“It’s just a tablet,” say the scoffers. Why are so many close observers of obesity care expressing such enthusiasm for approval of the first non-peptide GLP-1 oral tablet – the Foundayo brand of orforglipron from Lilly?

Well actually, as one of those observers, we can think of a number of reasons to expect the Foundayo launch will spark yet another transformation in obesity care.

Small Molecule Simplicity

Orforglipron is a small molecule, not a peptide like semaglutide or tirzepatide. That means it is much simpler to make and simpler to scale up. Remember the years of shortage for semaglutide and tirzepatide? That dragged out for so long because of more than the spectacular demand for those amazing drugs. It was also because, as peptides, they were difficult to scale up when demand far exceeded expectations.

With a small molecule, scaling up production is much easier. On top of that, these tablets are easier (and cheaper) to produce at scale than the injection pens that Wegovy and Zepbound require.

Finally, there is the simplicity thing. Taking a dose of orforglipron does not require following fussy rules about taking it first thing in the morning, at least 30 minutes before having any food or breakfast – as Wegovy tablets do. Talking to NPR, obesity medicine physician Cate Varney speculated that this dosing simplicity might even yield better real world outcomes for some of her patients. Simply because it’s easier for them to follow the regimen.

Daily Dosing for the Long Term

To be blunt, taking a daily tablet may suit many people for the long term who just can’t see giving themselves a weekly injection for the rest of their lives. The simplicity of it fits into a daily routine pretty easily. There’s no stash of injection pens in the fridge. Just take it with your multivitamin.

This is important because obesity is a chronic disease that requires ongoing treatment, just like high blood pressure, cholesterol, or diabetes. So people need to stop thinking in terms of short-term weight loss and start thinking in terms of long term obesity therapy to keep it under control. Most people have not yet come to terms with this. A simple daily tablet might make it easier for some of them.

Competition and Access to Care

In no way do we expect Novo Nordisk to take this lying down. Prescriptions for Wegovy tablets are flying out of pharmacies at an impressive rate. So we expect that the added competition of Foundayo will serve to expand the market. That will bring more downward pricing pressure and more people getting access to care. All good.

Watch and Learn

All of this is nothing but well-informed speculation. We will have to see how the effects of the Foundayo launch play out in the real world over time. For obesity, it is the long-term outcomes that matter. We are hopeful that this will spark change that brings better outcomes for many people. Kristina Lewis, a distinguished obesity medicine physician, summed things up nicely for the New York Times:

“People can really start to have good conversations with their doctor about not just what’s the newest medicine, but ‘what’s the right medicine for me?’”

Let’s see where this takes us.

Click here, here, here, here, and here for more on the Foundayo approval.

Per Os, painting of a yawning apprentice by Mihály Munkácsy / Wikimedia Commons