Will competition hurt Ozempic?

The next generation of drugs is coming and coming on strong. The first is Mounjaro, a diabetes drug from Lilly that the FDA is expected to approve for weight loss this year. One study led to 20 percent or more weight loss in up to 57 percent of people who took the highest dose; The Wall Street Journal recently called it the “King Kong” of weight-loss drugs. The market for weight loss drugs is about to become very crowded.

Ozempic is far from perfect. Though the drug has an impact, it requires weekly injections, a tolerance for uncomfortable side effects, and the stamina—not to mention the budget—for long-term treatment.

People on Mounjaro lose more weight quickly and generally have a “better experience” than those on Wegovy. It’s also cheaper. Mounjaro mimics the effects of GLP-1 but also hits receptors for another hormone—GIP. That leads to even more weight loss by further focusing on food and potentially increasing the activity of a fat-burning enzyme. But there are even more coming.

Diet pills.

Eli Lilly has another drug in the works that target three receptors; one from the drugmaker Amgen works by “putting the brakes” on the GIP receptor and “putting the gas” on GLP-1’s, a company spokesperson told me. Several other companies have already joined what some have dubbed a “race” to develop the next excellent obesity drug. Lilly, Pfizer, Amgen, Structure Therapeutics, and Viking Therapeutics are expected to be the front-runners.

Drug companies follow the money and realize there is a lot of money to be made in weight loss drugs. Pfizer’s CEO believes that a mega blockbuster could be in a pill form and that, eventually, one will be developed that is better tolerated.

 Some doctors, psychologists, and eating disorder experts worry these new medications, originally developed to treat diabetes, could become a problem long-term. Common side effects of these so-called GLP-1 receptor agonists – nausea, diarrhea, vomiting, and constipation – can be significant. Nearly half of the people with diabetes quit an earlier generation of the medications within a year, one real-world study showed, and 70% within two years.

Most people are likely to regain lost weight if they don’t keep taking the drugs for life, and the psychological toll of that rebound could be damaging, psychologists predict.

Those who lose weight on the once-weekly shots will probably still need to exercise and eat well to see a health benefit. Substantial weight loss is generally associated with health improvement, but that has not yet been shown with these medications.

Novo Nordisk, the maker of Wegovy and Ozempic, has hired leading obesity medicine doctors. Novo Nordisk paid doctors just under $14 million in 2021 for education and training, government records show, while Eli Lilly, maker of Mounjaro, paid less than $1 million.

Novo Nordisk was recently suspended  from a pharmaceutical lobbying group in the U.K. for two years for quietly sponsoring a training program that was actually a “promotional campaign which Novo Nordisk knowingly paid for.” It marked only the eighth time in 40 years the Association of the British Pharmaceutical Industry sanctioned one of its members.

study published in the New England Journal of Medicine last month found that covering these medications for only 20% of eligible patients would cost Medicare $13 billion annually. Some argue this undercounts the savings from the improved health of those who lose weight.

In the most extended study, lasting 68 weeks – about 16 months – weight loss plateaued and started to climb again by the end, suggesting people’s bodies had acclimated to the drugs. Even if they lose pounds, people who overeat because of emotional or mental health struggles will still have those problems. Weight loss does not cure eating disorders or trauma or depression.

Research found that weight stigma doesn’t need drug company educational help as most HCPs felt that caring for obese patients made them uncomfortable.


The media has given drug companies a lot of free DTC when it comes to these weight loss drugs, but obesity cannot be controlled simply by a weekly injection; behavioral issues need to be addressed as well.

The other challenge is communicating that some patients who are moderately obese can still be healthy. Saying that all obese people are unhealthy is not accurate. Still, drug companies understand that most obese people want to lose weight and will take the easy way after failing various diets and not getting enough exercise. The potential for huge profits will ensure that drug companies continue to refine and develop new weight-loss drugs.