GLP-1 medications dominate the conversation, but they are not the only treatment for obesity, and for a substantial number of people they are simply unaffordable, unsuitable, or intolerable. This guide covers what else exists — older prescription medications, newer oral agents, behavioural programmes, and surgical options — what the evidence shows for each, and how to think about the trade-off between a treatment that produces more weight loss and one you can actually sustain.

Quick Takeaway:

• Non-GLP-1 prescription options include orlistat, naltrexone/bupropion, and phentermine/topiramate combinations
• Oral options typically produce 5%–10% weight loss versus 15%–20% for injectable GLP-1s — but cost a fraction as much
• Oral GLP-1s are now available: oral semaglutide and orforglipron (Foundayo)
• Structured behavioural programmes produce meaningful results and address what happens after medication
• Bariatric surgery remains the most effective and most durable intervention for severe obesity

Looking for a Better Alternative?

If GLP-1 therapy is right for you, cost should not be the barrier. CoreAge Rx is our top-rated favorite for GLP-1 weight loss therapy, combining competitive pricing with exceptional customer service, faster medication delivery, and more comprehensive support resources.

Why we recommend CoreAge Rx:

• Lower monthly costs than most competitors ($179–$399 range)
• Faster prescription approval (typically 12–24 hours)
• More extensive provider support included at no extra charge
• Better medication availability during shortages
• Higher patient satisfaction scores (4.7/5)

New Patient Special: Save up to $200 on your first three months. Same-day prescription approval for qualifying patients. Rated 4.7/5 stars by verified customers. No insurance required.

Oral GLP-1 Medications

The newest development is that GLP-1 therapy no longer requires injection.

Oral semaglutide is available as the Wegovy Pill, offered by Sesame from $149/month, Hims & Hers, ZAVA, and Boots. ZAVA's guidance indicates patients on 7.5 mg or higher Mounjaro can usually switch to the maximum maintenance dose of the pill.

Orforglipron, marketed as Foundayo, is Eli Lilly's oral GLP-1 and a different molecule from semaglutide. Lilly rolled it out through LillyDirect, Amazon Pharmacy, telehealth providers, and pharmacies. Second Nature offers a Foundayo programme at £129–£179 per month in the UK — notably cheaper than its injectable programmes.

For anyone whose barrier is needle aversion rather than cost, this is the most important recent development in the field.

Older Prescription Options

These predate the GLP-1 era, produce more modest results, and cost dramatically less.

UK availability is broad and cheap: Asda Online Doctor prescribes orlistat, Xenical, Mysimba, and Alli from £39.99 per month. In the US, Nurx offers oral treatment plans with cash pricing reported from around $60 per month, and LifeMD offers an off-label "Triple Therapy" combining metformin, bupropion, and topiramate.

Important: A treatment producing 6% weight loss that you sustain for two years does more for your cardiometabolic health than one producing 18% that you abandon after three months because of cost. Ten percent weight loss is the threshold at which most obesity-related comorbidities begin to improve meaningfully — and several of these options can reach it.

Structured Behavioural Programmes

Behavioural intervention is not a consolation prize. It is the foundation on which every anti-obesity medication is licensed — both semaglutide and tirzepatide are indicated as an adjunct to a reduced-calorie diet and increased physical activity.

Programmes with published outcomes include:

• Second Nature — registered dietitian-led; reports 77.7% of participants achieving at least 10% weight loss at twelve months
• Oviva — NHS-commissioned, free via GP referral, with dietetic and psychological support over up to two years
• Noom Med — cognitive-behavioural curriculum with human coaching
• Omada Health and Teladoc — frequently free through employers
• Embla — sells coaching standalone at £110/month, without medication

That last option deserves emphasis. If you obtain medication through the NHS or a cheap pharmacy, buying behavioural support separately is often better value than switching to an all-in-one programme.

Bariatric Surgery

For severe obesity, bariatric surgery remains the most effective and most durable intervention available. Typical procedures — sleeve gastrectomy and Roux-en-Y gastric bypass — produce weight loss substantially greater than any medication, with long-term follow-up data on diabetes remission and mortality reduction that pharmacotherapy cannot yet match.

