🥊 Obesity Drug Showdown📊 Head-to-Head Trials✅ Aktualisiert 2026

Wegovy vs. Zepbound

Der wichtigste Vergleich bei Adipositas – Daten aus SURMOUNT-5

Wegovy und Zepbound sind die beiden führenden FDA-zugelassenen Medikamente gegen Adipositas. SURMOUNT-5 (2025) zeigte: Tirzepatid (Zepbound) liefert ca. 47% mehr relativen Gewichtsverlust.

Zuletzt überprüft: März 2026

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Die Zahlen

Wegovy (Semaglutide 2.4 mg)

→GLP-1 receptor agonist — single incretin mechanism
→Mimics endogenous GLP-1 released after meals
→Suppresses appetite via hypothalamic GLP-1 receptors
→Slows gastric emptying, prolonging satiety
→Glucose-dependent insulin secretion enhancement
→Half-life ~7 days; once-weekly autoinjector pen
→SELECT trial: 20% MACE reduction in obesity + CVD (2023)

Zepbound (Tirzepatide 15 mg)

→Dual GIP + GLP-1 receptor agonist
→GIP receptor activation enhances adipose insulin sensitivity
→GIP co-signalling may reduce GLP-1-driven nausea
→Additive appetite suppression from two incretin pathways
→Deeper weight loss vs GLP-1 monotherapy in all trials
→Half-life ~5 days; once-weekly autoinjector pen
→SURMOUNT-MMO cardiovascular outcomes trial ongoing

Head-to-Head Comparison

Factor	Wegovy	Zepbound
Active molecule	Semaglutide	Tirzepatide
Receptor targets	GLP-1 only	GIP + GLP-1
FDA approval (obesity)	June 2021	November 2023
Max dose	2.4 mg weekly	15 mg weekly
Weight loss — STEP-1/SURMOUNT-1	14.9% (sema 2.4 mg, 68 wks)	20.9% (tirz 15 mg, 72 wks)
Direct head-to-head (SURMOUNT-5)	Reference arm	~47% more weight loss vs Wegovy
Nausea incidence	~44% (STEP-1)	~31% (SURMOUNT-1 15 mg)
Cardiovascular outcome trial	SELECT 2023: 20% MACE reduction	MMO trial ongoing
Monthly cost (uninsured)	~$1,300–1,400	~$1,000–1,200
T2D brand	Ozempic	Mounjaro

Data from STEP-1 (Wilding et al., NEJM 2021), SURMOUNT-1 (Jastreboff et al., NEJM 2022), and SURMOUNT-5 (2025). [1, 2, 3]

Weight Loss: The Numbers

Wegovy 2.4 mg (STEP-1)

14.9%

Mean body weight loss at 68 weeks in STEP-1 (N=1961, adults with obesity, no T2D).

Zepbound 15 mg (SURMOUNT-1)

20.9%

Mean body weight loss at 72 weeks in SURMOUNT-1 (N=2539, adults with obesity, no T2D).

SURMOUNT-5 head-to-head

~47%

More relative weight loss with tirzepatide vs semaglutide in the 2025 direct head-to-head trial.

Choose Based on Your Goal

Maximum weight loss

Zepbound 15 mg achieved ~20.9% mean weight loss in SURMOUNT-1 and was directly superior to Wegovy in SURMOUNT-5.

Strongest cardiovascular evidence

Wegovy's SELECT trial (2023) showed a 20% MACE reduction in obesity + CVD. Zepbound's cardiovascular trial (MMO) is still ongoing as of 2026.

Lower nausea rates

Zepbound reported ~31% nausea in SURMOUNT-1 vs ~44% for Wegovy in STEP-1. GIP modulation may reduce GI side effects.

Cost and insurance access

Zepbound is often slightly less expensive uninsured. Both have limited insurance coverage for obesity. Check your plan's formulary.

Earlier FDA approval history

Wegovy was approved June 2021 — over two years earlier than Zepbound (November 2023). More real-world safety data is available for semaglutide.

T2D + obesity combination

Both have T2D equivalents (Ozempic/Mounjaro). Your prescriber may choose based on which indication — T2D or obesity — is primary.

Which Is Right for You?

For pure weight loss efficacy, the evidence favours Zepbound. SURMOUNT-5 (2025) is the definitive direct comparison: tirzepatide produced approximately 47% more relative weight loss than semaglutide. This is consistent with the individual trial data — SURMOUNT-1 showing 20.9% vs STEP-1's 14.9%.

Wegovy's key advantage is cardiovascular outcome data. The SELECT trial (2023) was the first obesity drug to show a statistically significant reduction in MACE (20%) in adults with obesity and established CVD — a landmark result. Zepbound's SURMOUNT-MMO cardiovascular trial is ongoing.

Tolerability: SURMOUNT-1 reported ~31% nausea rate vs ~44% for STEP-1. However, both trials used different populations and titration schedules, so direct nausea comparison should be interpreted with caution. Both drugs share the same class of GI side effects and are managed with slow dose escalation.

Track Either in Shotlee

Shotlee tracks Wegovy and Zepbound dose schedules, injection logs, weight charts, and side effect notes. If you switch between them, your baseline data stays intact for your prescriber to review.