$NVO $LLY all right boys let me get everyone’s attention again, I will explain why you don’t bet against Lily or NVO. You either buy both or buy one. Never short glp market. It’s terrifying for shorties.
Part 1 out of 3
The Second Wave of Obesity Medicine — The Bull Thesis
Core thesis
The central bull thesis for the obesity-drug industry is that investors may be treating Novo Nordisk and Eli Lilly as if they are fighting over a relatively fixed pool of patients, when in reality they are competing inside one of the largest, most underpenetrated, expanding chronic-disease markets in medicine. The first GLP-1 wave proved that pharmacological weight loss works. The second wave—likely unfolding from 2026 through the remainder of the decade—is about removing the barriers that prevented hundreds of millions of eligible people from becoming patients: price, insurance coverage, injections, physician access, manufacturing capacity, geographic availability and treatment choice. If those barriers continue falling, the dominant source of future growth does not have to be Novo stealing patients from Lilly or Lilly stealing patients from Novo. It can be millions of previously untreated people entering the market for the first time.
That distinction changes the entire investment thesis.
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1. Start with the denominator: the potential population is enormous
This is not a disease affecting ten or twenty million people.
WHO estimates that in 2022 approximately 2.5 billion adults were overweight, including more than 890 million adults living with obesity. Worldwide adult obesity prevalence has more than doubled since 1990. (World Health Organization)
And the denominator does not appear to be shrinking.
A major Global Burden of Disease forecasting study published in The Lancet projects that, if historical trends continue, approximately 3.8 billion adults aged 25+ could have overweight or obesity by 2050, including roughly 1.95 billion living with obesity. (PubMed Central (PMC))
That means the obesity pharmaceutical industry is not necessarily chasing a patient population that will eventually be exhausted.
The potential pool is continually replenished by:
new people developing obesity,
younger populations aging into treatment,
patients becoming medically eligible,
people receiving an obesity diagnosis for the first time,
new countries gaining access,
insurance expanding coverage,
and people who previously refused treatment changing their minds as medicines become cheaper, easier and better.
Therefore, the market has two potential growth engines simultaneously:
growth of the underlying eligible population
and
growth in the percentage of that population receiving treatment.
The second factor could be much more powerful than the first.
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2. Treatment penetration remains tiny relative to the medical need
Consider one number.
Novo Nordisk reported treating approximately 3.6 million people globally with obesity in 2025. Its obesity business nevertheless generated DKK 82.3 billion of revenue and grew 31% at constant exchange rates. (Novo Nordisk Annual Report)
Compare:
3.6 million Novo obesity patients
with
~890 million adults already living with obesity globally.
This is not saying only 3.6 million people globally receive obesity medication—Lilly, other drugs and other channels obviously add additional patients.
The important point is the order of magnitude.
Novo can operate an enormous obesity franchise while reaching only a tiny fraction of the global disease population.
That is characteristic of an underpenetrated market, not a mature one.
And the branded GLP-1 obesity market is still expanding extraordinarily quickly. Novo reported that global branded GLP-1 obesity-market volume increased 104% during 2025. (Novo Nordisk Annual Report)
That is one of the strongest pieces of evidence for the thesis.
The companies are not merely rearranging existing patients.
The category itself is expanding.
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3. This is why market share can be extremely misleading
Suppose there are initially 100 treated obesity patients.
Lilly has:
55
Novo has:
40
Others have:
5
Now imagine that five years later the treated market expands from 100 patients to 250 patients.
And Novo actually loses market share from 40% to only 30%.
Novo would then have:
30% × 250 = 75 patients.
Its market share fell:
40% → 30%
but its absolute patients increased:
40 → 75
or roughly 88%.
That is the mathematical insight that matters.
Losing share does not necessarily mean losing patients.
If the denominator expands sufficiently quickly, both competitors can become dramatically larger businesses while fighting each other intensely.
This is why thinking about obesity as:
“Will Lilly beat Novo?”
can lead investors to the wrong conclusion.
A better question is:
“How quickly will the number of treated obesity patients expand?”
Lilly could remain the injectable leader.
Novo could lose some injectable share.
And yet Novo’s total obesity volume could still grow substantially if oral drugs, international expansion, Medicare, self-pay channels and greater medical adoption create millions of incremental patients.
That is the bull case.
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4. The first wave proved the medicine works; the second wave removes friction
The first great GLP-1 adoption wave occurred roughly from 2021 through 2025.
Wegovy, Ozempic, Mounjaro and Zepbound transformed expectations about pharmacological weight management.
But there was an enormous problem.
The drugs could work extremely well medically while still being difficult to obtain commercially.
A potential patient had to confront some combination of:
high prices
insurance exclusions
prior authorization
doctor appointments
injections
supply shortages
limited manufacturing
limited international availability
side effects
uncertainty about long-term therapy
Every friction point reduces the conversion rate from:
“I would like obesity treatment”
to
“I am actually taking obesity medication every month.”
KFF’s polling illustrates this gap.
Among Americans who reported having been diagnosed with overweight or obesity, 23% said they were currently taking a GLP-1 in late 2025. Yet among diagnosed overweight/obese adults who weren’t currently using one, 43% said they were interested in using a GLP-1 for weight loss. (KFF)
There is therefore a substantial difference between interest and actual treatment.
Why?
Cost is one obvious explanation.
KFF found that 56% of people who had used GLP-1 medicines reported difficulty affording them, while cost was among the most common reasons people discontinued therapy. (KFF)
That is exactly what a bottleneck looks like.
It means existing sales don’t necessarily measure underlying medical demand.
They measure medical demand after applying all the current obstacles to access.
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5. Now several of those obstacles are falling simultaneously
This is why 2026 may represent the beginning of the second adoption wave.
Barrier #1: injections → pills
Novo launched Wegovy tablets in the United States in January 2026.
By April, weekly prescriptions had already exceeded 200,000. (Novo Nordisk)
By early June, Novo reported more than 3 million prescriptions in slightly more than five months, and importantly said that the majority of new prescriptions were going to people new to GLP-1 therapy. (Novo Nordisk)
That last piece matters enormously.
If pills merely converted people already using injections, the tablet would mostly cannibalize the existing category.
Instead, evidence that many users are new to GLP-1s supports the market-expansion thesis.
The product isn’t only redistributing patients.
It is helping create patients.
Novo subsequently passed 5 million Wegovy-pill prescriptions, while Q2 pill revenue reached roughly DKK 3.22 billion. (Reuters)
Lilly has now entered the oral market as well. Its once-daily Foundayo/orforglipron received U.S. approval in April 2026 and can be taken without food or water restrictions. (Lilly Investor Relations)
So the industry is moving from:
“Would you inject yourself once every week?”
toward:
“Would you take a pill every morning?”
Those questions can produce very different addressable populations.
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6. High cash prices are beginning to fall
Historically, an uninsured patient could face an enormous monthly bill for branded GLP-1 therapy.
Now both major companies are experimenting with dramatically cheaper direct-pay entry points.
Novo launched the starting dose of Wegovy pill with a $149-per-month self-pay offer. (Novo Nordisk)
Lilly launched the lowest dose of Foundayo at $149 per month for self-pay patients, while certain commercially insured patients may pay substantially less. (Lilly Investor Relations)
Those figures should not be confused with guaranteed pricing across every dose and every patient.
But directionally the change is important.
The industry is discovering that:
lower price × dramatically greater patient volume
may create a larger economic opportunity than:
extremely high price × restricted access.
That is exactly how a niche pharmaceutical market can begin transitioning toward a mass-market chronic-therapy category.
Not financial advice, all personal opinion, long novo.
