELECT trial, Wegovy reduced heart attack, stroke, or cardiovascular death risk by 20% in non-diabetic overweight or obese patients. Weight loss and blood pressure reductions were sustained for over two years.
  
  
• Tolerability: Gastrointestinal side effects such as nausea and vomiting are common but can be managed with gradual dose escalation.
  
  

Ozempic (0.5–2.0 mg weekly)
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• Glycemic control: Lowers A1C by around 1.0–1.5% and is approved for type 2 diabetes.
  
  
• Weight loss: Produces a 5–8% reduction in body weight in most patients with diabetes.
  
  
• Cardiovascular outcomes: Reduced major cardiovascular events by about 26% in high-risk type 2 diabetes patients.
  
  

Bottom line for shots: For weight loss, Wegovy has the clear edge. For blood sugar control in type 2 diabetes, Ozempic is the labeled choice and still offers moderate weight loss.

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The New Oral Pills

OASIS-1 (Obesity, no diabetes)

• Oral semaglutide 50 mg daily produced 15.1% mean weight loss at 68 weeks versus 2.4% with placebo, matching Wegovy’s injectable performance.
  
  

PIONEER PLUS (Type 2 diabetes)

• Oral semaglutide at 25 mg and 50 mg daily outperformed the current 14 mg dose for both A1C reduction and weight loss, without introducing new safety issues.
  
  

Why it matters: These results suggest high-dose oral semaglutide can deliver injectable-level weight loss, opening the door to an effective, needle-free option.

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Safety and Side Effects
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• Common side effects: Nausea, vomiting, and diarrhea, especially during dose titration.
  
  
• Serious risks: Rare pancreatitis, gallbladder disease, and a boxed warning for thyroid C-cell tumors (contraindicated in patients with a personal or family history of medullary thyroid carcinoma or MEN2).
  
  
• Special considerations: Rapid blood sugar drops can temporarily worsen diabetic retinopathy; careful monitoring is needed in high-risk patients.
  
  

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Which Is Better?
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• For maximum weight loss: Wegovy 2.4 mg weekly—or 50 mg oral semaglutide in trials—delivers the highest average reduction (~15%).
  
  
• For diabetes control: Ozempic provides strong blood sugar lowering and moderate weight loss, with proven cardiovascular benefit in high-risk diabetic patients.
  
  
• For needle-averse patients: Oral semaglutide is available at lower doses now and may soon match Wegovy’s performance once high-dose versions are approved.
  
  

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Market and Policy Angle: Novo Nordisk vs. Eli Lilly

Stock Performance

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Novo Nordisk (NVO)‍

Shares of Novo Nordisk have dropped sharply in recent weeks after the company cut its 2025 guidance amid slower U.S. GLP-1 growth and rising competition from compounding pharmacies and rival products. The decline wiped out tens of billions in market value. While demand remains high, the company is recalibrating expectations and focusing on efficiency.

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Eli Lilly (LLY)‍

Lilly raised its 2025 sales and profit outlook on strong demand for Zepbound and Mounjaro. However, shares pulled back about 10% after trial results for its oral GLP-1 candidate fell short of the most optimistic weight loss expectations, and on broader tariff concerns.

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Tariffs and Their Potential Impact

Policy backdrop: The U.S. administration has floated steep pharmaceutical import tariffs—starting modestly but potentially escalating to 150–250% over time. This has caused short-term volatility in pharma stocks.
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Novo Nordisk:

• Relies on European production for much of its U.S. semaglutide supply.
  
  
• Is investing $4.1 billion in a new plant in Clayton, North Carolina, to expand U.S. manufacturing and reduce tariff exposure. Completion is targeted between 2027–2029.
  
  
• Could face short-term cost pressures if tariffs arrive before U.S. capacity ramps up.

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Eli Lilly:

• Already manufactures a significant share of its U.S. drugs domestically.
  
  
• Announced a $27 billion investment in four new U.S. plants over five years, including active pharmaceutical ingredient and sterile injectable facilities.
  
  
• Well-positioned to weather tariff impacts and potentially benefit from U.S. manufacturing incentives.
  
  

In a high-tariff environment, domestic capacity becomes a competitive advantage. Lilly currently has the broader U.S. footprint, but Novo’s expansion will narrow that gap in the late 2020s. Both companies’ moves are designed to secure supply, protect margins, and support growth as GLP-1 demand continues to surge.