The Great Weight Hope

A maker of weight-loss drugs will soon be the largest company in the world

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I’ve been predicting for some time now—at least a year, I think—that within a decade or maybe even sooner the world’s largest company will be a maker of weight-loss drugs. It won’t be Nvidia and its AI chips or Tesla and its electric cars: It will be the people dosing the 600lb landwhale next door with modified lizard venom. Remember: There are a billion obese people worldwide now.

I first made that prediction when it was announced that Novo Nordisk had become Europe’s largest company, almost entirely off the back of its drug Wegovy / Ozempic. Novo was valued at $570 billion, a full $200 billion more than the entire economy of its home country, Denmark.

With its $2.3 billion annual tax bill, Novo was single-handedly keeping the Danish economy afloat. While the rest of the EU was circling the plug hole, Denmark was enjoying a comfortable 4% growth—all thanks to people who just can’t stop shovelling food in their mouths, mainly in the US.

According to an article in Fortune, the spoils of semaglutide—that’s the name of the drug: Wegovy and Ozempic are the brands—“drove record government spending on defense, the green transition and support for Ukraine.”

“Little in Denmark can escape Novo’s gravitational pull,” the article continued.

“It’s agenda influences educational and research priorities, and politicians consider the company’s perspective before making decisions on immigration policy or new infrastructure development. The drug maker has created thousands of jobs in the six-million-person country—and more will come as Novo expands across multiple locations—but even citizens with no ties to the firm benefit from its gains. Danish pension funds are flush from record returns on Novo shares, and mortgages are cheaper as booming diabetes drug exports have forced Denmark’s central bank to keep interest rates low.”

On Friday we reached another, even more significant, milestone on the road to my prediction coming true. This time, it wasn’t Denmark’s Novo, but America’s own Eli Lilly that got there. Lilly, creator of the competitor drugs Mounjaro and Zepbound, hit $1 trillion in market value. It’s now the first pharma company to join the exclusive thousand-billion club—that’s 12 zeroes—which is dominated by tech giants like Microsoft and the world’s current largest company, Nvidia.

As Reuters reports, “a more than 35% rally in the company’s stock this year has largely been driven by the explosive growth of the weight-loss drugs market.”

Shares in Lilly have far outpaced the growth of the broader US equity market. Since the launch of Zepbound in 2023, Lilly shares have grown by 75%, compared to a 50% rise in the S&P500.

In the last reported quarter, Lilly’s obesity and diabetes segment brought in combined revenue of $10.9 billion, well over half the company’s total revenue of $17.6 billion.

Lilly has managed to overtake Novo as the Great Weight Hope in part because of a series of studies that showed its products to be more effective, and it’s also cut important deals with the US government.

Lilly’s for continued growth now rest on its oral weight-loss drug, orforglipron, which is expected to be approved for general use next year.

A weight-loss pill, rather than an injection, will be a true game changer, allowing drug to reach the largest possible consumer-base. Novo, of course, is working on its own pill too.

Here’s where I modify my prediction: Whichever company can produce the most convenient weight-loss drug with the fewest and least severe side effects, at a fairly reasonable price—that will be the world’s largest company.

It could be Eli Lilly, or maybe Novo will regain the lead, but it’s going to be one or other of them. The two companies already hold the vast majority of the market share, and that’s not predicted to change.

I don’t think this is a good thing, by the way.

My objections to weight-loss drugs fall into two broad categories, as I’ve explained elsewhere. On the one hand, I have moral objections—I don’t like unearned virtue and think good health isn’t a “right” that should be given to you by a corporation, the government or anybody else for that matter—and on the other I object to the massive power these drugs are handing to pharmaceutical companies, which already have far too much power over politics and our lives.

My stance has softened somewhat in recent months, at least on the moral front. I think it’s unavoidable that some people will have to use these drugs if they want to lose weight. Some people are simply too fat, and many lack the willpower or resources or both. These drugs aren’t going anywhere, and they do have some legitimate uses.

The real question concerns my second objection, and how much more power we’re willing to give Big Pharma.

As the long quotation from Fortune above shows, the profits of these drugs can, quite literally, give a pharmaceutical company the power to dictate national political, social and economic policy. Hell, Novo’s profits from semaglutide have helped fund the war in Ukraine, via Danish foreign aid.

It’s not an exaggeration to suggest similar power could be wielded by an Eli Lilly in the US.

One obvious way this could happen is through bankrupting the taxpayer-funded healthcare system. The Senate’s HELP Committee recently gameplanned various uptake trajectories and found that, even in a conservative scenario, the Medicare and Medicaid budgets might have to double within six years just to accommodate spending on weight-loss drugs. Of course, this assumes the drug companies will continue to charge absurdly high prices to American consumers. Trump has already made moves to prevent them from doing so. We’ll see/

But there are other more subtle ways this growing power could manifest itself. These fall under the rubric of what the philosopher Ivan Illich called “iatrogenesis.” Illich’s great book Medical Nemesis describes how the medicalisation of society strips us of our freedom to govern ourselves and choose how we live our lives. This is a form of medical harm that’s less easy to quantify than, say, adverse side effects or unnecessary surgeries, but it’s every bit as real and, in all truth, it’s worse, because it reshapes society without our conscious input, reducing individual and collective freedom.