Battle of the Bulge: Novo Nordisk eyes India's waistline

The aroma of freshly fried jalebis, a treat in many Indian households, used to be a siren call for Rohan, a Bengaluru-based software engineer battling an expanding waistline. Like many in a city known for sedentary work and rich food, the 36-year-old’s health markers are starting to raise an alarm. He is combing online to learn about drugs such as Ozempic and Wegovy that are generating a buzz for their use in weight management.

Rohan’s case depicts a new reality in India where rising obesity is providing an opportunity for global pharmaceutical giants. Take Novo Nordisk. The Danish company, known for semaglutide—which has made waves globally for its effectiveness in treating obesity and Type 2 diabetes—is looking to make India central to its growth plans. The reason is simple. The company, after years of steady growth, is showing signs of strain from increased competition and regulations in developed markets. It is undergoing a significant leadership reshuffle amid pressure from investors following a sharp decline in its share price over the past year. CEO Lars Fruergaard Jørgensen, who has led the company since 2017, recently announced his decision to step down, weeks after Executive Vice President Camilla Sylvest exited the firm.

India was not initially on Novo’s radar. It had planned to launch Wegovy, its flagship weight-loss drug, in India around 2026. However, with growing global demand, competition from American pharmaceutical giant Eli Lilly’s diabetes-cum-weight-loss drug Mounjaro and imminent launch of the generic versions of the drug, it is accelerating its India plans. The patent for semaglutide is expiring in 2026.

Why India

A faster expansion in India will allow Novo to diversify growth and tap into a market with significant potential for obesity-related treatments. According to ICMR-INDIAB national study (ICMR-INDIAB-17), published in The Lancet Diabetes and Endocrinology, about 254 million had generalised obesity, and 351 million had abdominal obesity in India. The condition is notably higher among women, 40% of whom are affected, compared to men (12%). The obesity treatment market is currently valued at Rs 3,000-3,500 crore, with projections suggesting it could balloon to Rs 25,000 crore by 2030, as per an IMARC report. Novo wants to gain a foothold in this rapidly growing segment before Indian pharmaceutical giants such as Sun Pharma, Cipla, Lupin and Dr. Reddy’s launch their generic versions.

The response to Eli Lilly’s Mounjaro, already available in India at a relatively lower price, signals the competition is intensifying. “Obesity is a chronic disease that requires comprehensive management. Lilly is committed to enhancing the standard of care in obesity management in India. Results from SURMOUNT-5, a phase 3b open-label clinical trial published in The New England Journal of Medicine, demonstrated that Mounjaro (tirzepatide), a dual GIP and GLP-1 receptor agonist, led to greater weight reduction than Wegovy (semaglutide),” says Winselow Tucker, President and General Manager, Eli Lilly and Company (India).

Fast-tracking Wegovy’s launch will give Novo more time to stay ahead of the generic versions that are expected to flood the market after the semaglutide patent expires. The decision is rooted in patient need, regulatory preparedness and a clear shift in public health priorities, says Vikrant Shrotriya, Managing Director, Novo Nordisk India. “We are introducing Wegovy (injectable semaglutide 2.4 mg), which offers the full therapeutic strengths of semaglutide for comprehensive management of weight and obesity, this year,” says Shrotriya. “As a healthcare company, we acknowledge responsibility towards our patients to ensure availability, access and awareness,” he says.

According to Grand View Research, India’s obesity treatment market is growing at a rapid clip. It generated around Rs 760 crore ($91.6 million) revenue in 2024, projected to touch nearly Rs 2,710 crore ($326.6 million) by 2030, a compound annual growth rate of 25%.

The adoption of semaglutide-based drugs is already reshaping the market. Sales of Novo Nordisk’s Rybelsus, an oral form of semaglutide, grew 60% in 2022 and 66% in 2023, says Makreo Research.

