UCG/Contributor/GettyA new tablet version of Wegovy, a peptide used to help people lose weight, has been approved for the first time in Australia.Until now, the best-known medicines in this group (semaglutide, sold as Wegovy or Ozempic, and tirzepatide, sold as Mounjaro), have generally required weekly injections. The new daily tablet offers another option for people who would prefer not to (or can’t) inject themselves. But how does it work? And will swallowing a pill make weight loss easier, cheaper or safer?What are Wegovy pills, and what’s changed?Wegovy contains semaglutide, a medicine that copies the action of a naturally occurring hormone called glucagon-like peptide-1 (GLP-1). This hormone helps regulate blood sugar, appetite and digestion.On Tuesday, Australia’s Therapeutic Goods Administration (TGA) registered four strengths of Wegovy tablets: 1.5mg, 4mg, 9mg and 25mg. This makes it the first GLP-1 medicine approved in Australia in tablet form specifically for weight management.How do the tablets work, and who are they for?Semaglutide acts on the brain and digestive system. It reduces hunger, increases feelings of fullness and slows how quickly food leaves the stomach. This can help people feel satisfied with smaller meals and reduce how often they feel hungry.The medicine is intended for adults living with obesity, or people who are overweight and have other weight-related health conditions. It may also be prescribed to some people with heart (cardiovascular) disease to reduce their risk of serious heart problems, such as heart attack or stroke.These medicines are not intended as a quick fix for people wanting to lose a few kilograms. They are prescription treatments that should be considered as part of a person’s broader health needs, with guidance from a health-care professional.How do the pills compare to injections?The Wegovy tablet must be taken daily, on an empty stomach with a small amount of water, with a 30-minute wait before you eat or drink anything other than water. They contain a special absorption aid to pass through stomach acid, to allow it to be absorbed properly and work effectively.In contrast, the injection can be done any time of day, once weekly, with or without food. Both formats work to make you stay fuller faster, and trials showed similar gastrointestinal effects especially when first starting.Overall, they show similar rates of weight loss, with the tablet showing a 14% body weight loss over 64–68 weeks, and the injection showing a 15% weight reduction. However, the pill’s effectiveness relies on people remembering to take it each day and not eat or drink within half an hour of the dose, rather than just remembering to inject the drug once a week.What are the risks?Common side effects – affecting around 80% of patients – include nausea, vomiting, diarrhoea, indigestion and constipation. Less common, but more serious side effects include kidney injury, pancreatitis and gallbladder problems. Higher doses make negative side effects more severe. With a tablet, it’s important for people to know that, just as for an injection, doubling up their dose won’t encourage faster results and could cause harm.Doctor appointments are short, meaning they sometimes lack proper screening for eating disorders, body image or other psychological issues. Previous research has also highlighted a link between suicidal thoughts and GLP-1 use. So unless these issues are discussed in appointments, it could lead to negative outcomes for patients.An oral tablet may be easier for people who don’t like needles or have trouble using them, and could reduce potential injection-related injuries. Recently, needle and syringe programs have been overwhelmed with demand for needles used for GLP-1s and other peptides.When will pills be available, and what will they cost?The TGA approval doesn’t mean you can walk into your doctor and get a script today. Before Wegovy tablets hit THE shelves, the TGA will complete a final review of packaging and production, as well as retail pricing. Novo Nordisk, the company that manufactures Wegovy, aims to have tablets available in Australia by the end of the year. It is also important to distinguish TGA approval from Pharmaceutical Benefits Scheme (PBS) listing. TGA approval means a medicine can be prescribed for its approved uses. PBS listing means the government subsidises its cost. Wegovy is not currently subsidised through the PBS for weight management, meaning patients should expect to pay the full price.Official pricing hasn’t been released yet. However, the weekly injection costs A$250–$450 a month and the pill’s out-of-pocket costs are likely to be similar.Is this a ‘magic pill’?This pill isn’t meant to be used by itself. The TGA has approved Wegovy tablets to use alongside a reduced-calorie diet and increased physical activity.It’s also important to follow prescriber guidelines, eat nutritious food, and do weight training to help avoid muscle loss. This is why “lifestyle prescribing” should accompany any weight-loss drugs, which means GPs should also make a clear plan with patients to encourage healthy eating and regular exercise, alongside weight-loss medications.This matters because when people lose weight quickly, some of what they lose is lean muscle, not just body fat. Secondly, the weight can come back if you stop taking Wegovy without having changed your lifestyle. Follow-up research with participants has found people regained about two-thirds of the weight they had lost within a year of stopping these medications.Timothy Piatkowski receives funding from National Health and Medical Research Council, Queensland Mental Health Commission, Queensland Injectors Voice for Advocacy and Action, and Alcohol and Drug Foundation. He is affiliated with Queensland Injectors Voice for Advocacy and Action (Chair), The Loop Australia (Research Lead – QLD), and The Enhanced Games (Performance Enhancement Task Force). He is a co-founder of Safe Pulse, a charity focused on harm reduction for individuals who use human enhancement drugs.Kimberley Akrigg and Samuel Cornell do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.