The Race to Redefine Obesity Treatment

Obesity ranks as the second leading cause of preventable death, linked to the risk of inflammatory conditions that are directly and indirectly related to cardiovascular disease, diabetes, respiratory issues, psychological problems, hypertension, obstructive sleep apnea, cancer, and hyperlipidemia. This poses a major public health crisis that has steadily worsened over the last fifty years. Rising obesity rates have been noted among children and adults of both genders and are prevalent in both developed and developing nations.

According to DelveInsight’s analysis, as of 2023, ~196 million people were living with obesity across the 7MM. These cases are further expected to increase by 2034. As per the estimates, ~15 million patients are ≤ 19 years of age in the US. ~90% of obese patients do not seek help due to factors such as stigma, lack of awareness, and the high cost of drugs.

In the United States, the treatment rate for children was found to be less than that of adults, and the estimated number of total treated children of obesity was ~6K cases in 2023. The United States spends ~15% of its total health expenditure on obesity treatment.

Obesity Treatment: Then & Now 

Current obesity management aims to reduce body weight and fat percentage, mitigating associated health risks. Strategies include dietary modifications, exercise (aerobic, high-intensity interval, cardiovascular, resistance training), behavioral therapy, lifestyle adjustments, pharmacotherapy, and surgical interventions like intragastric balloons, bariatric surgery, and laparoscopic gastric banding.

In the last century, obesity pharmacotherapy has seen diverse approaches, including amphetamines, thyroid hormones, and withdrawn drug combinations. Current obesity treatment options, like phentermine, cathine, and diethylpropion, offer short-term benefits. Investigations into mitochondrial uncouplers, serotonergic agonists, and others show limited efficacy, with most failing to achieve over 10% placebo-adjusted mean weight loss at tolerable doses.

FDA-approved therapies for obesity treatment include CONTRAVE (bupropion-naltrexone), a combination of medications reducing appetite and cravings; SAXENDA (liraglutide), an injectable GLP-1R agonist suppressing appetite and affecting gastric emptying; Alli, XENICAL (orlistat), an inhibitor of pancreatic lipase aiding obesity management; QSYMIA (phentermine-topiramate), a prescription suppressing appetite and promoting weight loss; IMCIVREE (setmelanotide), approved for genetic-based obesity; and WEGOVY (semaglutide), an injectable medication aiding weight loss in adults with obesity or overweight, coupled with a reduced-calorie meal plan and increased physical activity.

Novo Nordisk Leading the Way in the Anti-Obesity Treatment Market

Novo Nordisk solidifies its dominance in the obesity market with SAXENDA, its pioneering GLP-1-based drug, and the recent addition of WEGOVY. 

SAXENDA, a product of Novo Nordisk was initially approved in December 2014 in the US for the treatment of chronic weight management in adults with a BMI of 30 kg/m2 or higher or a BMI of 27 kg/m2 or higher who have at least one weight-related condition. 

WEGOVY (semaglutide), another Novo Nordisk lead asset, is a GLP-1 receptor agonist indicated as an adjunct to a reduced-calorie diet and increased physical activity. In June 2021, the FDA approved WEGOVY injection for chronic weight management in adults. The prescription volume for WEGOVY was ~92,000 in the US in January 2024.

As per DelveInsight’s analysis, WEGOVY secured ~60% of the $2.8 billion total obesity treatment market in 2023 due to superior weight loss efficacy. Novo Nordisk experienced a staggering 147% surge in sales of its obesity care products due to the rapid adoption of WEGOVY among healthcare professionals. The drug also achieved over 70% commercial formulary access within six months of launch. Additionally, in January 2024, Novo Nordisk ramped up the supply of lower-dose WEGOVY to meet the surging demand. 

Eli Lilly and Novo Nordisk: A Battle for Supremacy in the Anti-Obesity Treatment Market

Eli Lilly and Novo Nordisk, two pharmaceutical giants, are at the forefront of the burgeoning anti-obesity treatment market, fiercely competing for supremacy. Eli Lilly, with its innovative drug ZEPBOUND, has made significant strides by demonstrating superior efficacy in weight reduction compared to existing treatments. ZEPBOUND, originally developed for type 2 diabetes, recently got approved for obesity treatment. The company’s strategic focus on leveraging its expertise in metabolic diseases positions it well to capture a substantial share of this rapidly growing obesity treatment market. As per DelveInsight analysis, ZEPBOUND is anticipated to grow at an exponential rate and is likely to capture ~35% of the obesity market by 2032

On the other hand, Novo Nordisk, a leader in diabetes care, has established itself as a formidable player in the anti-obesity treatment market with its drug semaglutide, marketed under the brand name WEGOVY. Semaglutide has received widespread acclaim for its effectiveness in weight management, significantly reducing body weight in patients. Novo Nordisk’s extensive experience in GLP-1 receptor agonists and its robust global distribution network gives it a competitive edge. As both companies continue to innovate and expand their portfolios, the battle for dominance in the anti-obesity treatment market is set to intensify, promising advancements that could transform patient outcomes and redefine the landscape of obesity management.