Indian pharmaceutical majors such as Sun Pharma, Cipla, Dr. Reddy’s and Lupin are also developing their own versions of weight-loss drugs like Wegovy. Biocon is also ready to jump on the bandwagon. The global GLP (glucagon-like peptide) market is projected to reach $130–135 billion by FY29. As key peptide drugs like Semaglutide and Tirzepatide begin to lose patent protection, significant opportunities will open up for biopharma companies like Biocon. Near-term, Biocon is targeting Liraglutide ($2 billion annual sales) and Semaglutide in emerging markets ($4-5 billion sales). It has launched its Liraglutide in the UK, has secured approvals from the EMA for Europe and filed with the USFDA. Its diabesity pipeline includes Liraglutide, Semaglutide and Tirzepatide. “We have built a robust GLP-1 portfolio to address the growing challenge of diabesity. Biocon is advancing its diabesity pipeline, including Semaglutide and Tirzepatide, towards major global markets such as Europe, the US, and key emerging economies,” says Siddharth Mittal, CEO & MD, Biocon.

The global obesity drug market is expected to soar to over Rs 8.3 lakh crore ($100 billion) annually by the end of the decade. The potential is too large to be ignored. But so are the risks.

Healthy Competition

The entry of Lilly’s Mounjaro has stirred the pricing debate, especially as Novo’s Wegovy is likely to be sold at a premium. “While we are working to make Wegovy available in India this year, we are also mindful of ensuring that people get it at a competitive price,” says Shrotriya. He points to the broader role of semaglutide. “Obesity management goes beyond weight reduction. It plays a critical role in mitigating risk associated with serious co-morbidities. GLP-1 receptor agonists such as semaglutide have shown efficacy not only in obesity management but also in addressing related conditions, including type 2 diabetes and cardiovascular disorders,” he says. An agonist is a molecule (like a drug or a hormone) that binds to a receptor on a cell and triggers a biological response. Novo knows that competition in India will only grow, especially after 2026, when semaglutide goes off-patent and local generic players begin to enter the segment en masse. Shrotriya sees this as a natural progression. “Patent expiry is a natural phase in the lifecycle of pharmaceutical products,” he says. “Despite more options, there is a significant unmet need for effective therapies for type 2 diabetes and obesity. There is a need to expand access to existing treatments and develop innovative solutions. Ultimately, innovation remains the key differentiator,” he adds.

Novo’s upcoming launch of Wegovy in India marks a significant step in weight management and diabetes care, says Dr Anoop Misra, Chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences. “With rising rates of obesity and type 2 diabetes, India is a key market where effective medical treatments are urgently needed. Wegovy, a GLP-1 receptor agonist with proven benefits, could play a valuable role, particularly for individuals who have not had success with lifestyle changes alone,” says Dr Misra. But its success will hinge on affordability and long-term access. “While I anticipate strong demand among a select group of patients, diet, exercise and lifestyle modifications will continue to be the cornerstone of obesity management for most people. Wegovy is likely to benefit a smaller segment that can afford and adhere to this therapy,” he says

Rising obesity in India has created significant demand for effective, non-injection-based treatments. Lilly launched Mounjaro (tirzepatide) in India in March 2025 following approval by the Central Drugs Standard Control Organisation. Priced between Rs 14,000 and Rs 17,500 per month, it is available in 2.5 mg and 5 mg doses and treats diabetes as well as obesity. Shrotriya says he doesn’t view the new entrants as a threat but a sign that global attention is shifting towards chronic disease management. “We recognise that competition is growing, which is ultimately a positive shift for healthcare, enabling greater awareness and improved solutions.”

Not An Easy Road

Maintaining market share in India is not easy. Cost sensitivity, wide differences in access to healthcare and infrastructure gaps remain hurdles. Novo is responding by building local partnerships and strengthening awareness. “India’s obesity market is poised for significant growth, and Novo Nordisk is committed to shaping this evolving landscape through innovation and collaboration,” says Shrotriya. It is developing next-generation therapies, enhancing access and awareness and working with healthcare professionals, policymakers and researchers to improve early diagnosis and long-term obesity care.

The company is also focusing on building a broader ecosystem. “We have successfully collaborated with state governments, leading medical institutions and healthcare stakeholders to advance diabetes care, and we are now applying this expertise to combat obesity,” he says. “Our focus remains on building a robust, science-driven ecosystem that ensures sustained impact and aligns with India’s broader public health priorities.”

Taking Stock

Analysts have started flagging concerns around how sustainable Novo’s growth is, especially as newer molecules challenge the dominance of semaglutide. India may hold the answer to this vexatious question.

