Weight Loss
Wegovy Pill vs Orlistat: How They Compare
In one sentence: The Wegovy pill and orlistat are both licensed weight-management medicines, but they work in completely different ways: one reduces your appetite and the other blocks some of the fat you absorb from food, so the right choice depends on you and your prescriber.
At a glance
The Wegovy pill reduces appetite; orlistat blocks fat absorption.
The Wegovy pill is semaglutide; orlistat is a different medicine altogether.
The Wegovy pill is taken once a day; orlistat is taken with each main meal.
Orlistat comes as Xenical (120mg, prescription) and Alli (60mg, over the counter).
Orlistat is available on the NHS; the Wegovy pill is private only.
Their side effects are very different, and both work alongside diet and activity.
If you are weighing up weight-management medicines, the Wegovy pill and orlistat are two of the names you will meet. They are both licensed to help with weight, but they could hardly be more different in how they work, how you take them, and how they feel day to day. This guide sets them side by side so you can see what separates them.
Key takeaways
Do they work the same way?
No. The Wegovy pill reduces appetite; orlistat blocks some fat from being absorbed.
How often do you take each?
The Wegovy pill is once a day; orlistat is with each main meal.
What are Xenical and Alli?
Both are orlistat: Xenical is the 120mg prescription form, Alli the 60mg over-the-counter one.
Which is on the NHS?
Orlistat. The Wegovy pill is private only.
What is the difference between the Wegovy pill and orlistat?
The biggest difference is how they work. The Wegovy pill is oral semaglutide, which reduces your appetite so you eat less.1 Orlistat works in the gut, blocking about a third of the fat in your food from being absorbed.2 Here is how they compare.
Feature | Wegovy pill (oral semaglutide) | Orlistat (Xenical / Alli) |
| Active ingredient | Semaglutide | Orlistat |
| How it works | Reduces appetite by acting on the GLP-1 hormone | Blocks about a third of the fat in food from being absorbed |
| Form | Daily tablet | Capsule taken with meals |
| How often | Once a day | With each main meal, up to 3 times a day |
| How it is taken | On an empty stomach with a small sip of water, then wait 30 minutes | Just before, with, or up to 1 hour after a meal containing fat |
| Main side effects | Digestive, such as nausea | Oily or fatty stools, flatulence, urgent toilet trips |
| Available on the NHS? | No, private only | Yes (Xenical), for those who are eligible |
| Prescription needed? | Yes | Xenical yes; Alli is over the counter |
How do the Wegovy pill and orlistat work?
They work in completely different places in the body. The Wegovy pill is semaglutide, which mimics a natural gut hormone called GLP-1 to reduce appetite, so you feel fuller and eat less.1 Orlistat does not affect appetite at all. It is a lipase inhibitor, which means it stops about a third of the fat in your food from being digested and absorbed, so that fat passes out of the body instead.2 Both are used alongside a reduced-calorie diet and more physical activity.3
"These two work in completely different ways, and that surprises people. The Wegovy pill works on your appetite, so you feel full sooner. Orlistat does not touch your appetite at all, it stops some of the fat in your food from being absorbed. They are not two versions of the same idea."
How is each one taken?
The routines are very different. The Wegovy pill is taken once a day, first thing, on an empty stomach with a small sip of water, then you wait at least 30 minutes before food or other tablets.1 Orlistat is taken with food: one capsule with each main meal that contains fat, up to three times a day, and you skip the capsule if you miss a meal or the meal has no fat in it.2 For the tablet routine in detail, see how to take the Wegovy pill.
What are the side effects?
The side effects reflect how each medicine works. With the Wegovy pill, the most common are digestive, such as feeling sick, and they often ease as your body adjusts.1 With orlistat, because the unabsorbed fat leaves the body, the side effects tend to be oily or fatty stools, flatulence and a sudden need for the toilet, and they are more likely after a fatty meal.2 For the tablet in detail, see Wegovy pill side effects and how to manage them.
"With orlistat, the side effects are a direct signal of what you have eaten. The more fat in a meal, the more likely you are to get the oily, urgent stools it is known for. Stick to a lower-fat diet, and it is much easier to live with. It also affects some vitamins, so a bedtime multivitamin is usually advised."
Xenical and Alli: the two forms of orlistat
Orlistat comes in two strengths under different names. Xenical is the 120mg prescription-only version.2 Alli is a lower 60mg dose that you can buy from a pharmacy without a prescription. Both are orlistat, and both work the same way. You can read more on our orlistat pages, including Xenical and Alli.
