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Zepbound May Be Better If: Maximum weight loss is your primary goal SURMOUNT-5 clearly favours it You want more dose flexibility (six strengths to fine-tune tolerance) You also have moderate-to-severe obstructive sleep apnoea with obesity You prefer the cheaper self-drawn vial option via LillyDirect Wegovy May Be Better If: You have established cardiovascular disease Wegovy has an FDA-approved indication to reduce heart attack and stroke risk You dislike injections the oral tablet is now available Your insurance covers Wegovy but not Zepbound (it has been on the market longer and is on more formularies) You respond well to GLP-1-only therapy and tolerate it comfortably What Both Require: Neither drug works in isolation