Novo Nordisk's Strategic Shift in the US Obesity Market: Can It Regain Lost Ground?

The obesity drug market in the United States has become a battleground for pharmaceutical giants, with Novo Nordisk's once-dominant position now under siege. In 2025, the Danish company faces a perfect storm of challenges: aggressive competition from Eli Lilly's Zepbound, regulatory headwinds, and a leadership transition that has rattled investor confidence. This article examines whether Novo Nordisk can recalibrate its strategy to reclaim its footing in the U.S. market, a critical driver of its global growth.

The Erosion of Market Leadership

Novo Nordisk's flagship obesity drug, Wegovy, and its diabetes medication Ozempic have long been the gold standard in GLP-1 receptor agonist (GLP-1RA) therapies. However, Eli Lilly's Zepbound has emerged as a formidable rival. Clinical trials show Zepbound outperforms Wegovy in key metrics: a 20.2% average weight loss in the 72-week SURMOUNT-5 trial compared to Wegovy's 13.7%, and 64.6% of Zepbound patients losing at least 15% of their body weight versus 40.1% for Wegovy. These results, combined with a lower price point ($1,059/month vs. $1,349/month), have driven Zepbound to overtake Wegovy in U.S. prescription volume.

The impact is stark in Novo's financials. In Q2 2025, the company reported operating profit of $5.2 billion, below the $5.3 billion forecast, as U.S. sales of Wegovy and Ozempic faltered. Compounded GLP-1 alternatives—unapproved but legally produced versions of Wegovy and Ozempic—continue to capture 30% of the U.S. market, despite the FDA's May 2025 decision to end their emergency use. These cheaper alternatives, priced as low as $199/month, have further eroded Novo's pricing power.

Regulatory and Pricing Pressures

The U.S. regulatory environment has added to Novo's woes. Pharmacy benefit managers (PBMs) like CVS Health have shifted formulary preferences to Wegovy, citing affordability, while Eli Lilly's Zepbound faces limited access in some plans. Novo has responded with a $499/month discounted rate for Wegovy through a U.S. healthcare provider, but this has yet to reverse the trend. Meanwhile, the Biden administration's push to cap insulin prices and reduce drug costs has heightened scrutiny on GLP-1RA pricing, creating a climate where cost-sensitive prescribing is the norm.

Leadership Transition and Strategic Reset

Maziar Mike Doustdar's appointment as CEO in August 2025 marks a pivotal moment. The former Novo executive, known for his operational rigor, inherits a company grappling with declining U.S. market share and a 64% drop in its stock price over the past year. His leadership will be tested by the need to balance short-term cost-cutting with long-term innovation.

Novo's pipeline offers a glimmer of hope. CagriSema, a combination of semaglutide and cagrilintide, demonstrated 15.7% weight loss in clinical trials and is expected to file for approval in early 2026. However, the drug's underwhelming performance compared to Eli Lilly's retatrutide—a triple-hormone agonist in development—raises questions about its competitive edge.

Investment Implications

The U.S. obesity market, projected to exceed $150 billion annually by 2030, remains a high-stakes arena. Novo's ability to regain momentum hinges on three factors:
1. Pricing Strategy: Can Novo match or undercut Zepbound's affordability while maintaining margins?
2. Regulatory Navigation: Will the FDA's crackdown on compounded GLP-1s hold, and can Novo secure favorable formulary placement?
3. Pipeline Execution: Can CagriSema differentiate itself in a crowded market dominated by Lilly's next-gen therapies?

For investors, the risks are clear. Novo's forward P/E ratio of 12.3x is significantly below its historical average, reflecting skepticism about its growth trajectory. However, the company's global obesity care segment still grew 56% in H1 2025, and Wegovy's cardiovascular benefits remain a unique selling point.

Conclusion: A Tenuous Path Forward

Novo Nordisk's U.S. market challenges are profound, but the company's deep expertise in GLP-1RAs and its global footprint provide a foundation for recovery. The new CEO's ability to streamline operations, negotiate favorable pricing, and accelerate CagriSema's approval will be critical. For now, the stock appears undervalued, but patience is required. Investors should monitor Q4 2025 guidance and CagriSema's regulatory timeline before committing. In a sector defined by rapid innovation, Novo's resilience will be tested—but its legacy as a leader in metabolic medicine offers a compelling long-term case.