GLP-1s: Still early in the growth story

GLP-1s remain an early-stage cardiometabolic growth platform with substantial expansion potential beyond weight loss.

• The market has grown by more than 40% annually to over $80 billion, with about 11 million US patients receiving treatment while roughly 40% of the US population is overweight.
• Clinical use is expanding from type 2 diabetes and obesity into areas such as obstructive sleep apnoea and cardiovascular risk, which could increase the addressable patient base.
• Oral therapies may broaden adoption because 8 out of 10 oral GLP-1 users are new to the category, while global adults living with obesity are projected to rise from 810 million in 2020 to 1.53 billion by 2035.
• Consensus estimates put total GLP-1 revenue at $98.6 billion in 2026 and $190.6 billion in 2031, with annual growth moderating to about 14% over the next five years; Columbia Threadneedle considers those expectations potentially conservative.
• Lilly holds about 62% of the market versus roughly 38% for Novo Nordisk, and its Mounjaro and Zepbound franchises, manufacturing capacity and pipeline support its competitive position; about one million patients still use compounded products costing $150 to $285 per month.

Takeaway: Low penetration, broader indications, oral formulations and late-stage programmes could sustain multi-year growth, although pricing pressure, reimbursement changes, regulatory setbacks and supply constraints remain material risks.