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Novo, Lilly to benefit the most from obesity, but Cowen says don’t ignore other players

A asian men measures his fat belly with a measuring tape on a plain background

Deepak Verma

Global obesity drug sales are likely to hit ~$30B by 2020, according to Cowen, with Novo Nordisk (NVO) and Eli Lilly (NYSE:LLY) likely to dominate the market.

But the Wall Street firm also tells investors to not only pay attention to other pharmas with weight loss drug in the pipeline, but keep an eye on companies developing medical devices and digital therapeutics to make in-roads in the obesity treatment space.

In a Nov. 18 report, Cowen said that treatment for obesity is only in its fledgling state. Only 30% of obese individuals ever receive a diagnosis and treatment rates are only in the low single digits. The firm added that drug treatment is only used by just 1%-2% of obese patients.

In a June survey, Cowen found that obesity specialists said they view medication as appropriate for ~60% of their patients. That compares to 20% for surgical intervention. A survey of physicians and payors conducted in October by Cowen found that they agree that the percentage of non-diabetic obese patients on weight-loss drugs is set to increase significantly.


Novo Nordisk (NVO) and Lilly (LLY) are seeking to increase obesity medication usage, and rapidly, with their respective GLP-1 receptor agonists, Wegovy (semaglutide) and tirzepatide. Cowen projects Wegovy sales of over $7B and over tirzepatide sales of more than $11B in 2030. Tirzepatide is currently approved as a type 2 diabetes therapy under the name Mounjaro but Lilly (LLY) is pursuing the drug for weight loss in phase 3.

Cowen is also bullish on Novo (NVO) candidate CagriSema, a combination of semaglutide and a novel amylin analogue, cagrilintide. The pharma released positive phase 2 results in August showing reductions in blood sugar level and weight. Phase 3 is slated to start in 2023. Cowen sees $5B in CagriSema sales if data continues to perform well.

In the pipeline, Lilly (LLY) has the GLP-1R/GIPR/GCGR triple agonist retatrutide in phase 2 with a data update expected in January 2023. Other large pharmas with obesity candidates in mid-to-late stage development include Merck’s (NYSE:MRK) GLP-1R/GCGR dual agonist efinopegdutide (data update also in January), Pfizer’s (NYSE:PFE) oral treatment danuglipron, AltImmune’s (ALT) GLP-1R/GCGR dual agonist pemvidutide (ALT-801 (data update June 2023), and AstraZeneca’s (AZN) GLP-1/GCGR dual agonist cotadutide (update July 2025).

Medical Devices

In this area, Cowen sees Apollo Endoscopy (APEN) as its top pick in obesity. The company’s endoscopic sleeve gastroplasty (ESG) procedure uses its proprietary OverStitch endoscopic suturing system. The company is developing the OverStitch NXT single channel endoscopic suturing system that is said to have enhanced performance characteristics making it easier to use, expanding access to the technology.

Cowen also touted Apollo’s (APEN) space-occupying device, the Orbera Intragastric Balloon System, calling it “the leading gastric balloon worldwide.” The firm added the device can lead to 10% weight loss.

Cowen highlighed ReShape Lifesciences (RSLS) which makes Obalon, an intragastric balloon that is filled with gas. In one study, Obalon led to an average 4.2% weight loss at 12 weeks, making it inferior to other balloons.

Digital Therapeutics

Although Better Therapeutics (BTTX) is developing BT-001 as a prescription digital therapeutic (“PDT”) for type 2 diabetes, Cowen said the software-based tool can be applied to obesity. A PDT, usually found in an app, utilizes cognitive behavioral therapy to identify behaviors that can lead to bad lifestyle and diet decisions and make personalized change recommendations.

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