Which GLP-1 is best for you? What a new efficacy index shows

There is no shortage of GLP-1 medications now, and that is exactly the problem. Ozempic, Wegovy, the oral Rybelsus tablet, the new Foundayo pill, with still more on the way. If you are trying to work out which GLP-1 is actually best for you, a new analysis finally scores them side by side, and not just on the number everyone talks about. It ranks them on your whole metabolic picture.

TL;DR

Researchers pooled 19 trials and 13,117 people to rank GLP-1 drugs with a single score, the Cardiometabolic Efficacy Index, that blends weight loss, cholesterol, blood pressure and blood sugar. Injected semaglutide at a higher 7.2 mg dose ranked first, the new oral pill orforglipron came in a strong second, and the standard Wegovy dose sat in the middle. The real lesson is not that one drug wins. It is that the best GLP-1 depends on which number you most need to move, and this ranking left tirzepatide, the Zepbound and Mounjaro drug, out entirely.

What the researchers actually measured

The analysis was published in Diabetes, Obesity and Metabolism in April 2026. Instead of running a new trial, the team pooled the results of 19 randomised controlled trials covering 13,117 adults with overweight or obesity, then compared the drugs against each other using a network meta-analysis. That is a statistical method for ranking treatments even when they were never all tested in the same study.

Their headline tool is the Cardiometabolic Efficacy Index, or CEI. It is a single score from 0 to 1 that folds together seven separate health measures:

• Total body weight loss, the percentage of starting weight lost.
• Waist circumference, a marker of belly fat.
• HbA1c, your average blood sugar over about three months.
• Systolic blood pressure, the top number on a reading.
• Triglycerides, a blood fat linked to heart risk.
• HDL cholesterol, the protective kind.
• LDL cholesterol, the kind you want lower.

Each drug was ranked on every one of those measures, and the rankings were combined into one number where a higher score means a better all-round metabolic result. Two things matter before you read the scores. First, the study looked only at what researchers call mono-agonists, single-target GLP-1 drugs. Second, it measured risk factors like weight and cholesterol, not hard outcomes like heart attacks, strokes or kidney failure. It tells you how well each drug moves the dials, not how many lives it saves.

Which GLP-1 came out on top

Here is how the main drugs and doses scored on the Cardiometabolic Efficacy Index:

• Injected semaglutide 7.2 mg - 0.86. The clear leader, and also the biggest weight loss in the whole analysis at about 15% of body weight (a mean reduction of 14.91%).
• Orforglipron 36 mg - 0.68. The new once-daily oral pill, sold as Foundayo. A strong second, and the top-scoring pill.
• Injected semaglutide 2.4 mg - 0.66. This is the standard Wegovy dose most people are actually prescribed for weight loss.
• Oral semaglutide 25 mg - 0.63. The higher-dose semaglutide tablet.

One detail is easy to miss and it matters a lot. The drug that topped the ranking, semaglutide 7.2 mg, is a higher dose than the 2.4 mg currently approved for weight loss in Wegovy. It is not what most people are handed at the pharmacy today. When you look at the standard approved dose, the gap between the leading injection and the leading pill nearly disappears.

The caveat that changes how you read this

Before you take semaglutide 7.2 mg as the answer, look at who was not in the race. This study ranked mono-agonists only, and that rule quietly removed the two drugs a lot of people are most curious about. Tirzepatide, the medicine in Mounjaro and Zepbound, works on two receptors at once (GLP-1 and GIP), so it is a dual agonist and it was excluded. So was retatrutide, the triple-agonist still in trials.

That single design choice means you cannot read this as semaglutide beating Zepbound. In fact, when the two have been tested directly against each other, tirzepatide has produced the greater weight loss. We broke that trial down in our piece on how tirzepatide beat semaglutide in the SURMOUNT-5 head-to-head trial, and we compared the wider evidence in semaglutide vs tirzepatide, what the 2026 trials actually show. The new index is best understood as a ranking of the single-target GLP-1 drugs, not the whole field.

A couple of other limits are worth holding in mind. The authors noted substantial statistical variation between trials for several measures, which makes the exact order less firm than a tidy list of scores suggests. And because the CEI captures efficacy only, it says nothing about side effects, tolerability or safety.

Do the pills finally match the shots?

