Novo Nordisk and Eli Lilly have been battling head-to-head in an exploding obesity market. They should never have been compared apples to apples.
The two fourth quarter earnings calls held Wednesday for Eli Lilly and Novo Nordisk could not have been more different. Eli Lilly was triumphant, braggadocious even. Novo was monotone and defensive.
It’s hard to believe, comparing the two, that they both have some of the best-selling medicines of 2025. Their GLP-1 franchises each brought in over $30 billion in 2025, and these therapies may just prove to be the biggest blockbusters in the pharmaceutical industry’s history.
But despite playing in the same market with the same mechanism and comparable overall sales, the two pharmas are headed in dramatically different directions. Lilly just breached the $1 trillion valuation mark—a first for pharma. Novo sits at $262.98 billion.
Novo’s semaglutide franchise actually beat Eli Lilly in the fourth quarter, recapturing a lead lost in the second for the first time since Mounjaro and Zepbound followed Ozempic and Wegovy to market. And Novo CEO Maziar Mike Doustdar said 2025 marked the achievement of a goal set back in 2019: the company doubled sales and operating profit, with obesity sales increasing 1,299% to nearly $13 billion in 2025.
But it’s not enough for investors, who want Novo to reach the heights that Lilly has scaled. Doustdar was forced to defend his company’s actions after revealing that total sales are expected to decline by about 5% in 2026.
But Lilly is expecting $80 billion to $83 billion for 2026, with analysts expecting the Indianapolis pharma to reach over $94 billion in revenue by 2027.
Novo will never catch up.
2026 thus represents a new phase in this closely watched head-to-head battle. This year we will see how the launch of oral options changes the game, with the Wegovy pill already prescribed to more than 100,000 patients and Lilly hot on Novo’s tail with the FDA expected to rule on orforglipron by early April.
Doustdar touted oral Wegovy’s first four weeks on the market as “phenomenal”—the best pharma launch ever. While a rich analysis of these new prescriptions has not been conducted by Novo, Lilly believes they are pulling in completely new patients to obesity treatment that had previously been “sitting on the sidelines waiting for an oral option,” Ken Custer, executive VP of Lilly cardiometabolic health, said on the company’s fourth quarter earnings call on Wednesday.
Pending approval, orforglipron will go head-to-head against the Wegovy pill. The two assets are different, with Novo achieving more weight loss but Lilly’s option having fewer restrictions around water and food consumption.
Both companies will also benefit later this year from the opening up of Medicaid coverage for obesity medications. Doustdar and Ricks appeared at the White House in the fall to negotiate the deal, offering lower prices for the GLP-1 medicines.
The pricing deals in turn kicked off another new milestone for the obesity market: the shift to a volume play from one focused on higher costs.
And new competitors, both big and small, are getting closer and closer to market. Novo’s Metsera deal rival Pfizer is throwing its weight behind a clutch of new assets from that company. Amgen and Roche are piling on, while GSK seeks to address diseases downstream of obesity. Add onto that the countless biotechs, including heavyweights like Viking Therapeutics, and the obesity space is feeling very crowded indeed.
It seems Novo, the early leader, will never escape the shadow that Lilly has cast over it. Nevermind that they are two distinct companies with different portfolios beyond obesity. They should never have been compared apples to apples.
These earnings are unfathomable. Still, the quest for more insatiable.