Is the Wegovy pill or orlistat available on the NHS?
Orlistat can be prescribed on the NHS. Xenical is available on the NHS for people who are eligible, usually based on their BMI and any weight-related health conditions, and Alli can be bought over the counter.2 The Wegovy pill is newer, approved by the MHRA in 2026, and is currently available privately only.4 Both are available privately once a prescriber has confirmed they are suitable for you.
Which is right for me: the Wegovy pill or orlistat?
Neither is described as better, and the right choice depends on you. Orlistat has been available far longer, is on the NHS for those who qualify, and suits people who are happy to keep to a lower-fat diet. The Wegovy pill is newer, private, taken once a day, and works on appetite rather than fat absorption. A prescriber reviews your health, your eating habits and your goals before recommending either one.
"Orlistat has been around far longer and is available on the NHS, while the Wegovy pill is newer and private. Which suits you depends on how you eat, how you feel about the different routines, and what a prescriber thinks is appropriate for you. There is no single right answer for everyone."
If weight management is your goal and you would like to be assessed, you can start an online weight-loss consultation for the Wegovy pill. To compare weight-loss tablets and injections more broadly, see weight-loss tablets vs injections.
Related Wegovy pill guides
Frequently asked questions about the Wegovy pill and orlistat
Is the Wegovy pill or orlistat better for weight loss?
Neither is described as better here. They are different medicines that work in different ways: the Wegovy pill reduces appetite, while orlistat blocks some fat from being absorbed. The right choice depends on your health, how you eat and your preferences. A prescriber can help you decide.
What is the difference between the Wegovy pill and orlistat?
They work differently. The Wegovy pill is semaglutide, which reduces appetite, taken once a day. Orlistat blocks about a third of the fat in your food from being absorbed and is taken with each main meal. Their side effects and routines are quite different too.
How does orlistat work?
Orlistat is a lipase inhibitor. It stops about a third of the fat in your food from being absorbed, so it passes out of your body instead. It does not affect your appetite. It works best alongside a lower-fat, reduced-calorie diet.
Is orlistat available on the NHS?
Yes. Xenical, the 120mg prescription form of orlistat, can be prescribed on the NHS for people who are eligible. Alli, a lower 60mg dose, is available to buy over the counter. The Wegovy pill is currently available privately only.
What is the difference between Xenical and Alli?
They are both orlistat. Xenical is the 120mg prescription-only version. Alli is a lower 60mg dose you can buy from a pharmacy without a prescription. Both work the same way, by blocking some of the fat in your food from being absorbed.
Can you take the Wegovy pill and orlistat together?
This is not a standard combination, and it is not something to arrange yourself. If you are considering weight-management medicine, a prescriber will recommend the right single option for you and will not usually combine them. Always tell your prescriber about any medicines you take.
Sources and references
electronic medicines compendium (emc). Wegovy tablets: Summary of Product Characteristics. Describes oral semaglutide as a GLP-1 medicine that reduces appetite, licensed for weight management, taken once daily on an empty stomach.
NHS. Orlistat. Explains that orlistat stops about a third of the fat from food being absorbed, is taken with meals up to three times a day, comes as Xenical (120mg, prescription) and Alli (60mg, over the counter), and lists the oily-stool side effects.
NHS. Overweight and obesity. Sets out that weight-loss medicines are used alongside a reduced-calorie diet and increased physical activity.
The Pharmaceutical Journal. MHRA approves semaglutide oral tablets for weight loss. Reports the 2026 MHRA approval of oral semaglutide tablets for weight management.
Medical disclaimer: This article is for general information and does not replace advice from a qualified healthcare professional. The Wegovy pill and Xenical are prescription-only medicines that need an assessment by a prescriber; Alli is a pharmacy medicine. If you have questions about your health, contact your GP or call NHS 111.
Our commitment to accuracy: This page reflects current UK guidance from sources such as the NHS, NICE, the MHRA and the approved product information. It is reviewed by our Superintendent Pharmacist and updated as guidance changes.
About the author
Blog author
Dayna Sheppard
Dayna is a pharmacy manager with over 15 years of pharmacy experience. She is focused on delivering a safe and excellent pharmacy service for patients.
Medically reviewed by
Medical reviewer
Taslima Hussain
Taslima is a pharmacist who is passionate about patient care. She has experience working in community pharmacy as a locum.
