Rybelsus for weight loss: The “oral semaglutide”
While FDA-approved only for type 2 diabetes, Rybelsus (3mg, 7mg, 14mg) promotes weight loss by suppressing appetite, with average losses of 5-10% body weight over 6 months.
Key highlights
- Rybelsus is an oral tablet FDA-approved for lowering blood sugar levels in adults with type 2 diabetes and may also help with weight loss.
- Although it’s not FDA-approved to reduce the risk of heart attack or stroke, studies suggest it’s safe for people with heart disease.
- Results show that the 25 mg dose of Rybelsus can lead to weight loss similar to Wegovy, which is specifically approved for weight management.
- It is available in 3 mg, 7 mg, and 14 mg tablets for diabetes, with higher doses like 25 mg and 50 mg studied for weight loss in adults without diabetes.
- Not officially approved for weight loss, but can be prescribed off-label if medically appropriate.
Rybelsus is a GLP-1 (glucagon-like-peptide-1) medication with the active ingredient, semaglutide, FDA-approved to help lower blood sugar levels in adults with type 2 diabetes.
While Rybelsus is FDA-approved solely for blood sugar control in type 2 diabetes, many users have reported significant weight reduction as an additional benefit.
Explore the link between Rybelsus and weight loss. Learn how this oral type 2 diabetes medication can also lead to weight reduction, typical results, and how it compares to other weight loss drugs.
What is Rybelsus?
Rybelsus is a prescription drug containing the active ingredient, semaglutide, approved by the FDA (U.S. Food and Drug Administration) to help lower blood sugar levels in adults with type 2 diabetes mellitus, alongside diet and exercise.
Semaglutide belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists and is known for its dual benefits: it helps control blood glucose levels in adults with type 2 diabetes and supports weight loss in people with or without diabetes (off-label) when used in combination with diet and increased physical activity.
Semaglutide works for weight loss by mimicking the action of incretin, a natural gut hormone called GLP-1, and targeting GLP-1 receptors in the brain that control appetite and slow down how quickly the stomach empties, making you feel fuller for longer. By increasing GLP-1 activity, semaglutide helps to reduce hunger and suppress appetite.
It’s taken daily at least 30 minutes before eating or drinking. The tablets should be swallowed whole and cannot be crushed, split, or chewed.
Rybelsus, manufactured by Novo Nordisk, is available in 3 mg, 7 mg, and 14 mg tablets for treating type 2 diabetes. There’s also another version with 1.5 mg, 4 mg, and 9 mg doses.
Researchers have also tested higher doses of oral semaglutide, 25 mg and 50 mg, for weight loss in adults without diabetes who have:
A body mass index (BMI) of 30 or higher
A BMI of 27 or higher with at least one weight-related health condition, such as high blood pressure
Although not FDA-approved for weight management, Rybelsus also helps in weight loss (as an additional benefit) in people with type 2 diabetes, especially when diet and exercise alone do not provide sufficient control.
Rybelsus is currently being studied in a long-term trial to confirm its potential cardiovascular benefits.
Rybelsus is not approved for the treatment of type 1 diabetes or diabetic ketoacidosis.
Does Rybelsus cause weight loss?
Rybelsus is an oral tablet that is FDA-approved for lowering blood sugar levels in adults with type 2 diabetes and may also help with weight loss. Although it’s not FDA-approved to reduce the risk of heart attack or stroke, studies suggest it’s safe for people with heart disease.
While Rybelsus is primarily approved for the treatment of type 2 diabetes, many patients experience weight loss as a secondary benefit.
In STEP trials, patients taking a 7 mg dose of Rybelsus experienced an average of 8.9% weight loss over 68 weeks, compared to 1.8% in the placebo group.
A real-world study also confirmed that by 6 months, 62% of patients using Rybelsus achieved at least 5% weight loss, showing promising results outside of clinical trials.
Rybelsus contains semaglutide, a GLP-1 receptor agonist, which mimics the effects of the natural hormone glucagon-like peptide-1 (GLP-1). This hormone plays a key role in appetite and digestion. By activating GLP-1 receptors, Rybelsus helps:
Reduce appetite, making you feel less hungry
Increase satiety, so you feel full sooner and stay full longer
Slow gastric emptying, which delays how quickly food leaves the stomach, further enhances fullness
Calorie intake reduction: Because Rybelsus helps people feel full sooner and reduces cravings, it naturally leads to lower calorie intake. Over time, this calorie deficit contributes to weight loss, even without strict dieting.
Potential impact on food preferences: Some studies and patient reports suggest that GLP-1 medications like Rybelsus may decrease cravings for high-fat, sugary, or processed foods. This shift in food preference can make it easier to maintain a healthier diet and reduce overeating.
