Alternatives
GLP-1 alternatives in 2026
GLP-1 medications are not the only weight-management tool. The other FDA-approved options have specific tradeoffs — and bariatric surgery remains the most durable intervention for severe obesity. Here is the honest comparison.
Phentermine
- Avg weight loss
- 5-7%
- Duration
- Short-term (≤12 weeks)
- Typical cost
- $10-50/mo
Sympathomimetic appetite suppressant. DEA Schedule IV — controlled substance. Insomnia and elevated heart rate are common. Avoided in cardiovascular disease, hyperthyroidism, glaucoma.
Best for: Patients needing a kick-start with no cardiovascular history.
Orlistat (Xenical, Alli)
- Avg weight loss
- 3-4%
- Duration
- Indefinite
- Typical cost
- $60-120/mo cash; OTC Alli ~$50
Blocks intestinal fat absorption. GI side effects (oily stool, urgency) are limiting for most patients. Fat-soluble vitamin deficiency risk; supplementation required.
Best for: Lower-risk patients who tolerate dietary modification well.
Naltrexone-bupropion (Contrave)
- Avg weight loss
- 4-6%
- Duration
- Long-term
- Typical cost
- $100-200/mo with savings card
Combines opioid antagonist + smoking-cessation aid; targets reward pathways and food noise. Insomnia, nausea, hypertension elevation are common. Contraindicated in seizure disorder, eating disorders.
Best for: Patients with reward-driven eating + co-occurring nicotine dependence.
Bariatric surgery
- Avg weight loss
- 25-35% (durable)
- Duration
- Permanent (anatomical)
- Typical cost
- $15-25k (often insured)
Sleeve gastrectomy and Roux-en-Y bypass remain the most-performed. Mortality <0.3% in major centers. Recovery is 2-6 weeks. Lifetime nutrition follow-up required.
Best for: BMI ≥35 with comorbidities or BMI ≥40 with failed pharmacotherapy.