For years the honest answer to "can I get GLP-1 results from a pill" was "not quite." This analysis narrows that gap. The orforglipron pill scored 0.68, essentially level with the standard 2.4 mg injected Wegovy dose at 0.66, and it edged out the oral semaglutide tablet at 0.63. For anyone who dreads a weekly needle, a daily tablet landing that close to the injection is a genuine shift.

Keep two reality checks attached to that. The pill did not match the top-ranked 7.2 mg injection, only the standard dose. And orforglipron is brand new, having reached the market in 2026, so real-world results outside trials are still being gathered. If a pill is the deciding factor for you, our explainer on Foundayo and orforglipron, what patients need to know covers how it is taken and who it suits. Encouragingly, the ranking held up in both people with type 2 diabetes and people without it, with the same drugs on top in each group.

So which GLP-1 is best for you?

Here is the useful part, and the part the headlines skip. A combined score is handy for a league table, but you are not treating seven things at once. You usually have one or two that matter most. That is where the "best" drug shifts depending on you:

1. If your main goal is maximum weight loss: the higher-dose injectables led this index, and tirzepatide, which sits outside it, has beaten semaglutide on weight in direct trials. The heaviest hitters are still injections.
2. If avoiding injections is the priority: the orforglipron pill scored close to the standard Wegovy dose, making a daily tablet a more serious option than it was a year ago.
3. If a specific number is your concern, like blood pressure, cholesterol or blood sugar: the top overall drug is not automatically best for your one measure. A combined index can bury a standout result on a single marker. This is the exact question to bring to your prescriber, backed by your own labs.

The takeaway the researchers themselves point to is that there may be no single best GLP-1 for everyone. That sounds unsatisfying, but it is actually good news. It means the growing menu of drugs is a chance to match the medicine to your body and your goals, rather than everyone chasing the same prescription.

What the score does not tell you

An efficacy index is only half of any real decision, and the missing half is where things get personal. The CEI does not account for how a drug makes you feel or what it costs your body along the way. Three gaps stand out.

The first is tolerability. Nausea, and how well you handle the climb to a higher dose, can decide whether you stay on a drug at all, and this ranking ignores it completely. The second is muscle. Rapid weight loss always sheds some lean tissue, and on these drugs that share can be large, which is why protein and resistance training matter so much. We cover that in what GLP-1 users need to know about muscle loss and protein intake. The third is nutrition. When appetite collapses, so does your intake of vitamins and minerals, no matter which drug delivered the weight loss.

That last gap is the one GLP-1 Shield was built around. Whichever GLP-1 you and your doctor choose, eating far less means the basics get harder to cover, and our guide to the GLP-1 supplement protocol, what to take and how much walks through closing those gaps safely. The right drug and the right nutrition are two separate decisions, and this new score only helps with one of them.

Frequently asked questions

Which GLP-1 medication is best for weight loss?

In this analysis the biggest weight loss came from injected semaglutide at a higher 7.2 mg dose, about 15% of body weight. But the study only looked at single-target GLP-1 drugs and left out tirzepatide, the drug in Zepbound and Mounjaro, which has produced greater weight loss in head-to-head trials. So the best drug for weight loss depends partly on options this ranking did not include.

Is the Foundayo pill as good as the Ozempic or Wegovy shot?

On this combined score the orforglipron pill (sold as Foundayo) reached 0.68, very close to the standard 2.4 mg injected Wegovy dose at 0.66, and it beat the oral semaglutide pill at 0.63. That is efficacy on risk factors like weight, cholesterol and blood sugar, not a promise about how you personally will respond. Individual results and side effects still vary a lot.

Why was tirzepatide (Mounjaro or Zepbound) not included?

This study only ranked mono-agonists, meaning drugs that act on a single receptor. Tirzepatide is a dual agonist that hits both the GLP-1 and GIP receptors, so it fell outside the study's scope, as did the triple agonist retatrutide. That is why you cannot read the results as semaglutide beating Zepbound.

Does the highest score mean it is the right drug for me?

Not necessarily. The index blends seven different measures into one number, so the top overall drug may not be the best for the single thing you most need to improve. It also ignores side effects, muscle loss and nutrition, which is where two drugs with the same score can feel completely different day to day. Use it as a starting point for a conversation with your prescriber, not the final word.