GLP-1s

Glucagon-like peptide-1 receptor agonists. The new class of obesity + diabetes drugs (Novo Nordisk's Ozempic/Wegovy, Eli Lilly's Zepbound/Mounjaro) that transformed both pharma and the industry. In this vault, GLP-1s function as the platform around which Eli Lilly is trying to reinvent pharma.

Scale

• Lilly = 3/5 of GLP-1 sales in America (mid-2026).
• Zepbound — Lilly's slimming jab — first-full-year sales $4.9bn (2024); 2026 projection ~$20bn (4×).
• Bloomberg Intelligence: Lilly could capture 2/3 of a $120bn+ global obesity-drug market by 2030.
• McKinsey State of the Consumer 2026: ~25M US GLP-1 users by 2030.
• 120+ companies developing competing drugs; 190+ candidates in clinical trials.

Why GLP-1s matter beyond obesity

Growing evidence GLP-1s reduce risk of:

• cardiovascular disease
• sleep apnoea
• chronic kidney disease
• addiction (early signal)
• psychiatric illness (early signal)

Central question for Lilly: can GLP-1-family drugs prevent maladies from developing in the first place?

The platform framing

Per Dave Ricks (Lilly CEO), GLP-1s are "not a product but a platform" — a common foundation on which multiple medicines can be built by adding other hormones. Manufacturing crossovers matter as much as science: other injectables can "ride on the same rails" as GLP-1s, sharing the manufacturing network + lowering costs.

Novo vs Lilly

• Novo Nordisk (Denmark) — launched its treatment in America 2yr+ before Lilly.
• Lilly overtook in 2025 — via superior science (greater weight loss + fewer side effects), earlier manufacturing capex, lower prices, treating obesity as a consumer market as much as medical.

Obstacles Ricks names for the prevention pivot

• Health-care systems are built to treat, not prevent.
• Who pays? Costs are immediate; savings emerge years later; hard for insurers to value.
• Over-diagnosis / over-treatment risk.

Microdosing (added 2026-11-02)

Taking less than the label dose as a goal, to cut cost or side-effects or to hold weight on a maintenance dose, has become "one of the biggest off-label medical experiments ever" (Should You Microdose GLP-1 Drugs for Weight Loss (Economist), 2026-07-25). Headline numbers: ~1 in 7 users have microdosed; up to 55% of them without supervision; sold by Noom, Hims & Hers and medical spas in America. The evidence is anecdotal plus one April 2026 pharmacogenomic paper; the American Association of Clinical Endocrinology advises FDA dosing. The point that bears on this page: the cardiovascular, kidney and sleep-apnoea benefits listed above were shown at full doses, and there is no evidence they survive at lower ones, so a self-dosing population may get the weight effect without the prevention effect. Full treatment on GLP-1 Microdosing.

Brain and neuro: the next "Ozempic moment" (added 2026-11-02)

The GLP-1 precedent (aim a drug at a whole regulatory system, hunger, and benefits spill across organs) is now the template drugmakers apply to the brain. The candidate system is the orexins, hypothalamic peptides that regulate wakefulness (The Brain May Be About to Have Its Ozempic Moment (Economist), 2026-08-15):

• 5 Aug 2026: FDA approved oveporexton (Takeda), the first orexin agonist, for narcolepsy, on a phase 2 trial of 90 NT1 patients over 8 weeks (12.5–25 min longer wakefulness by dose; cataplexy roughly a third as frequent; insomnia and urinary urgency as side-effects).
• Eli Lilly bought Centessa (orexin agonist; 55-patient early trial) for up to $7.8bn contingent on trial success. Lilly CSO Dan Skovronsky: hunger and sleep are both "master homeostasis mechanisms".
• Market: Morgan Stanley sees $16bn/yr by 2035 from sleep disorders alone vs ~$3bn today for narcolepsy drugs.
• Unproven: every use beyond narcolepsy (ADHD, sleep apnoea, addiction, depression, motivation). The Economist calls them "hints, not proof".

The GLP-1 page's own early signals on addiction and psychiatric illness (above) remain unconfirmed; the orexin bet is a different peptide aimed at the same conditions.

Cross-references

• Eli Lilly — the trillion-dollar company GLP-1s built
• State of the Consumer 2026 (McKinsey) — the macro consumer-side trend where GLP-1s appear as the "health revolution" pillar
• Novo Nordisk — the Danish first-mover (no page yet)
• GLP-1 Microdosing — the off-label dose-stretching practice
• Dementia Prevention — the other prevention thread in the health brain
• Type 2 Diabetes Remission — the drug-free route to metabolic remission (RESET trial)

Sources

• Eli Lilly Is Reinventing the Pharma Business (Economist)
• State of the Consumer 2026 (McKinsey)
• Should You Microdose GLP-1 Drugs for Weight Loss (Economist) — 2026-07-25
• The Brain May Be About to Have Its Ozempic Moment (Economist) — 2026-08-15