Weight loss injections Saxenda, Wegovy, or pills? Which is better?

For many people, the fight against the kilos is a daily challenge. Despite dieting and regular exercise, the scale and the mirror do not always show the desired result.

Those suffering from severe overweight can consider medicinal treatment for weight loss under medical supervision. Medications to support weight reduction are currently a major focus of media attention. This is due, among other things, to new, innovative active ingredients that have been approved for several years but have only recently become available by prescription.
It is important to see them as part of a holistic approach: The basis for the treatment of severe overweight or obesity is always the so-called basic therapy (dietary, physical activity, and behavioral interventions). If a sufficient weight reduction is not achieved with the help of this basic therapy, accompanying medications can support the weight loss.
In Germany, various medications for weight loss are approved, which fall into two main categories: pills and injections. Each of these options has its specific advantages and disadvantages, modes of action, and target groups, which we will examine in the following article:

Medications for weight loss approved in Germany

In Germany, various medications for weight loss are currently available by prescription in the form of both pills (Orlistat) and injections (Liraglutide, Semaglutide, and Tirzepatide).
Agents containing the amphetamine amfepramone, on the other hand, are no longer available and are considered outdated since the European Medicines Agency (EMA) recommended the withdrawal of their authorization due to the risk of serious side effects.
The following medications are approved and intended for effective weight reduction under medical supervision:

Weight loss injections for the treatment of overweight: Semaglutide (Wegovy and Ozempic):

• A GLP-1 receptor agonist that reduces hunger and contributes to weight reduction. Ozempic was originally developed for the treatment of type 2 diabetes and is mainly used to improve blood sugar control in adults with this condition. Wegovy (a higher dose of semaglutide) is specifically approved for weight reduction in adults with overweight or obesity who have at least one weight-related comorbidity. Treatment with semaglutide can lead to significant weight reduction; studies show weight losses of up to 15% of body weight.

Weight loss injections for the treatment of overweight: Liraglutide (Saxenda):

• Also a GLP-1 receptor agonist, which helps to increase the feeling of fullness and decrease appetite. According to studies, an average weight loss of 8% can be achieved with liraglutide. Weight loss with liraglutide reaches a plateau after about one year.

Weight loss injections for the treatment of overweight: Tirzepatide (Mounjaro):

This active ingredient is newer on the market and targets both the treatment of type 2 diabetes and weight reduction in cases of overweight or obesity.

Pills instead of weight loss injections for the treatment of overweight

Orlistat: Available as a prescription medication (Xenical) and in a lower dosage without a prescription (Alli). Orlistat blocks fat absorption in the intestine.

Orlistat: How it works and what side effects to expect

Orlistat was approved in Germany for obesity therapy back in 1998 and works differently than GLP-1 receptor agonists. Orlistat inhibits lipases in the stomach and upper small intestine, meaning triglycerides are no longer broken down into fatty acids and monoglycerides. Fat excretion through bowel movements is increased, resulting in a calorie loss. Put simply, Orlistat preparations bind the fat in the intestine, which is then excreted undigested in the stool.

Orlistat is also available without a prescription under the name Alli, while stronger dosages like Xenical require a prescription. The average weight reduction in clinical studies is approximately 4 kilograms after one year. While Orlistat can be effective in supporting weight loss, the active ingredient is also associated with a number of side effects that mainly affect the digestive system. These side effects can vary and are often dependent on the user's diet – specifically the fat content of the consumed food.
The most common side effects of Orlistat include:

• Digestive problems: These include fatty or oily stools, as undigested fat is excreted from the body.
• Frequent bowel movements: Users may feel an urgent need to go to the toilet, especially after meals with high fat content.
• Flatulence: Can be associated with unpleasant discharge.
• Abdominal pain or discomfort: Some users report abdominal pain or a feeling of discomfort.

• Fatty or oily spotting: Can occur on underwear, indicating the excretion of undigested fat.

Less commonly, more serious side effects can occur, such as impaired absorption of fat-soluble vitamins (A, D, E, and K) and rarely liver damage. Users should ensure they follow a balanced diet rich in fruit and vegetables and potentially take a multivitamin supplement that contains fat-soluble vitamins, though at a different time of day than Orlistat, to ensure the absorption of these vitamins.

Costs and health insurance coverage of weight loss medications

The costs for obesity treatment with medications like Wegovy, Ozempic, or Saxenda can vary depending on the dosage and current availability.
In Germany, coverage for weight loss injections like Wegovy and Saxenda by statutory health insurance is currently very limited. These medications are generally not covered by statutory health insurance because they are classified as "lifestyle medications." This means they are not considered necessary for the treatment of an illness, but rather used to support weight reduction in cases of obesity.
An exception may exist if a patient has serious health problems in addition to obesity, such as type 2 diabetes or cardiovascular diseases. In such cases, a doctor may apply for coverage of the medication, but this is decided on a case-by-case basis and requires a detailed review by the health insurance provider.
For patients who are privately insured, or within the framework of certain corporate health programs, these medications may be partially or fully reimbursed, though this depends heavily on the respective insurance policy.
For most people, however, the option remains to pay for these medications themselves, which, depending on the dosage and medication, can mean costs of several hundred euros per month.
The discussion about potential extended coverage is ongoing, but there are no clear guidelines or changes in sight yet.

