Obesity patients at Juan Manuel Esparza Luna’s clinic in Chihuahua, Mexico, have options to slim down, with access to Novo Nordisk A/S and Eli Lilly & Co.’s blockbuster shots. But many leave his office with prescriptions for older, less effective therapies for one reason: cost.
Luna tries to make treatment more affordable. Sometimes he combines low doses of Novo’s Wegovy and Lilly’s Zepbound with older stimulants like phentermine, or stretches out the time patients stay on the cheapest doses.
“You have to think of the economic situation of your patients,” he said. “It’s very expensive.”
Change is coming, however. After facing off in the US in a rivalry that made powerful GLP-1 drugs ubiquitous and more affordable, Novo and Lilly are now looking elsewhere for growth. The shift will make the newest obesity medicines more accessible to Luna’s patients and millions of others.
Lilly’s global bet hinges on a new pill called Foundayo. The US company has sought approval for the medicine in 40 countries and plans to flood the market, Ken Custer, the company’s chief of cardiometabolic health, said recently at the biggest international conference for obesity medicine.
“Obviously the US is an important market, and we will compete there,” Custer said. “But it’s also time to expand our thinking, and think about global population health. That’s what a medicine like this can do.”
Novo has a pill too — an oral version of Wegovy that goes by the same name. The drugmaker introduced the product in the United Arab Emirates this week after winning its first clearance outside the US. It’s also on track for approval in Europe.
The Danish company’s approach to international launches is more gradual than Lilly’s and less focused on oral medicine. Novo will move into new markets only when it’s certain it can meet demand there, according to Emil Kongshoj Larsen, the head of international operations.
“There will be no half-measures,” Larsen said. “So we go all-in, in every single country that we launch in, because that is the way to be successful.”
Even in countries where Novo hasn’t launched the pill, the company believes that a Wegovy “halo effect” will drive interest in the shots as well, Larsen said. “The world is quite local these days.”
Obesity treatments will also become more affordable as the first generic versions of semaglutide, the main ingredient of Novo’s Wegovy and Ozempic, hit more countries. This year, cheaper copycats are becoming available in India, Canada and Brazil.
Until now, the obesity-treatment revolution has largely happened in the US. One in eight Americans has tried a GLP-1 medicine, a KFF analysis found. But globally, just 1 per cent to 2 per cent of people who could benefit from one of the new drugs that mimic gut hormones are currently taking one, Lilly says. And poorer countries are where obesity rates continue to climb.
At the European Congress on Obesity in Istanbul last month, Lilly addressed stigma around weight loss with an art installation depicting positive and negative weight-loss slogans: “Just go for a walk,” “Lazy is a label,” and “Just eat less.” Red flags with the US company’s logo flapped in the wind above the Bosphorus, and attendees snapped selfies while sipping iced coffee in Lilly-branded cups.
Unlike when the drugmaker first introduced its blockbuster shots outside the US, it can make enough pills to flood the market. But for many people, access may come down to what insurance will pay for, said Judit Pettko, a patient advocate from Hungary, where about a fifth of adults have obesity. Monthly wages there are below $2,000 after tax, while a prescription of Ozempic costs about $118 if it’s not subsidized by insurance.
“For an average family, it’s too expensive,” she said. If drugmakers want to make a difference, “they really should go to the government and negotiate.”
In some countries, there are also cultural barriers to treatment. In India and Pakistan, for instance, chubby “golu molu” children are seen as especially cute and celebrations center around what to eat. In India, where the advent of generics has driven costs down this year, many patients are worried about side effects and not entirely sure of how the drugs work, said Swati Pradhan, a Mumbai-based obesity specialist and founder of LiveLight Clinic.
“They will ask, ‘Will this melt fat,” Pradhan said, using a colloquial Hindi word, “charbi,” that can also refer to grease – or in slang usage, to somebody who’s too big for their britches.
And like Luna’s patients in Mexico, Pradhan’s struggle with cost. Stigma around seeking treatment also plays a role. Women who don’t have their own income and don’t feel they can ask their partners to pay for the medicine might scrape together only enough savings for a short course of drugs.
“They have given me a deadline, like, you know, I have money only for three months,” Pradhan said. “They are not willing to talk to their families or even ask for money for it.”
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Published on June 5, 2026
