Novo Nordisk’s answer to losing ground in the weight-loss drug wars: more semaglutide.

The FDA on Wednesday approved Wegovy HD, a 7.2 mg injection that triples the active ingredient of the current top dose and delivered 20.7% average weight loss in clinical trials — a meaningful jump from the 17.5% seen at 2.4 mg.

The approval, granted just 54 days after filing under the FDA’s National Priority Voucher program, hands Novo a sharper weapon in a market it once dominated but has been steadily ceding to Eli Lilly. As of late 2025, Lilly’s Mounjaro and Zepbound commanded 57% of U.S. GLP-1 prescriptions for diabetes and obesity, according to CNBC, while Novo held 43%. Lilly’s drugs pulled in $39.5 billion in revenue last year. The global GLP-1 market is now projected at $58 billion for 2026, heading toward $133 billion by 2035, according to industry forecasts.

The logic is pharmaceutical arms race in its purest form: if you can’t beat the competitor’s molecule, escalate your own. In the STEP UP trial of 1,407 adults with obesity, nearly one in three patients on the 7.2 mg dose lost 25% or more of their body weight, according to Novo Nordisk. Over 89% cleared the 5% threshold that clinicians consider meaningful.

There’s a trade-off. Dysesthesia — altered skin sensation described as sensitivity, pain, or burning — hit 22% of patients on the higher dose, compared to 6% at 2.4 mg and essentially zero on placebo, per the FDA. The agency says it’s investigating further.

Novo expects to launch Wegovy HD through more than 70,000 U.S. pharmacies in April. Whether a three-percentage-point bump in average weight loss is enough to shift prescribing patterns remains the $58 billion question — but in a market where fractions of a percent move billions in revenue, Novo is betting the answer is yes.

Sources