“As generics enter the market post-2026, Novo Nordisk remains focused on delivering scientifically advanced high-quality therapies that go beyond weight loss to address broader metabolic and chronic health conditions,” says Shrotriya. “We are investing in next-generation innovations, expanding access and strengthening partnerships across the healthcare ecosystem to ensure long-term value and sustained patient trust.”

Wegovy’s launch in India is not just another product rollout—it is a strategic signal. As obesity becomes a defining public health issue, Novo is looking to embed itself early, build long-term patient trust and shape how the disease is addressed on the ground. “As a healthcare brand with a legacy of 100+ years, we are committed to serving all people who depend on our medicines through a strong and diversified product portfolio,” says Shrotriya.

The coming years will reveal whether Novo’s first-mover advantage holds in the face of rising competition and a highly dynamic healthcare environment. Shrotriya believes that innovation, not just pricing, will determine who leads the obesity treatment market in the long run. “Innovation is the cornerstone of Novo Nordisk’s product strategy,” he says. “Our obesity portfolio is backed by over 25 years of research and innovation.”

That research, he says, is not merely about weight reduction. “Semaglutide, the active ingredient in Wegovy, stands out for its clinically proven health benefits extending beyond weight loss—such as reducing cardiovascular incidents, fatty liver disease and chronic kidney disease.”

Preparing for The Launch

A key component of Novo Nordisk’s India strategy for Wegovy is its Global Business Services (GBS) centre in Bengaluru. The centre plays an important role across functions, supporting the value chain from early research to supply chain management.

John Dawber, Corporate Vice President & Managing Director of Global Business Services at Novo Nordisk, says the Bengaluru hub is involved in everything right from regulatory submissions and marketing strategies to medical support and commercial analytics.

Serving as a bridge between the company’s Denmark headquarters and over 80 global affiliates, GBS Bengaluru also handles market intelligence, digital content creation safety surveillance and regulatory documentation. The centre’s contributions include support for medical strategy such as safety monitoring and medical writing. It is also involved in managing the global distribution by coordinating production schedules and aligning them with demand forecasts.

“India’s market dynamics offer useful insights that may shape our global obesity strategy,” says Dawber. “The country’s demographic diversity, varying cultures, affordability and patient needs offer an opportunity to refine our education channels and partnerships. With our local collaborations and established ties with policymakers, India has the potential to influence future developments in obesity care.”

Demand for GLP-1 Drugs

Novo Nordisk reported strong growth in 2024 with revenue reaching DKK 290.4 billion (approximately $42.1 billion), a 25% increase over the previous year. Net profit rose to DKK 100.9 billion ($14.5 billion), up 20%, while operating profit was DKK 116.9 billion ($17 billion). The trend continued in the first quarter of 2025, with revenue at DKK 78.09 billion ($11.3 billion), up 19% year-on-year, and net profit at DKK 29.03 billion ($4.2 billion), a 14% increase over Q1 2024.The weight-loss portfolio contributed significantly to this growth. Wegovy’s sales reached DKK 58.2 billion ($8 billion) in 2024, doubling from the previous year. However, the company continues to face headwinds in the US market because of the presence of compounded alternatives, which the USFDA plans to phase out by May 2025. Novo Nordisk has adjusted its 2025 sales growth forecast to 13-21%. The US accounted for 57% revenue in Q1 2025.

India, where concerns around diabetes and obesity are growing, with over 200 million people estimated to be living with diabetes, offers a way out.

“Expanding middle class, urban living and evolving diets are contributing to both conditions,” says Dr Rashmi Chaturvedi Upadhyay, Senior Pharma Consultant at Dialectica. “GLP-1 drugs are being seen as important because they address diabetes as well as obesity. As awareness improves and more affordable versions enter the market, these therapies are expected to play a larger role in diabetes care in the years ahead.”

But access and pricing remain key challenges. Local pharmaceutical companies and public health programmes are working to improve availability. “The introduction of semaglutide in January 2022 marked a shift in India’s obesity treatment market, which has grown several times over in the past five years,” says Sheetal Sapale, VP, Commercial, Pharmarack.

“This expansion reflects not only increasing obesity rates but also a broader change in attitudes. More people are open to medical treatments, and the presence of international therapies like Wegovy and Ozempic has brought greater attention to this space,” she says.

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