Eli Lilly's weight-loss pill goes on sale in Britain - critical summary review

A daily tablet from the same drug family as the weight-loss injections became available in UK pharmacies from Monday. It is called Foundayo — the compound is orforglipron — and it is made by the American pharmaceutical firm Eli Lilly, which says the UK is the first country in Europe where it is on sale. The MHRA, the British medicines regulator, authorised it earlier this month.

It is not the first pill of its kind on British shelves. In June the same regulator approved a tablet form of Wegovy, and Henry Gregg, chief executive of the National Pharmacy Association, described Monday as the arrival of "a second weight loss pill available from today in certain pharmacies". That is the shift worth understanding: GLP-1 treatment, until recently a weekly injection under medical supervision, is turning into something closer to an ordinary consumer product — and the counterfeit market, the sport authorities and the population data are all reacting at different speeds.

What changes when the needle goes away

Foundayo is taken once a day, at any time, with no food or water restrictions. It is licensed for people with a body mass index of 30 or above, or between 27 and 30 with at least one weight-related condition, and it can also be used to improve blood sugar in patients with poorly controlled type 2 diabetes.

For now it is sold only on private prescription. Eli Lilly says it is working with the National Institute for Health and Care Excellence, the body that assesses whether treatments are funded by the health service in England, on a possible rollout there. Khalil Asmar, vice-president of cardiometabolic health at Lilly Northern Europe, said the launch means "there is another oral treatment option for eligible UK patients alongside licensed injectable treatments".

Gregg said the format matters most for people who "cannot or do not want to take an injectable medicine", and argued that government and the NHS should use pharmacies to reach more eligible patients, instead of what he called the current postcode lottery for weight management services through GPs — access that varies depending on where a patient lives.

Easier to make also means easier to fake

Pharmacists welcomed the launch and issued a warning alongside it. Fake, unlicensed or counterfeit versions of GLP-1 tablets are a growing problem, and pills can be easier to produce than injectables — which is precisely what makes the shift to oral treatment a supply-chain question, not only a convenience one.

The scale of the parallel market is already visible. Last year the MHRA seized £250,000-worth of unlicensed weight-loss pens and ingredients from a factory in Northampton, in England. Eli Lilly is suing various suppliers it accuses of taking part in an illegal hidden market for its drugs. Patients are being urged to obtain weight-loss treatments only through regulated pharmacies.

Sport has no answer ready

Weight-loss medicines are not banned in professional sport. They sit on the monitoring list of the World Anti-Doping Agency (WADA), which, a spokesperson told the BBC, "includes substances that are not on the prohibited list but that WADA wishes to track in order to detect possible patterns of abuse in sport".

For a substance to be classed as doping it has to meet specific criteria, explains David Cowan, an anti-doping and drug-detection specialist at King's College London: potential to improve performance, risk to the athlete's health, or violation of the "spirit of sport". On that basis, Cowan says, WADA currently does not consider these drugs unfair or performance-enhancing. The debate resurfaced when Serena Williams returned to professional tennis this year after four years away, having said publicly that she uses tirzepatide; she is a paid ambassador for Ro, a company that supplies the medications, and her husband, Alexis Ohanian, is an investor in it.

The clearest opening is in sports with weight categories. In boxing and wrestling, athletes have to hit a limit to compete — and there, cardiologist and exercise physiologist Massimo Mapelli argues, these drugs could come to be treated as doping: "You are essentially taking a medication that can provide an advantage." Diuretics are already banned partly for that reason.

The obstacle is that nobody has studied the drugs in elite athletes. Endocrinologist Daniel Drucker, of the University of Toronto, who took part in the pioneering research behind GLP-1 medicines and also consults for several manufacturers, says the honest position is neutrality: there are no data showing they enhance athletic performance, but "absence of evidence is not evidence of absence". Until more data exist, he says, anti-doping agencies are essentially flying blind.

There is also a case for the opposite effect. Known side effects include muscle loss, gastrointestinal problems and, more rarely, severe inflammation of the pancreas. And the drugs work by suppressing appetite in the brain. "Fuel is everything for performance, and a shortage of it directly damages training adaptation, recovery and competitive output," says Abbie Smith-Ryan, professor of exercise physiology at the University of North Carolina at Chapel Hill. A recent meta-analysis calculated that about 35% of the weight lost on semaglutide was lean mass, including muscle and water, against roughly 25.4% with tirzepatide — a loss the study says can be significantly limited with resistance training and adequate protein intake.

Both manufacturers keep their distance. Novo Nordisk, which makes Wegovy and Ozempic, told the BBC it does not support use of its medicines outside approved indications. Eli Lilly restated the approved indications for tirzepatide. Neither commented on use by professional athletes.

The first drop in US obesity in decades

The United States has faced an obesity epidemic since the late 1970s, and there are now growing signs that the curve has turned. In 2024, epidemiologist Benjamin Rader, of Boston Children's Hospital and Harvard Medical School, published with colleagues a study drawing on data from more than 16 million adults that suggested a fall in obesity prevalence in 2023 — the first in more than a decade. The National Health and Nutrition Examination Survey also pointed to a slight reduction between 2021 and 2023.

The timing is suggestive: prescriptions for Ozempic, Wegovy and Mounjaro in the US more than quadrupled between 2021 and early 2026. Peminda Cabandugama, an endocrinologist and spokesperson for The Obesity Society, says there is "robust evidence showing a significant decline in obesity" and that the drugs played an important and direct part, alongside post-pandemic behaviour changes and greater attention to weight control.

Rader is more cautious: he has no doubt many individuals lost weight on the drugs, but says there is no definitive proof of a causal link at population level, and it is too early to know whether this becomes stabilisation, a decline, or a slower rise. A projection by the Institute for Health Metrics and Evaluation, at the University of Washington, still forecasts a rise in the share of obese adults from 42.5% in 2022 to 46.9% in 2035. Rader, writing in the Journal of the American Medical Association, warned that models built on data from before the GLP-1 boom may overstate the future burden. The institute's authors did not dismiss the criticism, but noted that only a small share of people with obesity use the drugs, that many stop treatment within a year, and that some regain weight afterwards.

What to do with this information

Three concrete fronts are worth watching. First, whether NICE clears Foundayo for the health service in England: while the pill is on private prescription only, it stays a paid-for product, and public coverage is what would test the "wider range of patients" that pharmacists say the format makes possible. Second, what WADA does with the monitoring list — either GLP-1 drugs come off it, or rules tighten first where Mapelli says the case is strongest, in sports with weight categories. Third, whether the next US population surveys turn the fall in obesity into a trend or leave it as post-pandemic noise; the projections and the recent measurements currently disagree.

For anyone considering these substances outside a medical indication — aesthetic weight loss or athletic performance — the warnings in the reporting are specific. Pharmacists say counterfeit and unlicensed versions are a growing problem and that pills can be easier to fake than injectables, which is why the advice is to buy only through regulated pharmacies. And the drugs have not been studied in elite athletes, so, as Drucker puts it, nobody can yet say what risks, benefits or performance effects apply to people who are not the patients the medicines were approved for. Rader's caveat about the broader picture still stands: a turning point, he says, does not mean the problem has gone away.