Tablet or injectable: who will lead the global obesity market?

In early 2026, Novo Nordisk launched Wegovy in tablet form (oral semaglutide, daily use) in the US, with an announced entry price of US$149/month for initial doses, scaling to higher doses, and price adjustments expected from April 15th . This move helps to highlight a transition that goes beyond a simple product line extension: the global obesity market is becoming a game of leadership at scale , where "tablet versus injectable" is just the tip of the iceberg in a broader competition for access, production capacity, distribution channels, and treatment retention.

The question that is beginning to dominate the category is straightforward: who will be able to combine robust clinical results with sustainable access on a large scale? In a field of chronic use and massive demand, leadership is not sustained solely by clinical trial data: it depends on an entire architecture of product, price, distribution, and therapeutic continuity.

The race has changed phases: from efficiency to scale.

In the early years of the LPG-1 boom, the public conversation revolved around "does it work?". To a large extent, the sector has already passed that stage. Now, the challenge is less glamorous and more crucial: scaling sustainably .

Scale, here, means three things at once. First , producing sufficient volume (and regularly). Second , reaching the patient through channels that truly convert demand into treatment. Third , maintaining use for a sufficient amount of time so that the benefit does not turn into a costly "win-lose" cycle, both clinically and economically.

This is where the pharmaceutical form becomes a strategy. The tablet is not just about convenience; it can expand the addressable market and open up distribution and pricing avenues that injectables cannot offer as easily. But it also creates new usage requirements and new adherence challenges in the real world.

Has the "tablet vs. injectable" debate become a battle for leadership in the global obesity market?

Novo Nordisk played a leading role in consolidating the modern category. However, in recent years, Eli Lilly has gained ground with tirzepatide (Zepbound/Mounjaro), supported by a strong perception of efficacy. A widely cited statistic is the result of SURMOUNT-1: an average weight loss of approximately 20.9% over 72 weeks in the higher-dose regimen (compared to placebo, under controlled conditions).

When competition reaches this level, the natural response is not just "to be more powerful." It's also about competing in what determines large-scale adoption: form, access, channel, and retention . International coverage describes Wegovy oral's strategy as aimed at attracting consumers who pay directly , with a presence in large retail chains and digital/telemedicine platforms, in addition to its own pharmacy operations.

This shift is crucial: part of the competition no longer takes place exclusively in the doctor's office but in retail and digital environments. In mature markets, those who control the path to the patient and reduce friction at the beginning and onward tend to have an advantage, even when competitors are clinically excellent.

"Oral" is not synonymous with automatic ease.

It's intuitive to think that a pill is always easier than an injection. For many people, that will be true: needles present psychological and practical barriers. But oral Wegovy requires a specific daily ritual, which can become a significant behavioral challenge.

According to FDA-approved labeling, the tablet should be taken on an empty stomach with a small amount of water , and at least 30 minutes must pass before eating, drinking other beverages, or taking other oral medications. This may seem like a detail, but chronic treatments are made up of details. For those who already use other medications in the morning, for example, this window can complicate their routine.

The point is that the "oral" format removes one obstacle (injection), but it can create another (rigid daily discipline). And, as the category matures, the market tends to reward less "how many start" and more "how many stay," because staying is what transforms effectiveness into sustained benefit.

What the effectiveness data show (and what they don't solve)

Results from high-dose oral semaglutide were published in the New England Journal of Medicine (OASIS 4), showing greater weight loss than placebo under controlled conditions and frequent gastrointestinal events (a common pattern in this class). Novo Nordisk also highlighted, in a corporate statement, straightforward figures: in an approach that considers adherence, it cites an average weight loss of 16.6% , and states that about one-third of participants achieved 20% or more weight loss.

These data support the argument that the pill is not just "convenient": it can be competitive in results for a significant portion of patients. And this matters because, in large markets, "good enough + more affordable + more scalable" can be a powerful combination.

But weight loss data alone do not end the debate. In healthcare systems and in real life, the question shifts to maintaining the benefit, long-term safety, and total cost. The more the category grows, the more it is judged by a harsh and inevitable concept: sustained value , not just initial effect.

The unmet need that could define the next decade: maintenance.

