Louis Aronne, MD, is the Sanford I. Weill Professor of Metabolic Research at Weill Cornell Medical College and director of the Comprehensive Weight Control Center at New York Presbyterian Hospital in New York City. He is a former president of the Obesity Society and has been involved in some of the clinical trials for Foundayo (orforglipron).
The injectable weight loss medications Wegovy (semaglutide) and Zepbound (tirzepatide) have been game changers for millions of Americans. But they require weekly injections, and they’re expensive, which means they are out of reach for many patients.
A new drug, Foundayo (orforglipron), was FDA approved in April 2026 for weight loss. It’s a pill that you take once a day. While it’s slightly less effective than the injectable, it’s also more cost-conscious, which makes it a good option for people who want to lose smaller amounts of weight or want a long-term maintenance option.
How does Foundayo work?
Foundayo works in much the same way as the injectable medications. It mimics a natural hormone in your body that regulates your appetite. It activates a receptor called GLP-1, which controls hunger and fullness. As a result, you’ll eat less. But it’s a smaller molecule, which means it’s more easily absorbed by your stomach. That means that you can take a lower dose than you would of say, oral semaglutide, and get similar effectiveness.
Who is a good match for Foundayo?
Foundayo is FDA approved for adults with obesity, or adults who are overweight (a BMI of 27 or higher) with at least one weight related condition such as high blood pressure or type 2 diabetes. We tend to use oral GLP-1 medications like Foundayo in patients with lower BMIs.
Research shows that people lose on average about 11% of their body weight on Foundayo after 18 months. That’s lower than the Wegovy pill or low-dose injection, which is about 15%, as well as the Zepbound injection, which is 20%. But some people find it more convenient to take a pill rather than an injection, and it is less expensive than other GLP-1s on the market.
One option may be for patients to switch to Foundayo as a maintenance therapy after they’ve lost all their weight. My research has found that it seems to help prevent most weight regain, compared to a placebo.
How soon should I expect Foundayo to work?
Foundayo works fairly quickly, and most of the weight loss occurs within the first few months. Patients lose about 5% of their body weight within three months, and patients who go up to the highest dose see about a 10% weight loss after six months. It slows down after that. But at the end of 18 months, patients who took the highest dose of Foundayo lost an average of about 27 pounds, or about 12% of their starting body weight. In general, we like to see patients lose about a pound a week. If it’s more than that, you may be on too high of a dose.
What can I do to increase Foundayo’s effectiveness?
Live a healthy lifestyle. Regular exercise doesn’t cause weight loss, but it will blunt changes in metabolism that occur as you drop pounds. While eating less is the way to lose weight, your body thinks it is going into starvation mode. To compensate, it slows down your metabolism.
Regular activity, including resistance training, builds muscle to counter that effect.
It’s also important to eat plenty of protein to help maintain and build muscle mass. I tell my patients that 100 grams is a good ballpark estimate.
Sleep is important, too. People who slept just an hour and 20 minutes less every night for six weeks gained weight and were less active, according to a July 2026 study published in the Annals of Internal Medicine.
You should also take a regular multivitamin. Since people on Foundayo eat less, they have more of a risk to develop nutrient deficiencies.
How do I take Foundayo?
You take Foundayo once a day, as a pill. It doesn’t matter when you take it or with what. Unlike oral Wegovy, which requires you to be on an empty stomach, you can take Foundayo with food. You’ll start at 0.8 milligrams once a day, then move to 2.5 milligrams after at least 30 days. If you experience side effects such as nausea, your doctor may want you to stay on your current dose until your body adjusts. After that, you’ll move up to 5.5 milligrams, then 9 milligrams, then 14.5 milligrams, then finally 17.2, staying a minimum of 30 days at each step.
You don’t have to get up to the highest dose, either. If you continue to drop pounds on a lower dose, you can stay there until your weight plateaus. The key is to increase your dose gradually so that your body adjusts to the medication.
What’s the best way to manage side effects from Foundayo?
Foundayo’s side effects are similar to other GLP1 medications. The main ones are GI-related and include nausea, vomiting, constipation, and diarrhea. Some of these side effects occur because of what patients eat and the way they eat. GLP-1 drugs tend to relax the lower esophageal sphincter, which is the ring-shaped muscle located where your stomach meets your esophagus. As a result, food and acid rise up again, which can cause heartburn and nausea.
The best way to avoid this is to eat small portions and stop as soon as you feel full. It’s also important to avoid fatty, greasy, or spicy foods, which can irritate the stomach lining. Over-the-counter antacids can also help.
If you are constipated, it’s very important to eat a high fiber diet — at least 25 grams each day. If it’s hard to get enough in, consider a fiber supplement that contains psyllium. Make sure you increase your fluid intake, too. It’s natural to drink less when you eat less, but if you are dehydrated, you are more likely to be constipated.
Finally, I can’t stress enough how important it is to increase Foundayo gradually. When we do clinical trials, we have to raise the dose each month. But that’s not how I practice in real life. If a patient loses a pound a week, there’s no need to increase the dose, especially if they do have side effects.
How should I be monitored when I’m on Foundayo?
Most people on Foundayo have other medical conditions such as high blood pressure or type 2 diabetes, so they need to see their health care provider at least every three months. Since Foundayo, like other GLP-1 drugs, will reduce blood pressure, we like to monitor that carefully. We often need to adjust blood pressure medications. I also screen all my patients for two of the most common vitamin deficiencies — D and B12 — at least once a year.
Is Foundayo safe?
Anywhere from 5% to 10% of patients discontinue Foundayo because of side effects, usually GI-related. Much more rarely, Foundayo has been associated with pancreatitis, or inflammation of the pancreas, as well as gallstones. The more rapid your weight loss, the more likely you are to develop these sorts of serious side effects.
There have been concerns that Foundayo, along with other GLP-1 medications, can cause thyroid cancer. So far, studies have been reassuring. But it is contraindicated for people who have a family history of a certain type of thyroid cancer called medullary thyroid carcinoma, as well as people who have a condition called multiple endocrine neoplasia syndrome type 2 (MEN2).
Is Foundayo covered by insurance?
Unfortunately, not always. It is covered by the Medicare GLP-1 Bridge program, which requires patients to only pay $50 a month. But commercial insurance is less likely to cover it due to cost. Many people need to pay for it out of pocket.
Foundayo itself is less expensive than injectable Wegovy or Zepbound.
Can I take Foundayo if I just want to lose a few pounds?
No. People who are at a healthy weight often want to use Foundayo for cosmetic purposes, but I don’t recommend it. You wouldn’t take a hypertensive medication if you had normal blood pressure, would you? No, because it could cause your blood pressure to drop too low, and cause side effects like dizziness. The exact same problem can crop up with Foundayo. These are serious medications that require you to be monitored frequently by your doctor.