Similarities between Rybelsus and Ozempic
Rybelsus and Ozempic are both GL-1 medications and have many similarities:
Active ingredient: Both contain the active ingredient semaglutide, a GLP-1 receptor agonist.
FDA approvals: Both are FDA-approved to control blood sugar in adults with type 2 diabetes.
Mechanism of action: Both mimic a natural hormone in your body called GLP-1, increase insulin, decrease glucagon to prevent liver sugar production, slow gastric emptying, and target GLP-1 receptors in the brain to reduce appetite and increase feelings of fullness.
Effectiveness: Both work to lower blood sugar when used with diet and exercise.
Weight loss: A study showed that both medications led to similar weight loss, around 5 to 6 kg after 6 months. Ozempic also comes in a 2 mg dose, but the weight loss difference between the 1 mg and 2 mg doses is not significant. In a clinical trial, people taking 14 mg of Rybelsus once a day lost an average of 3.6 kg after one year. In comparison, those who took a placebo (a non-active pill) gained 0.5 kg during the 52-week trial.
Mechanism: Same GLP-1 agonist as Ozempic/Wegovy, but in pill form (vs. injection).
Reduction in HbA1c levels: Both Rybelsus and Ozempic are effective at reducing HbA1c levels, a key marker for blood sugar control in people with type 2 diabetes. However, Ozempic tends to be more effective in lowering HbA1c. Ozempic can reduce HbA1c by about 1% to 1.5%, while Rybelsus typically reduces it by around 0.8% to 1%. The difference may be because Ozempic is injected weekly, providing more consistent control, while the dose of Rybelsus is once daily.
How much weight can you lose with Rybelsus?
While Rybelsus is primarily approved to manage type 2 diabetes, many patients also experience weight loss as a secondary benefit. The amount of weight loss varies based on dosage, treatment duration, and individual factors.
The OASIS 1 and OASIS 4 studies looked at how much weight adults could lose by taking oral semaglutide at 50 mg and 25 mg doses.
In the OASIS 1 trial, people taking the 50 mg dose lost about 15% of their body weight after 68 weeks (around 16 months). In OASIS 4, those on the 25 mg dose lost nearly 14% of their body weight after 64 weeks (about 15 months).
Higher doses of Rybelsus have also been tested in people with type 2 diabetes in a study called the Pioneer Plus trial. If approved, Rybelsus could be prescribed in higher doses than what’s commercially available.
Similar to weight loss studies, people with type 2 diabetes who took the 25 mg and 50 mg doses lost more weight than those taking the current 14 mg dose. The 50 mg dose led to more than twice as much weight loss as the 14 mg dose.
Rybelsus leads to slower and more modest weight loss compared to high-dose semaglutide (Wegovy 2.4 mg weekly), partly due to its lower maximum dose (14 mg daily).
Weight loss with Rybelsus is estimated to be around 30% slower than with Wegovy, primarily because Rybelsus has a lower maximum dose of 14 mg daily, compared to Wegovy’s 2.4 mg weekly injection. Both medications contain semaglutide, but the dosing and absorption differ, affecting overall effectiveness for weight reduction.
Weight loss outcomes can vary significantly from person to person. Factors that influence results include your starting weight or BMI, diet quality, exercise habits, consistency, and metabolic response. Some patients may see rapid changes, while others may experience slower or minimal weight loss, even on the same dose.
Rybelsus vs. other weight loss drugs
Here are some differentiating points of Rybelsus from medications primarily approved for weight loss (Wegovy, Zepbound, Saxenda):
Dosage differences: Rybelsus contains semaglutide at lower doses and is used primarily for blood sugar control in people with type 2 diabetes. In contrast, drugs like Wegovy and Zepbound contain higher doses of semaglutide or tirzepatide (the active ingredient in Mounjaro/Zepbound) specifically formulated for weight loss, often leading to more significant weight reduction. Saxenda uses liraglutide, another GLP-1 receptor agonist, and is also approved specifically for weight loss.
Primary indication: Rybelsus is FDA-approved to manage blood sugar levels in people with type 2 diabetes. Meanwhile, Wegovy, Zepbound, and Saxenda are approved primarily for weight management, with or without diabetes.
Efficacy for weight loss: While Rybelsus can promote weight loss as a secondary benefit, weight loss medications like Wegovy and Saxenda have shown greater average weight loss in clinical trials due to their higher dosages and specific formulation for this purpose.
