Can Novo Nordisk catch up—or will Lilly run away with the metabolic crown?

The explosive growth of obesity and type 2 diabetes has triggered one of the most consequential rivalries in the pharmaceutical sector. Eli Lilly and Company (Lilly) and Novo Nordisk are now locked in a high-stakes race to dominate the metabolic health market, with both companies betting their future on glucagon-like peptide-1 (GLP-1) therapies. Once considered a niche segment, metabolic health has become the most aggressively expanding therapeutic space in biopharma. The outcome of this race may determine not only the next decade of healthcare innovation, but also who earns the title of the most valuable global drugmaker.

Eli Lilly and Company has surged ahead in 2025, propelled by the breakout commercial success of Zepbound and Mounjaro. But Novo Nordisk, long considered the pioneer of the GLP-1 category, remains a formidable challenger with a deep portfolio and entrenched market presence. As both firms expand into oral formulations, triple-agonists, and combination therapies, the question is no longer whether metabolic health will be central to biopharma strategy—it is who will lead the next phase of its evolution.

How Eli Lilly and Company gained a decisive lead with dual-agonist therapies

Eli Lilly and Company’s momentum has accelerated rapidly in 2025, thanks to the commercial ramp-up of Zepbound, its obesity-focused version of tirzepatide, and Mounjaro, its type 2 diabetes counterpart. These dual GLP-1 and GIP agonists have demonstrated superior weight loss and glycemic control compared to earlier GLP-1 monotherapies. Zepbound in particular has seen rapid adoption across multiple geographies, with analysts noting that it has already claimed a significant share of new prescriptions in the obesity category.

The company’s success is not limited to injections. Eli Lilly and Company has advanced Orforglipron, a once-daily oral GLP-1 candidate, into late-stage development. Clinical data have suggested that Orforglipron offers meaningful weight loss and glucose control, with efficacy metrics that challenge injectable standards. If approved, this product could dramatically expand access and improve patient adherence, particularly in primary care and emerging markets where injection aversion remains a barrier.

What differentiates Eli Lilly and Company’s approach is the combination of rapid pipeline progression, strategic manufacturing expansion, and a vertically integrated global rollout strategy. The company has invested heavily in production facilities to scale capacity, including multiple new plants in the United States and Europe. This end-to-end infrastructure allows it to meet growing global demand while preserving pricing flexibility and supply reliability.

Why Novo Nordisk remains a serious contender despite recent setbacks

Novo Nordisk is no newcomer to metabolic health. The company pioneered GLP-1 therapy with its diabetes drug Ozempic and later extended the platform into obesity with Wegovy. For years, these products defined the category and delivered consistent revenue growth. Novo Nordisk’s global brand equity in diabetes management remains unmatched, and its expertise in endocrine disorders gives it a defensible base in both developed and emerging markets.

However, recent quarters have exposed challenges. Novo Nordisk cut its 2025 full-year guidance after experiencing slower-than-expected uptake in certain geographies. The company cited growing competition, the impact of compounded semaglutide formulations, and increasing scrutiny from regulators over pricing and access. While Wegovy continues to perform in core markets, the broader operating environment has become more complex.

Novo Nordisk is also investing in the future. Its oral semaglutide program continues to advance, and new combination therapies are entering the pipeline. The company’s next-generation obesity drug, CagriSema, combines semaglutide with cagrilintide, aiming for deeper appetite suppression and weight loss. It also retains a first-mover advantage in several international markets where Eli Lilly and Company is still scaling up distribution.

What factors could tip the balance in the metabolic health power struggle

Several critical variables are likely to determine whether Eli Lilly and Company can maintain its lead or if Novo Nordisk can reclaim the top spot. One of the most important is therapeutic breadth. Both companies are now racing to expand their metabolic portfolios beyond obesity and diabetes into related indications such as cardiovascular risk reduction, sleep apnea, fatty liver disease, and prediabetes. The ability to secure multiple indication approvals and demonstrate real-world benefits in comorbid conditions could reshape market leadership.

Another key factor is delivery innovation. Eli Lilly and Company’s oral candidate, Orforglipron, is widely viewed as a potential game-changer due to its non-peptide structure and ease of manufacturing. Novo Nordisk’s oral semaglutide, while effective, has faced formulation and absorption challenges that complicate scalability. If Orforglipron secures faster approval and broader market access, it could give Eli Lilly and Company a lasting advantage in primary care channels.

Manufacturing capacity and global supply readiness are also essential. Eli Lilly and Company’s aggressive expansion of production capabilities may give it an edge in meeting surging demand. Novo Nordisk, while experienced in high-volume diabetes drug production, may need to invest further to keep pace with the evolving global footprint of GLP-1 therapies.

Regulatory pressure and payer response are additional wildcards. Both firms are likely to face increased scrutiny over pricing, particularly in the United States and Europe. Success in negotiating value-based reimbursement, securing formulary placement, and demonstrating cost-effectiveness will determine long-term market penetration.

What the outcome means for investors, patients, and the pharmaceutical sector

For investors, the contest between Novo Nordisk and Eli Lilly and Company is more than a rivalry—it is a case study in platform investing within healthcare. The winner is likely to be the company that best transitions from blockbuster drugs to an integrated platform strategy, delivering recurring revenue across multiple indications and delivery formats. That model is already familiar in technology, and now it is defining the future of biopharma.

For patients, increased competition has the potential to accelerate innovation, improve access, and lower costs. The move toward oral formulations and chronic maintenance therapy could also help destigmatize obesity care and expand coverage by public and private insurers. As more data emerges on long-term safety and cardiovascular benefits, GLP-1-based drugs may become foundational tools in population health management.

For the pharmaceutical industry, this rivalry is reshaping R&D priorities and strategic planning. Companies that previously ignored or underfunded metabolic disease areas are now entering the fray, either through internal pipelines or acquisitions. The surge of interest has also sparked M&A activity, with several mid-sized biotech firms now seen as potential targets for larger players seeking to enter or scale in the category.

Who will wear the crown in the age of metabolic medicine?

While Eli Lilly and Company currently holds the lead in momentum, valuation, and platform expansion, Novo Nordisk remains an agile, well-resourced competitor with deep expertise. The coming year will likely prove decisive as both companies prepare to launch new products, report late-stage trial results, and scale up supply.

What is clear is that metabolic health is no longer a therapeutic afterthought. It is now one of the most competitive and strategically significant domains in global biopharma. Whether Eli Lilly and Company solidifies its lead or Novo Nordisk stages a comeback, the industry will be watching, and investing accordingly.