Lose weight with tablets – medical weight loss without injections

How do weight-loss tablets work?

Losing weight with tablets involves using scientifically proven medicines that influence the body’s appetite, sense of fullness, or fat absorption — thereby helping to reduce calorie intake (2). It is important to understand that these medicines are not miracle pills. Medical treatment works best when combined with lifestyle changes, including diet and physical activity (3).

Different types of tablets for weight loss

GLP-1 receptor agonists – influencing blood sugar control and weight loss

The most notable development in weight loss at the moment comes from medicines originally developed for type 2 diabetes, such as GLP-1 receptor agonists. Among these is semaglutide, a substance that improves the body’s ability to regulate blood sugar while also affecting appetite and satiety.

Semaglutide is the active substance in medicines such as Wegovy and Ozempic and is administered by injection. However, the substance is also produced in tablet form in the medicine Rybelsus. The tablets therefore contain the same active substance as the injections, but are taken orally rather than subcutaneously (4).

GLP-1 receptor agonists mimic the hormone GLP-1 (glucagon-like peptide-1), which occurs naturally in the body. GLP-1 is normally released from the small intestine after meals and can influence several central functions in the body’s regulation of satiety, appetite and blood sugar. By enhancing these processes, semaglutide can contribute to several different effects:

• Reduced appetite and increased satiety: The medicine affects the brain’s appetite centre, causing satiety to occur more quickly and to last longer. This leads to reduced calorie intake and can therefore contribute to weight loss.
• Slower gastric emptying: Semaglutide also delays the emptying of the stomach, which stabilises blood sugar levels after a meal and enhances feelings of fullness.
• Improved blood sugar control: Treatment stimulates insulin release at elevated blood sugar levels and suppresses glucagon production, which contributes to more stable glucose levels.

Who can be treated with Rybelsus?

Rybelsus (semaglutide) is a medicine approved for the treatment of adults with type 2 diabetes. It is used as a complement to dietary changes and physical activity when these measures are not sufficient to achieve stable blood sugar control. Rybelsus is currently not formally approved for the indication of obesity (5).

In some cases, however, doctors may consider so-called off-label use if an individual medical assessment shows that the treatment may be appropriate and beneficial. In such cases, the same medical criteria used for weight-management medicines are often applied. This typically involves a BMI of 30 or higher, or a BMI of at least 27 combined with weight-related conditions such as high blood pressure, type 2 diabetes, or dyslipidaemia (3).

Appetite-suppressing tablets that reduce hunger and cravings

Mysimba is an appetite-regulating medicine that contains a combination of naltrexone, an opioid antagonist, and bupropion, a dopamine and noradrenaline reuptake inhibitor.

The medicine works by influencing areas of the brain involved in appetite regulation and the reward system, which can help reduce cravings and increase control over impulsive eating between meals (6,7).

Tablets that reduce fat absorption in the intestine

Medicines such as orlistat (Xenical, Beacita) represent another approach. Instead of influencing the brain, they block roughly 30% of the fat in food from being absorbed in the intestine. This results in reduced calorie intake, as fat contains many calories per gram.

Orlistat does not influence the experience of hunger or fullness, but instead reduces how much dietary fat the body absorbs (8).

Tablets combined with lifestyle changes

Weight-loss tablets are tools — not solutions on their own. They help reduce food intake and increase satiety, but patients still need to make conscious choices around both diet and physical activity. Studies clearly show that the best results are achieved when medicines are combined with dietary counselling and regular physical training (3).

Regular physical activity

Physical activity is an important part of weight-loss treatment. It enhances the effect of medicines, improves metabolism and wellbeing, and reduces the risk of side effects and related diseases.

Recommended forms of physical activity (9):

• Everyday movement: such as taking the stairs, walking or cycling
• Aerobic activity: e.g. brisk walking, swimming or cycling
• Strength training: 2–3 times per week to preserve muscle mass and support metabolism

Training should be adapted to the individual’s health status, circumstances and goals.

Sleep

Adequate and regular sleep is an important part of healthy weight regulation. Poor sleep can affect the hormonal systems that regulate appetite, satiety and energy balance, which in turn can make weight loss more difficult and increase hunger or cravings for energy-dense foods. Maintaining regular sleep habits and prioritising good sleep quality is therefore a central component of a successful and long-term weight-loss programme (10).

Stress

Chronic stress increases cortisol levels and can negatively affect hunger, metabolism and recovery. Because the experience of stress varies between individuals, support and treatment must be tailored (11).

Who is suitable for treatment?

Medical weight loss is safe and effective when used for the right patient under appropriate supervision. A thorough medical assessment by a doctor before starting treatment is essential to ensure both safety and success.

‍

Criteria for when weight-loss tablets are appropriate

Medical treatment with weight-loss tablets is generally recommended for adults with:

• a BMI of 30 kg/m² or higher, or
• a BMI of at least 27 kg/m² who also have weight-related conditions such as type 2 diabetes, high blood pressure or obstructive sleep apnoea (3).

Semaglutide in tablet form (Rybelsus) is approved for adults with type 2 diabetes who do not achieve sufficient glucose control through diet and exercise. It is not formally approved for the treatment of overweight or obesity.

In some cases, however, a doctor may consider off-label use of Rybelsus when deemed medically motivated and safe (5).

Side effects, warnings and precautions for weight-loss tablets

Rybelsus

The most common side effects when using Rybelsus are nausea and diarrhoea. Other common side effects include vomiting, abdominal pain, constipation and bloating. These symptoms are usually mild to moderate and tend to decrease as the body adapts to treatment. Side effects can be reduced by starting with a low dose, being physically active, and eating smaller and more frequent meals (4,5).