Eligibility typically requires a BMI of 40 or above, or 35 or above with significant comorbidities, though thresholds are lower in some guidelines and for some populations. In the UK this is NHS Tier 4, generally accessed after Tier 3 specialist weight management.

Surgery carries operative risk, requires lifelong nutritional supplementation and monitoring, and is not reversible in the case of bypass. It is also, for the right patient, the intervention with the strongest evidence base in the entire field.

Non-Medical Foundations

None of the above works without these, and all of them are free:

• Protein intake. Adequate protein preserves lean mass during weight loss, whatever the method.
• Resistance training. Two to three sessions weekly is the primary stimulus for retaining muscle in a deficit.
• Sleep. Short sleep duration is independently associated with weight gain and impaired appetite regulation. See our article on sleep and immune function.
• Alcohol. Energy-dense, appetite-disinhibiting, and frequently the largest single modifiable intake.

Frequently Asked Questions

What can I take instead of a GLP-1 for weight loss?

Options include orlistat (Xenical, Alli), naltrexone/bupropion (Contrave, Mysimba), phentermine/topiramate (Qsymia), and off-label metformin. Oral GLP-1s — oral semaglutide and orforglipron (Foundayo) — are also now available for those whose barrier is injection rather than the drug class.

How much less effective are the older medications?

Considerably. Orlistat produces around 5% weight loss, naltrexone/bupropion around 5%–9%, and phentermine/topiramate around 8%–10%, versus roughly 15% for semaglutide and up to 20%+ for tirzepatide at maximum doses. They also cost a fraction as much, which matters if the alternative is no treatment at all.

Is there a GLP-1 pill?

Yes. Oral semaglutide is available as the Wegovy Pill, and Eli Lilly's orforglipron is marketed as Foundayo, distributed through LillyDirect, Amazon Pharmacy, telehealth providers, and pharmacies.

Do behavioural programmes actually work without medication?

Yes, though results are more modest on average. Second Nature reports 77.7% of participants achieving at least 10% weight loss at twelve months in its published research, and NHS-commissioned services such as Oviva provide up to two years of dietetic and psychological support at no cost to eligible patients.

When should I consider bariatric surgery?

Typically at a BMI of 40 or above, or 35 or above with significant comorbidities, though thresholds vary by guideline and population. It produces the greatest and most durable weight loss of any intervention, with the strongest long-term outcome data, but carries operative risk and requires lifelong nutritional monitoring.

What if I can't afford any medication?

Adequate protein intake, resistance training two to three times weekly, adequate sleep, and reducing alcohol are free and underpin every medical treatment. In the UK, ask your GP about NHS Tier 3 weight management. In the US, check your employer benefits — programmes like Omada and Teladoc are frequently free to members.

Bottom Line

GLP-1s are the most effective pharmacological option currently available, and if you can access and tolerate them they are a reasonable first choice. But the field is wider than the headlines, and the best treatment is the one you can sustain.

If cost is the barrier, a £40 tablet or a $60 oral combination is a legitimate treatment, not a failure. If injection is the barrier, oral GLP-1s now exist. If you have severe obesity, surgery has better long-term evidence than any drug. And if you qualify for an NHS or employer programme, that is almost certainly better value than anything you would buy privately.

Ask about all the options, not just the ones being advertised to you.

If GLP-1 therapy is right for you, CoreAge Rx offers all-in monthly pricing from $179–$399 including medication, provider messaging, and titration support. 12–24 hour approvals. Save up to $200 on your first three months.

Medical disclaimer: Informational only, not medical advice. All medications discussed carry risks and contraindications, and several are used off-label. Bariatric surgery carries operative risk. Consult a qualified healthcare professional before starting, stopping, or changing any treatment.

Sources: FDA prescribing information for orlistat, naltrexone/bupropion, phentermine/topiramate, and GLP-1 products; NICE obesity management guidance; Second Nature published outcome research; Obesity Medicine Association clinical resources; Fierce Healthcare reporting on the Foundayo launch.

Date reviewed: August 2026