Anti-obesity pills, the new billion-dollar race between Lilly and Novo Nordisk

After the meteoric rise of GLP-1 injectables, the pharmaceutical industry is shifting its focus to what many see as the real game changer: pills. Eli Lilly and Novo Nordisk, the companies that set off the obesity drug boom, are now racing to bring once-daily oral formulations to market—easier to take, store, and distribute, with the potential to reach tens of millions more patients worldwide.

Lilly unveiled phase 3 results for its candidate orforglipron, showing patients lost an average of 12.4% of their body weight over 72 weeks, with nearly 40% shedding more than 15%. In a head-to-head trial against oral semaglutide, orforglipron also came out ahead in blood sugar control and weight loss for type 2 diabetes patients.

Novo Nordisk quickly countered with data from its Oasis-4 trial on a 25 mg oral semaglutide pill. Over 64 weeks, patients lost an average of 16.6% of their weight, with more than a third cutting over 20%—figures on par with its best-selling injectable version that has already reshaped the global obesity market. Beyond weight loss, studies highlighted reduced risks of heart attack and stroke as well as mental health benefits, including relief from obsessive food-related thoughts.

The commercial opportunity is staggering: analysts see a market worth tens of billions of dollars annually. Success would mark a turning point, transforming obesity treatment from complex chronic management into a simple daily pill.

In Italy, the debate is also playing out at the regulatory level. For now, GLP-1 therapies are reimbursed only for diabetic patients under the national health system. But Health Undersecretary Marcello Gemmato recently signaled openness to extending coverage to non-diabetic obese patients, positioning the drugs as a preventive investment to reduce future healthcare costs.

The contest between Lilly and Novo Nordisk is no longer confined to clinical trials and stock markets—it is increasingly being shaped by governments and regulators deciding how quickly these treatments will enter mainstream use.