However, pharmaceutical companies face an uphill battle in securing public reimbursement for obesity treatments as access to weight loss medications is frequently limited by both private and public insurers. The drugs are excluded from Medicare coverage, and many private health plans resist covering them due to their high cost. In Germany, Novo Nordisk’s obesity drug WEGOVY will continue to be excluded from reimbursement for the treatment of obesity, while in Spain and France, WEGOVY and Saxenda are not reimbursed by public and private insurance. Despite the strong demand for anti-obesity drugs like WEGOVY and ZEPBOUND after approval, a supply shortage has occurred.

The Competition Among Leading Manufacturers to Revolutionize Obesity Treatment

The current obesity pipeline comprises over 80 clinical-stage assets undergoing trials, dominated by GLP-1 receptor agonists, either alone or in combination with GIP agonists. Some of the drugs in the obesity pipeline include Oral semaglutide, danuglipron, Survodutide (BI 456906), and others. Key players, such as Novo Nordisk, Pfizer, Carmot Therapeutics, Rivus Pharmaceuticals, and others are involved in developing novel therapies for, overweight and obesity which will eventually help in weight management.

Oral semaglutide, marketed as RYBELSUS, is approved in the US, EU, and Japan as an adjunct to diet and exercise to improve glycemic control in adults with type II diabetes. It is an oral GLP-1 receptor agonist, mimicking the naturally occurring hormone GLP-1. The drug is currently being developed for obesity and is undergoing a Phase III trial (NCT05564117; OASIS 4) to assess its safety and efficacy in subjects with overweight or obesity.

Pfizer has developed danuglipron (PF-06882961), an oral small-molecule GLP-1R agonist, and announced in June 2023 its decision to progress this candidate toward further clinical development for obesity treatment. In December 2023, Pfizer reported topline data from a Phase IIb clinical trial demonstrating a statistically significant change in body weight in adults with obesity without type II diabetes. Boehringer Ingelheim is developing survodutide (BI 456906), a dual GCGR/GLP-1 agonist, which leverages the effects of oxyntomodulin to decrease food intake and increase energy expenditure. In August 2023, Boehringer Ingelheim announced plans to advance survodutide into three registrational Phase III studies for people with overweight or obesity, based on promising Phase II data.

The anticipated launch of these emerging therapies for obesity are poised to transform the market landscape in the coming years. As these cutting-edge therapies continue to mature and gain regulatory approval, they are expected to reshape the obesity market landscape, offering new standards of care and unlocking opportunities for medical innovation and economic growth.

DelveInsight estimates that the market for obesity treatment in the 7MM is likely to grow at CAGR ~23.0% due to growing demand and increasing research to launch new products to cater to the patient pool.

What Lies Ahead in Obesity Treatment?

The rivalry between WEGOVY and ZEPBOUND, two prominent weight loss medications, is intensifying as both seek to dominate the market for obesity treatments. WEGOVY, developed by Novo Nordisk, is a higher-dose version of their diabetes drug semaglutide, repurposed to target weight loss. It has gained significant attention for its efficacy, showing substantial weight reduction in clinical trials. ZEPBOUND, on the other hand, is a newer contender from Eli Lilly, based on the active ingredient tirzepatide, which combines GLP-1 and GIP receptor agonism. This dual mechanism has demonstrated impressive results, potentially offering greater weight loss compared to WEGOVY. As both drugs vie for supremacy, their competition is characterized by aggressive marketing, continuous innovation, and efforts to improve patient outcomes.

The competition is expected to become even fiercer with the arrival of upcoming obesity therapies. Several pharmaceutical companies are developing new weight loss medications that target different pathways and offer various benefits, such as improved cardiovascular outcomes or fewer side effects. These new obesity therapies might include novel combinations of existing drugs, advanced formulations, or entirely new classes of medications. The success of WEGOVY and ZEPBOUND will depend on their ability to not only maintain their current advantages but also adapt to the evolving landscape by enhancing their formulations, demonstrating long-term safety and efficacy, and possibly integrating complementary treatments. This dynamic environment promises rapid advancements in obesity treatment, ultimately benefiting patients through more effective and personalized therapies.