Insurance coverage: Insurance plans often have stricter requirements or may not cover weight loss medications as widely as diabetes treatments like Rybelsus. This can affect accessibility and cost for patients seeking weight loss-specific drugs.
| Rybelsus | Wegovy | Zepbound | Mounjaro | Saxenda | |
|---|---|---|---|---|---|
| Active Ingredient | Semaglutide | Semaglutide | Tirzepatide | Tirzepatide | Liraglutide |
| Mechanism of Action | GLP-1 receptor agonist | GLP-1 receptor agonist | Dual GIP and GLP-1 agonist | Dual GIP and GLP-1 agonist | GLP-1 receptor agonist |
| Primary Indication | Type 2 diabetes | Obesity / weight management | Obesity / weight management | Type 2 diabetes (weight loss benefit) | Obesity / weight management |
| Administration | Oral tablet | Subcutaneous injection | Subcutaneous injection | Subcutaneous injection | Subcutaneous injection |
| Frequency | Once daily | Once weekly | Once weekly | Once weekly | Once daily |
| Dosage | Up to 14 mg daily | Up to 2.4 mg weekly | Up to 15 mg weekly | Up to 15 mg weekly | Up to 3 mg daily |
| Average Weight Loss | 5-8 lbs (4-6 months) | 15-20% body weight (16-68 weeks) | 15-20% body weight (16-68 weeks) | 15-20% body weight (16-68 weeks) | 5-10% body weight (16-56 weeks) |
| Monthly Cost (approx.) | $900 - $1,000 | $1,300 - $1,500 | $1,300 - $1,500 | $1,200 - $1,500 | $1,200 - $1,400 |
| Insurance Coverage | Usually for diabetes only | Approved for obesity; may have stricter coverage | Approved for obesity; may have stricter coverage | Primarily diabetes, weight loss benefit | Approved for obesity; may have stricter coverage |
Who is more likely to experience weight loss with Rybelsus?
Several factors can influence how much weight a person loses while taking Rybelsus:
Higher starting weight/BMI: People who begin treatment with a higher weight or BMI often experience a greater percentage of weight loss early on compared to those with lower starting weights.
Adherence to lifestyle modifications: Rybelsus works best when combined with healthy habits like following a reduced-calorie diet and regular exercise. Sticking to these lifestyle changes can significantly boost weight loss results.
Individual metabolic response: Everyone’s body reacts differently to medications. Some people may lose more weight than others due to differences in metabolism and how their body responds to Rybelsus.
Dosage: Higher doses, such as 14 mg daily, are generally linked to more weight loss compared to lower doses like 7 mg, but it’s important to follow your healthcare professional’s instructions on dosing.
Understanding these factors can help set realistic expectations and encourage a holistic approach to weight loss while using Rybelsus.
Sustainability of weight loss with Rybelsus
While Rybelsus can help with weight loss, especially when combined with healthy habits, its effects may not last if the medication is stopped.
Like many other weight management drugs, discontinuing Rybelsus often leads to weight regain over time. This happens because appetite and food cravings may return to previous levels once the medication is no longer active in the body.
To maintain weight loss after stopping Rybelsus, long-term lifestyle changes are essential. This means continuing with a balanced, reduced-calorie diet, staying physically active, managing stress, and monitoring your progress.
These habits form the foundation for lasting weight control, with or without medication. Rybelsus can be a helpful tool, but sustainable results depend on the daily choices you make over the long run.
Maximizing weight loss while taking Rybelsus
If you’re taking Rybelsus and want to get the most out of it for weight loss, here are some practical steps to help support your journey:
Follow a reduced-calorie, balanced diet: Focus on whole, unprocessed foods. Include lean proteins (chicken, fish, tofu), plenty of fruits and vegetables, whole grains, and healthy fats. Watch your portion sizes to avoid overeating.
Engage in regular physical activity: Aim for at least 150 minutes of moderate-intensity aerobic activity per week (brisk walking or cycling), plus strength training exercises at least twice a week.
Stay hydrated: Drink plenty of water throughout the day to stay hydrated, reduce cravings, and support digestion.
Follow your prescribed dosage: Take Rybelsus exactly as your doctor prescribes. Don’t change the dose or timing without medical advice.
Manage side effects: If you experience nausea, constipation, or other gastrointestinal issues, talk to your doctor. Managing these possible side effects can help you stick to a healthy diet and stay active.
Consider working with a registered dietitian: A dietitian can provide a personalized meal plan that works with your lifestyle and Rybelsus treatment to support safe, effective weight loss.
Track your progress: Keep a journal or use an app to track your weight, food intake, physical activity, and how you feel. This can help you stay motivated and make necessary adjustments.
These strategies can help enhance the weight loss benefits of Rybelsus while supporting overall health and well-being.
Rybelsus side effects
The most common side effects of Rybelsus are:
Nausea
Stomach pain
Diarrhea
Poor appetite
Vomiting
Constipation
Although rare, some people taking Rybelsus may experience serious side effects:
Severe allergic reaction
Kidney problems
Gallbladder problems
Low blood sugar (hypoglycemia)
Pancreatitis (inflammation of the pancreas)
Diabetic retinopathy in patients with Type 2 Diabetes
Thyroid tumors, including medullary thyroid carcinoma, a rare but serious condition
Warnings
Rybelsus has a black box warning from the FDA for the risk of thyroid tumors or thyroid cancer. They must not be given to people with a personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN 2) or medullary thyroid carcinoma (MTC).
