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HOW TO CHOOSE Semaglutide might be a better fit if: You want the medication with the longest track record (available since 2017) Your insurance covers it (semaglutide has broader insurance coverage currently) You've tried tirzepatide and experienced intolerable side effects You prefer an oral option (Rybelsus is available as a daily pill, though the injectable form is more effective for weight loss) Tirzepatide might be a better fit if: You want the highest average weight loss based on clinical data You have significant insulin resistance or type 2 diabetes (the dual mechanism may provide better blood sugar control) Semaglutide wasn't effective enough at maximum dose You want to maximize results and the cost difference isn't a barrier The truth: Both work well