Other pharmaceutical companies are eager for a slice of the pie, with dozens of new entrants developing products to challenge the sector's two giants.

These drugs primarily work by mimicking natural hormones that regulate appetite, satiety, and metabolism. They do not merely stimulate the nervous system, as some previous treatments did. Instead, they successfully alter how the brain and the body perceive hunger. For instance, Wegovy, Ozempic, and Zepbound mimic GLP-1 (Glucagon-Like Peptide-1), a hormone produced by the gut after a meal.

Novo Nordisk and Eli Lilly

Let's begin with the sector pioneer, Novo Nordisk. Q1 sales of its obesity products represented 29.85% of its total revenue, or 93.98% if diabetes product turnover is included. These figures are impressive, yet relatively expected, as Novo Nordisk is highly specialized in diabetes, obesity, and metabolic health.

The figures are perhaps even more striking for Eli Lilly, a diversified laboratory with significant exposure to Alzheimer's, oncology, and immunology. Over the first three months of the year, the American firm's obesity treatments generated $12.822bn in sales out of a total of $19.799bn, representing a 63.13% share.

The common thread between these two companies, from a stockmarket perspective, is their dominance at the top of global pharmaceutical market capitalizations. The market cap of Novo Nordisk, a Danish company, has even exceeded Denmark's GDP on several occasions. In terms of records, Eli Lilly is the first healthcare company to surpass $1bn in market capitalization: it currently holds 12th position globally, between South Korea's Samsung Electronics and Warren Buffett's American investment juggernaut, Berkshire Hathaway.

While Novo Nordisk is considered a pioneer, the stock has faced a difficult path in recent years. Since its all-time high reached in late June 2024, the share price has lost nearly 73% of its value. This sharp decline is linked to a market correction following excessive optimism, amid concerns regarding future growth and specifically which treatment will succeed Wegovy. Furthermore, Novo has faced a series of earnings warnings and setbacks regarding its ability to maintain leadership, particularly against Eli Lilly.

Conversely, Eli Lilly's stock is at an all-time high: since the commercialization of its first obesity product, it has surged by approximately 90%. This rise is mainly linked to the success of these treatments, but the group has recorded other victories, notably with Kisunla. With this product, the laboratory has entered a colossal market: the treatment of early-stage Alzheimer's disease.

From just Two Players to Many: The New Generation

Today, these two players face stiff competition, even as the market is expected to continue its hyper-growth. The sector is projected to exceed $100bn in annual revenue by 2030, with some estimates reaching $190bn when including combined diabetes-obesity indications.

The market will also shift with the arrival of oral formulations, which are easier to use than injections. Novo Nordisk was the first laboratory to market its Wegovy in pill form in the United States earlier this year. This version also received approval in the United Arab Emirates for an immediate launch on June 3. In Europe, on May 22, the Committee for Medicinal Products for Human Use of the European Medicines Agency issued a favorable opinion recommending marketing authorization for oral Wegovy. Commercialization is expected in the second half of this year.

Eli Lilly is close behind, as its oral product entered the US market shortly after Novo Nordisk's. Where Eli Lilly could increase its competitive advantage is with the second generation of these treatments. Its Retatrutide achieved weight loss approaching 30% at the highest dose after 104 weeks of treatment. By comparison, in a comparative study, CagriSema, Novo Nordisk's next-generation treatment, achieved 23% weight loss after 84 weeks, compared to 25.5% for patients receiving Tirzepatide (the molecule found in Eli Lilly's Zepbound and Mounjaro).

Behind the two giants, other laboratories are seeking to carve out a share of the market. Among them is Survodutide from Zealand Pharma and Boehringer Ingelheim. Its positioning is slightly different, however, as it targets not only weight loss but also a significant reduction in visceral and liver fat, making it attractive for patients with MASLD/MASH (metabolic fatty liver disease and its most severe inflammatory stage).

In addition to weight loss, other companies are targeting the reduction of cardiovascular risk, benefits for sleep apnea, preservation of muscle mass, better digestive tolerance, or simpler administration schedules, such as monthly doses. Among the best-known or most advanced are Amgen, Roche, AstraZeneca, Pfizer and Viking Therapeutics.

Regulatory, Commercial and Industrial Gridlock

With the arrival of all this competition, dozens of drug candidates are currently being developed. Between 2026 and 2030, numerous Phase III study results are expected. Laboratories are competing to recruit the same types of patients, and the cost of studies is rising.

Furthermore, announcing an average weight loss of 10% is no longer sufficient: companies must prove superior efficacy, better tolerance, more convenient administration, and/or new indications.

Health agencies will see a simultaneous influx of numerous studies involving new molecules, different combinations, innovative formulations, and expanded indications. Each file requires safety data spanning several years, cardiovascular monitoring, and the analysis of sometimes complex side effects.

Once a treatment is approved, it must be produced, and the manufacturing of GLP-1 peptides requires very specific capabilities. Both the sector giants have already invested tens of billions of dollars in their industrial capacity. Newcomers will need to find factories, suppliers, as wall as filling and packaging capacity.

Finally, some may distinguish themselves through pricing. While their efficacy is proven, one year of treatment costs between $5,000 and $15,000 per patient, depending on the country and the level of discounts granted. Health insurers must also be considered. Some are reluctant to reimburse part of the treatment because if a patient changes insurers after benefiting from obesity treatment coverage, it is the new insurer that will reap the health-related savings. These savings stem from long-term benefits: fewer heart attacks, fewer strokes, less diabetes, and less MASH.

In France, the Social Security system has formalized the reimbursement of anti-obesity drugs, such as Wegovy and Mounjaro, starting June 15, 2026. Reimbursement is reserved for patients with a high BMI or associated comorbidities who have not lost at least 5% of their weight after six months of diet and physical activity. The reimbursement rate has been set at 65% by the National Health Insurance, with a majority of patients receiving 100% reimbursement due to their health issues.