Obesity is a chronic condition. This poses a practical dilemma: if the effect depends on continuity, how do we design a treatment that is viable for years, for both individuals and systems?

The extension of the STEP 1 study showed weight regain and reversal of some metabolic gains after discontinuation of semaglutide. Recent syntheses reinforce the same idea: discontinuing therapy tends to lead to a gradual loss of benefits over time. A Reuters report, based on a publication in the BMJ , describes this pattern as consistent in the literature.

This shifts the market's center of gravity. The race is no longer just for the most potent therapies, but to include solutions for sustaining benefit: clinical follow-up, management of adverse events, long-term strategies, and possibly therapeutic combinations. In market terms, this is where leadership can shift from "best study outcome" to "best ability to keep people well-treated in the real world."

The demand is driven by epidemiology, not by "consumption trends."

Globally, the WHO estimates that around 16% of adults were obese in 2022. In Brazil, a widely used annual source for monitoring risk factors in capital cities is Vigitel — Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey , from the Ministry of Health. In simple terms, it is a recurring survey that tracks indicators related to chronic diseases. Based on historical data, the frequency of obesity in adults in capital cities rose from 11.8% (2006) to 25.7% (2024) .

This background explains why the category has become a global industrial dispute: it is a prevalent condition, associated with comorbidities and significant costs. When the dispute scales up, the question changes in each country: who can reduce costs, expand supply, and build access without compromising budgetary sustainability ?

Brazil: When global leadership encounters the barrier of access, and national industry enters the game.

In the US, Wegovy oral arrives with a defined entry price and a channel architecture to accelerate adoption. In Brazil, the scenario is more restrictive: the monthly cost of these therapies at retail remains out of reach for most, and the SUS (Brazilian public health system) has not yet incorporated semaglutide/liraglutide for obesity.

Conitec recommended to the Ministry of Health not to incorporate liraglutide and semaglutide into the SUS (Brazilian Public Health System), mentioning, among other points, an estimated financial impact of R$ 8 billion per year . In retail, the gap between need and access is concrete: as a reference, Wegovy 2.4 mg appears in large chains for around R$ 1,699 under promotional conditions (with a higher full price).

What is changing in Brazil and deserves attention is that the discussion is no longer just about "high prices" but now includes supply capacity and local competition . EMS, for example, has already entered the segment with liraglutide -based products (injectable pens) and has been communicating a strategy of national production and presence in large retail chains, with prices starting at R$ 307.26 for some presentations. This does not solve the problem of access in obesity by itself, but it signals an important change: a "second axis" of competitive pressure is beginning to emerge, coming from within the country.

Furthermore, EMS and Fiocruz formalized technology transfer agreements for the national production of liraglutide and semaglutide , with the explicit aim of expanding production capacity and reducing external dependence on medications used for diabetes and obesity. If this path matures, it could have a structuring effect: more local supply tends to increase competition and, over time, create more realistic conditions for discussing expanded access and the eventual reopening of the debate on incorporation, not out of "goodwill," but due to economic viability .

There is also a legal-industrial component on the horizon: recent decisions in the Superior Court of Justice (STJ) upheld the expiration of the semaglutide patent in Brazil as originally planned, in March 2026. This does not mean an automatic price drop the next day, but it usually accelerates competitor activity and investments in equivalent versions, and could reposition Brazil as a relevant field in the scale competition, especially if there is production capacity and a channel strategy.

In short, Brazil still faces a tough barrier to entry, but it's not standing still. The entry of national companies and the local production agenda suggest a possible, albeit uncertain and conditional, path for the sector to move beyond being a restricted market and towards a genuine discussion of equity.

What to watch out for going forward

The initial buzz of the launch fades quickly. The structural signs remain. Four questions tend to guide the next phase:

1. What will the actual price be for the patient in practice (and not just the advertised price)?

   
   

2. How many people remain on treatment after 6–12 months, especially with more demanding usage routines?

   
   

3. How will competition in formats (oral and injectable) reposition access and cost?

   
   

4. How will the value debate (sustained benefit, security, long-term cost) shape coverage, inclusion, and equity?

   
   

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by Marcio de Paula

Brazilian Health Innovation Institute - IBIS