You should not use Rybelsus if you:
Are allergic to semaglutide or any of the ingredients.
Are pregnant or planning to become pregnant.
Are breastfeeding.
Have serious kidney or liver problems.
Have a severe gastrointestinal disease, such as gastroparesis (delayed stomach emptying).
5 foods that support Rybelsus weight loss
Here are 5 foods that can help support weight loss while taking Rybelsus:
Chia pudding: Full of fiber, it helps keep your digestion regular and prevents constipation.
Grilled shrimp: A lean source of protein that keeps you feeling full longer.
Kimchi: This fermented food has probiotics that can help with stomach issues like bloating or gas.
Walnuts: Healthy fats in walnuts may help reduce nausea and keep you satisfied.
Green tea: A good, caffeine-free drink that keeps you hydrated without upsetting your stomach.
Always tell your doctor or pharmacist about all over-the-counter medications, supplements, and vitamins you take.
Cost and insurance coverage for weight loss with Rybelsus
Rybelsus is only available as a brand-name medication. There are currently no generic alternatives available for Rybelsus. The cost of Rybelsus varies based on your dose, insurance coverage, and whether you qualify for the manufacturer’s savings card program or patient assistance program.
Eligible patients can receive free Rybelsus through the Novo Nordisk Patient Assistance Program (PAP). This program helps uninsured or underinsured patients access medication for free if they meet certain criteria. Patients generally need to meet income and insurance criteria to qualify. However, the program is only for people with type 2 diabetes and not for weight loss.
Most insurance plans cover Rybelsus for type 2 diabetes, but coverage for weight loss alone is unlikely, especially with Medicare and Medicaid plans. How much you pay with insurance depends on your specific insurance plan, drug tier, and deductible. Contact your insurance provider for coverage details to find out if they cover Rybelsus and find out the associated out-of-pocket costs.
The cost of Rybelsus can vary depending on your pharmacy and insurance coverage.
Without insurance, a 30-day supply of Rybelsus costs about $997.58. If you’re eligible, you could pay $10 for Rybelsus (1-month supply) with a copay savings card from the manufacturer. The Rybelsus Savings Card program is limited to those with commercial insurance.
FAQs
How fast does Rybelsus work for weight loss?
Rybelsus typically begins to show weight loss effects within 4 to 8 weeks, especially as appetite decreases and food intake is reduced. However, noticeable and sustained weight loss usually becomes more evident over several months of consistent use.
Can you take Rybelsus forever?
Yes, you can take Rybelsus long-term if prescribed by your healthcare professional. However, if you stop taking it, there’s a high chance that the weight loss may return over time.
Does Rybelsus cause hair loss?
Rybelsus itself rarely causes hair loss. When it does occur, it’s usually due to rapid weight loss, which can temporarily disrupt the hair growth cycle.
How is Rybelsus administered?
Rybelsus is an oral tablet that you take once a day by mouth on an empty stomach for at least 30 minutes before eating or drinking.
Can Rybelsus replace Ozempic?
Rybelsus and Ozempic work similarly, but they are not interchangeable. Rybelsus is an oral medication, while Ozempic is an injectable, so whether one can replace the other depends on your doctor’s recommendation based on your needs.
How to get Rybelsus for weight loss
Although Rybelsus is not officially approved for weight loss, some people can access it for that purpose through the following options:
A1C ≥6.5%: If your A1C level is 6.5% or higher, you may be diagnosed with type 2 diabetes, which qualifies you for a Rybelsus prescription covered by insurance. Even an A1C in the prediabetes range (5.7–6.4%) may help in some cases.
Manufacturer coupon: If you qualify, you can use a Rybelsus savings card to get Rybelsus for as low as $10/month, depending on your insurance plan.
Telehealth options: Some telehealth services, like PlushCare, may prescribe Rybelsus off-label for weight loss, especially if you’re overweight or have obesity-related health concerns.
Conclusion
Rybelsus can help promote weight loss in individuals with type 2 diabetes, especially when combined with healthy lifestyle changes.
It’s most effective when used as part of a comprehensive plan that includes a balanced, reduced-calorie diet and regular physical activity.
Rybelsus comes as a tablet you take by mouth once a day. You should take it at least 30 minutes before eating or drinking anything in the morning, and you must swallow the tablet whole; don’t split, crush, or chew it.
Weight loss with Rybelsus is more modest and slower than with other weight loss medications, such as Wegovy or Zepbound.
Always talk with your healthcare provider about your weight management goals and the best treatment options for your individual needs. They can help tailor a plan that’s safe, effective, and sustainable for you.
