The exclusive private market shaping the GLP-1 era of obesity management

More than one million Australians have been dispensed a GLP-1 receptor agonist over the past five years, fuelling the emergence of an exclusively private obesity treatment ecosystem while bariatric surgery has declined significantly.

The findings come as obesity overtook tobacco to become Australia’s leading modifiable risk factor, accounting for 8.3% of the nation’s total disease burden and costing the economy an estimated $45 billion annually through healthcare expenditure and lost productivity.

According to a recent IQVIA report, second-generation obesity medicines including Wegovy (semaglutide) and Mounjaro (tirzepatide) represent 68% of the chronic weight management market of which 75% are females. In the past four years, the over-the-counter weight management market has halved, while bariatric surgery has declined by 17% per year – from 24,200 MBS services in 2022 to just 11,600 in 2026.

The report also found that more than 85,000 social media mentions of GLP-1 therapies were recorded in the past 12 months, reflecting a highly engaged patient population actively managing its own care, comparing brands, discussing cost strategies and reshaping the consumer landscape.

Novo Nordisk and Eli Lilly have each invested heavily in direct-to-consumer disease-awareness campaigns. Novo Nordisk’s You’ve Tried Everything campaign and Lilly’s We Won’t Weight campaign have leveraged social media, traditional advertising and dedicated online resources to encourage Australians to discuss evidence-based medical weight management with their healthcare providers. The public engagement strategies have extended beyond advertising, with Novo Nordisk partnering with Shane Warne Legacy to deliver free health checks at the 2024 Boxing Day Test, while Lilly partnering with Oprah Winfrey during her 2025 Australian tour.

The commercial landscape has also shifted beyond weight loss alone.

Novo Nordisk and Lilly are competing on comorbidity platforms rather than kilograms. Wegovy became the first approved GLP-1 RA for metabolic dysfunction-associated steatohepatitis (MASH), while Mounjaro became the first approved for obstructive sleep apnoea.

IQVIA analysed healthcare professional verbatims from more than 2,000 sales representative interactions. The analysis found that while both Mounjaro and Wegovy sponsors primarily positioned their products around obesity and weight loss, their messaging increasingly focused on brand differentiation. Wegovy sales representatives placed greater emphasis on cardiovascular benefits, whereas Mounjaro representatives centred their messaging on efficacy and comparisons with Wegovy, likely reflecting findings from the SURMOUNT-5 head-to-head trial as well as obstructive sleep apnoea serving as the primary differentiator.

Despite these developments, Australian clinical policy remains comparatively cautious. Local guidelines continue to be among the most conservative of major international frameworks, even as global consensus has shifted towards complication-driven care with earlier integration of pharmacotherapy.

The Therapeutic Goods Administration (TGA) approved Wegovy and Mounjaro for obesity management in August 2024. However, the Pharmaceutical Benefits Advisory Committee (PBAC) advised the Health Minister Mark Butler to pursue a managed rollout of obesity medicines targeting priority populations, with no recommendation for broader preventive PBS funding due to health budget impact.

Wegovy’s pathway towards PBS reimbursement highlights the ongoing tension between clinical evidence, health budget sustainability and equitable patient access.

The PBAC considered Wegovy on three occasions before recommending it on its final resubmission in November 2025 for patients with established cardiovascular disease (eCVD) and obesity (BMI >35 kg/m² or BMI >32.5 kg/m² for high-risk First Nations and Asian populations). The recommendation also proposed a risk-sharing agreement, including a 100% rebate above expenditure caps, to mitigate the potential budgetary impact. However, no agreement on PBS listing arrangements has yet been reached.

The exclusively private market for GLP-1 RAs, with treatment costs ranging from approximately $260 to $700 per month, continues to fuel debate around a two-tiered health system and equitable access. Yet, Australians already pay out-of-pocket for more than 16% of the national healthcare expenditure, equating to approximately $44 billion annually or more than $1,600 per person. This covers specialist and GP gap payments, surgical gaps, prescription medicines, imaging and dental care.

Competition within the obesity medicines market is expected to intensify further as the R&D pipeline expands.

Boehringer Ingelheim has already broken the Novo Nordisk-Lilly duopoly, releasing topline Phase 3 obesity data for its glucagon/GLP-1 dual agonist survodutide in April 2026, with additional data expected throughout the year.

Amgen’s MariTide (maridebart cafraglutide) is anticipated to report pivotal results in early 2027. The first-in-class antibody-peptide conjugate functions as a bispecific molecule combining GLP-1 receptor agonism with GIP receptor antagonism. Its dual mechanism is designed to deliver durable weight loss and is under investigation for both obesity and type 2 diabetes. Unlike current once-weekly GLP-1 RAs, MariTide is being developed with dosing ranging from once monthly to once every three months for long-term weight maintenance.

With almost 200 obesity medicines currently in development worldwide, the next phase of market competition is expected to extend well beyond weight reduction. Future therapies are likely to compete on broader comorbidity indications, formulation, dosing convenience and the ability to sustain long-term weight management.

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