Does Wegovy offer better improvements in metabolic health compared to other weight loss drugs?

Trials such as STEP-1 and SELECT showed Wegovy not only reduced weight but also improved blood pressure, cholesterol, and markers of heart health. Other medicines, like Saxenda, also improve some metabolic measures but to a smaller extent, and drugs like Orlistat mainly affect fat absorption rather than broad cardiometabolic outcomes.

Why metabolic health matters

Weight management is not just about the number on the scales. Many of the health risks linked to excess weight — including type 2 diabetes, heart disease, and high blood pressure — come from underlying changes in metabolism. That’s why researchers look at improvements in blood sugar, cholesterol, and cardiovascular outcomes, not just kilograms lost.

Wegovy’s evidence base

The STEP-1 trial, published in The New England Journal of Medicine, showed that people using Wegovy (semaglutide 2.4 mg weekly) lost around 15% of their body weight over 68 weeks. Importantly, they also saw improvements in blood pressure, cholesterol, and glucose control compared with placebo. The SELECT trial went further, demonstrating that semaglutide reduced the risk of major cardiovascular events such as heart attack and stroke in people with obesity and established cardiovascular disease. These findings suggest that Wegovy is more than a weight-loss drug — it has tangible benefits for metabolic and heart health.

Saxenda’s role

Saxenda (liraglutide 3 mg daily), another GLP-1 receptor agonist, has also been shown to lower blood sugar and improve some cardiovascular risk factors. However, its effects are generally smaller than those of semaglutide. For example, in the SCALE trials, Saxenda users lost around 6–8% of their body weight over a year, with corresponding but modest improvements in metabolic health. NICE acknowledges Saxenda’s role but has prioritised Wegovy because of its stronger evidence and greater clinical impact.

Orlistat and other medicines

Older treatments such as Orlistat work by reducing fat absorption in the gut. This can lead to modest weight loss and slight improvements in cholesterol, but its effect on broader cardiometabolic outcomes is limited. Medicines like Mysimba (naltrexone/bupropion) target cravings and can aid weight loss of 6–9%, but their impact on blood pressure or cholesterol is not as well established as for GLP-1 therapies.

NHS considerations

NICE’s appraisal of Wegovy reflects the importance of these wider health benefits. The guidance notes that the reduction in cardiovascular risk factors and diabetes progression makes semaglutide a cost-effective option for the NHS, even given its high price. Saxenda and Mysimba are licensed, but their uptake is far smaller, in part because they offer fewer metabolic improvements alongside weight loss.

Real-world implications

For individuals, this means that Wegovy is more likely to improve not only weight but also blood pressure, blood sugar, and cholesterol — the very measures most linked to long-term health risks. Doctors often highlight this when explaining why Wegovy is now preferred in NHS services compared with earlier drugs. Patients benefit not only from

s but also from a healthier metabolic profile overall.

What the evidence shows overall

Yes, Wegovy offers broader and stronger improvements in metabolic health compared with other weight loss drugs. STEP and SELECT trial results showed benefits across weight, blood pressure, cholesterol, and heart outcomes, while older medicines such as Saxenda or Orlistat deliver more limited metabolic gains. This is one reason NICE guidance has made Wegovy a central option in NHS weight-management services.