Rybelsus should be used with caution in patients with a history of pancreatitis, significantly delayed gastric emptying, or other serious gastrointestinal conditions. It must not be used for type 1 diabetes.

Mysimba

The most common side effects when using Mysimba are nausea, vomiting and constipation. Other common side effects include dizziness and dry mouth (6).

Mysimba must not be used by individuals with certain medical conditions that increase the risk of side effects. These include severely impaired kidney or liver function, uncontrolled high blood pressure, a history of seizures, certain psychiatric disorders, brain tumours, or those undergoing withdrawal treatment from alcohol or certain medicines.

Orlistat

Common side effects are related to the gastrointestinal system and may include loose or oily stools — particularly if the diet is high in fat (8). It is therefore important that people using this medicine adjust their dietary fat intake to minimise symptoms. Orlistat is contraindicated in chronic malabsorption and cholestasis.

The importance of regular medical follow-up during treatment

Regular medical follow-up is essential to ensure that the treatment is both safe and effective — regardless of which medicine is used. During these check-ups, the effect of the treatment is assessed through measurements of body weight and body composition, as well as laboratory values such as blood glucose, liver function and kidney function.

Any side effects must be documented and managed proactively. Between scheduled appointments, patients are encouraged to contact their healthcare team if they have questions, concerns, or notice any symptoms.

If side effects become difficult to manage

If side effects are pronounced or difficult to handle, a doctor should always be contacted for an individual assessment. In some cases, reducing the dose may ease symptoms while maintaining some therapeutic effect. If necessary, the doctor may consider switching to another medicine with a different mechanism of action.

If the side effects persist or are considered serious, treatment may need to be paused or discontinued entirely. Alternative strategies for weight loss can then be discussed with the doctor or healthcare team to find an appropriate treatment plan.

Summary

Medical weight loss in tablet form offers a treatment option for people who wish to lose weight without injections. The medicines work through different mechanisms — some influence appetite and satiety, while others reduce fat absorption in the intestine.

It is important to emphasise that medicines do not replace healthy lifestyle habits. They function as a supplement to changes in diet, physical activity and behaviour. Regular medical follow-up and an individually tailored treatment plan are crucial to achieving safe and long-term results.

With the right support and guidance from healthcare professionals, medical weight loss can contribute to improved health and a better quality of life.

References

1. World Health Organization (WHO) Regional Office for Europe. European Regional Obesity Report 2022. Copenhagen: WHO; 2022. Available from: https://www.who.int/europe/publications/i/item/9789289057738.    
2. Fredrick TW, Camilleri M, Acosta A. Pharmacotherapy for Obesity: Recent Updates. Clin Pharmacol. 2025;17:305-327
   https://doi.org/10.2147/CPAA.S497904
3. Konstantinos C Koskinas, Emeline M Van Craenenbroeck, Charalambos Antoniades, Matthias Blüher, Thomas M Gorter, Henner Hanssen, Nikolaus Marx, Theresa A McDonagh, Geltrude Mingrone, Annika Rosengren, Eva B Prescott, the ESC Scientific Document Group , Obesity and cardiovascular disease: an ESC clinical consensus statement, European Heart Journal, Volume 45, Issue 38, 7 October 2024, Pages 4063–4098, https://doi.org/10.1093/eurheartj/ehae508
4. Knop FK, Aroda VR, do Vale RD, Holst-Hansen T, Laursen PN, Rosenstock J, Rubino DM, Garvey WT; OASIS 1 Investigators. Oral semaglutide 50 mg taken once per day in adults with overweight or obesity (OASIS 1): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2023 Aug 26;402(10403):705-719. doi: 10.1016/S0140-6736(23)01185-6. Epub 2023 Jun 26. PMID: 37385278. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01185-6/abstract
5. European Medicines Agency (EMA). Rybelsus: European public assessment report (EPAR). https://www.ema.europa.eu/en/medicines/human/EPAR/rybelsus
6. European Medicines Agency (EMA). Mysimba – EPAR – summary for the public. [Internet].  https://www.ema.europa.eu/en/medicines/human/EPAR/mysimba
7. Liu Y, Han F, Xia Z, Sun P, Rohani P, Amirthalingam P, Sohouli MH. The effects of bupropion alone and combined with naltrexone on weight loss: a systematic review and meta-regression analysis of randomized controlled trials. Diabetol Metab Syndr. 2024 Apr 24;16(1):93.
   https://pubmed.ncbi.nlm.nih.gov/38658994/
8. European Medicines Agency (EMA). Xenical – EPAR – summary for the public. [Internet]. Published 13 Nov 2008; last updated 10 May 2023 Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/xenical
9. World Health Organization (WHO). (2020) WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240015128
10. Chaput JP, McHill AW, Cox RC, Broussard JL, Dutil C, da Costa BGG, Sampasa-Kanyinga H, Wright KP Jr. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol. 2023 Feb;19(2):82-97. doi: 10.1038/s41574-022-00747-7. Epub 2022 Oct 24. PMID: 36280789; PMCID: PMC9590398.
11. Lengton R, Schoenmakers M, Penninx BWJH, Boon MR, van Rossum EFC. Glucocorticoids and HPA axis regulation in the stress-obesity connection: A comprehensive overview of biological, physiological and behavioural dimensions.
    https://pubmed.ncbi.nlm.nih.gov/39623561/

‍