Where can you buy weight loss medications?

Medications for weight loss are available in Germany through various channels. It is important to look for reputable sources when purchasing weight loss medications to ensure the safety and efficacy of the product. Prescription medications like Wegovy, Ozempic, Mounjaro, and Saxenda can only be purchased with a prescription from an (online) doctor and are generally available in (online) pharmacies.

Buying weight loss medications without a prescription?

The modern active ingredients for weight loss such as semaglutide, liraglutide, and tirzepatide in injection form are available exclusively by prescription. This is issued only after a medical examination. If medications like Mounjaro, Saxenda, or Wegovy are offered without a prescription, you should pause, as this is likely not a reputable provider.

Non-prescription medications for weight loss, such as low-dose Orlistat capsules, do not have sufficient evidence of efficacy in studies - especially not regarding their long-term effects. This also applies to Formoline L112, Refigura Sticks, XLS Medical Fat Binder, and XLS Medical Carb Blocker. Also available without a prescription are so-called formula diets; well-known products include Almased, Slimfast, and Beavita. These are low-calorie ready-to-drink shakes or powders that are mixed with liquid and replace one or more complete meals. Due to the reduced calorie intake, rapid weight loss (1.5-2.5 kg/week) is possible here with a lot of discipline; nevertheless, medical guidelines recommend using formula diets only for severe obesity and only for a limited time. Otherwise, there is a risk of side effects such as constipation or malnutrition.

Saxenda or Wegovy: What are the differences and similarities?

Both Wegovy and Saxenda are medicinal treatment options used for weight reduction in overweight and obese patients. Both medications belong to the class of GLP-1 receptor agonists, which were originally developed for the treatment of type 2 diabetes. Despite their similarities, there are important differences in their application, dosage, and mode of action. Here is a detailed analysis of the differences and similarities between Saxenda and Wegovy.

Similarities

1. Drug class: Both Saxenda and Wegovy belong to the class of GLP-1 receptor agonists (glucagon-like peptide-1). These medications work by increasing insulin secretion, reducing hunger, and slowing gastric emptying.
2. Mechanism: Both medications mimic the GLP-1 hormone, which is naturally produced in the body and plays an important role in regulating blood sugar levels and appetite.
3. Application: Both Saxenda and Wegovy are administered as injections. Patients inject the medication subcutaneously, usually in the abdominal, thigh, or upper arm area.
4. Target group: Both medications are approved for adults with a Body Mass Index (BMI) of 30 or higher (obesity). They can also be used in adults with a BMI of 27 to 29.9 (overweight) if additional weight-related health problems such as high blood pressure or type 2 diabetes are present.

Differences

Active ingredient:

• Saxenda contains the active ingredient liraglutide.
• Wegovy contains the active ingredient semaglutide, which is also used in a lower dosage regimen under the name Ozempic for the treatment of type 2 diabetes.

Dosage and administration:

• Saxenda is injected daily. The dosage starts at 0.6 mg and is gradually increased to a maintenance dose of 3.0 mg per day.
• Wegovy is injected once weekly. The dosage starts at 0.25 mg and is gradually increased to a maintenance dose of 2.4 mg per week.

Efficacy and study results:

• In clinical studies, Wegovy has shown that it can lead to an average weight reduction of about 15% of body weight.
• Saxenda showed an average weight reduction of about 5-10% of body weight in studies.

Side effects:

• Both medications can have similar side effects, including nausea, vomiting, diarrhea, and constipation. However, due to the different dosage regimens and active ingredient profiles, the frequency and severity of side effects can vary.
• Wegovy tends to have stronger side effects in the first weeks of treatment due to the higher dosage of semaglutide, which, however, can decrease over time.

Market authorization and use:

• Saxenda was approved by the FDA back in 2014 and has since established itself as a reliable medication for weight reduction.
• Wegovy was officially launched in Germany at the end of July 2023 and offers a newer alternative with a slightly different active ingredient profile and dosage regimen.

Conclusion on weight loss injections or tablets

Saxenda and Wegovy both offer effective solutions for weight reduction in overweight and obese patients. The choice between the two medications depends on individual preferences, the body's reaction to the medications, and the recommendation of the treating physician. While Saxenda offers a more constant release of the active ingredient through its daily application, Wegovy allows for more convenient administration through its weekly application and has shown a higher average weight reduction in studies. Both medications should be used under the supervision of a medical professional to achieve the best results and minimize side effects.
The decision to use medications to lose weight should be made as part of a comprehensive approach to improving health and lifestyle. A preparation is only part of the solution. Also essential for your success is a change in diet to a healthy, calorie-reduced nutrition as well as regular physical activity. It is important that the decision for such treatment is made in close consultation with a doctor to evaluate individual health conditions and suitability for the therapy.

Sources

• Wegovy launched in Germany: Pharmalive
• S3 Guideline on Obesity - Prevention and Therapy: DAG e.V.
• Xenical: European Medicines Agency
• Alli (formerly Orlistat): European Medicines Agency
• Semaglutide: Is this medication the "game changer" for obesity?: rnd
• Wegovy weight loss injection: What you need to know about semaglutide: mdr