Obesity Davids and Goliaths face off at ADA 2026

 

The American Diabetes Association’s annual congress will feature a superstar lineup, including weight loss giants Eli Lilly and Novo Nordisk. But several scrappy biotechs will also present obesity candidates with the potential to match—if not outperform—their deep-pocketed competitors.

This weekend, many of the world’s leading metabolic experts will flock to New Orleans to attend the 2026 American Diabetes Association’s Scientific Sessions.

Recent editions of the meeting have unsurprisingly had a heavy focus on obesity. Weight loss has become one of the most lucrative areas across biopharma, with IQVIA forecasting $92 billion in sales of obesity medicines this year and up to $200 billion by 2027 and beyond. And last year, obesity unseated long-reigning oncology as the top contributor of pharma pipeline value, with weight-loss medications accounting for 25% of the overall pharma pipeline value.

Obesity’s ascent has spilled over into conferences like ADA, where many of the most highly anticipated presentations focus on weight control. This is especially true for the 2026 edition of the congress, which features a superstar lineup of companies presenting new data on both approved and investigational drugs.

These include readouts from undisputed weight loss leaders Eli Lilly and Novo Nordisk, as well as from other major pharmas looking to stake their claim in the sector. But ADA 2026 will also see some plucky biotechs stand up to these giants, bringing their own obesity candidates that could give these deep-pocketed counterparts a run for their money.

Frontrunners face off with next-gen obesity bets

All eyes at ADA will be on Lilly and Novo and their next-generation assets as they chart the way forward for the obesity space.

Lilly will present data from the Phase 3 TRIUMPH-1 and TRANSCEND-T2D-1 studies of its triple-G agonist retatrutide in obesity and diabetes, respectively. Lilly has deemed retatrutide part of a “different drug category,” as compared with its current weight-loss drugs, Andy Hsieh, healthcare research analyst at William Blair, told BioSpace in an email.

Hsieh expects the triple-G asset, “given its high potency,” to set itself apart from Lilly’s other obesity products—including the GLP-1/GIP dual agonist Zepbound and small-molecule drug Foundayo. Still, he anticipates that the debate around retatrutide will focus on the tradeoff between its weight loss efficacy and tolerability.

Indeed, data that Lilly has disclosed so far demonstrate impressive weight reduction. Retatrutide generated 28.3% weight loss over 80 weeks in the Phase 3 TRIUMPH-1 study, Lilly announced on May 21, likening the results to those elicited by bariatric surgery. The trial assessed the candidate in patients with obesity but without diabetes.

The Phase 3 TRIUMPH-4 study, reported in December, showed a 26.6% placebo-adjusted weight-loss at 68 weeks in patients who have obesity or are overweight with knee osteoarthritis, results BMO Capital Markets said at the time “help to solidify retatrutide’s profile as an even higher efficacy next generation GLP-1+ asset.”

But the drug’s safety profile has tempered some of the industry’s excitement, with Lilly reporting a signal called dysesthesia—a neurological anomaly characterized by unpleasant or painful sensations—in more than a fifth of patients on the 20-mg dose of retatrutide in TRIUMPH-4. Dysesthesia also occurred in TRIUMPH-1, with rates rising with dose level.

Not to be outdone by its chief competitor, Novo is bringing its own next-generation weight-loss candidate, CagriSema, to ADA 2026. The drug is a fixed-dose combination of its GLP-1 giant semaglutide and long-acting amylin analog cagrilintide.

While the pharma will give several presentations at the conference, William Blair believes investors will be more interested in CagriSema’s data in diabetes—outlined in the Phase 3 REIMAGINE 1, 2 and 3 studies—than in obesity after the asset “failed to demonstrate non-inferiority” versus Lilly’s Zepbound, according to a May 4 note.

In February, data from Novo’s head-to-head REDEFINE-4 study showed that patients on CagriSema lost 23% of their body weight on average at 84 weeks, whereas comparators on Zepbound saw a 25.5% reduction in weight.

Novo remains confident in CagriSema, however, and expects the drug to hit U.S. shelves next year. “When CagriSema will make it to the market early next year as the first amylin-based product, it will have the best weight loss label than any product marketed at that time,” CEO Maziar Mike Doustdar told investors and analysts at the time of the head-to-head readout.

Behind the duopoly, Big Pharmas play for third

With Lilly and Novo firmly in the lead, the rest of biopharma is looking to claim that coveted third place, with Boehringer Ingelheim, Roche and more hustling to get their candidates to the market. Many of these aspirants will be at ADA 2026.

Based on timelines alone, Hsieh told BioSpace, Boehringer appears poised to win the race.

Boehringer is working with Zealand Pharma on survodutide, a dual agonist of the GLP-1 and glucagon receptors, “designed to go beyond weight reduction by targeting pathways relevant to metabolic dysfunction and liver disease,” Vani Manja, global head of Obesity and Liver Health at the German pharma, told BioSpace in an email.

With survodutide, Boehringer is shifting its focus “from weight loss to metabolic health, from single targets to multi‑pathway approaches, and from short‑term outcomes to more durable impact,” Manja said.

At ADA, the company will present detailed data from the Phase 3 SYNCHRONIZE-1 study, a topline readout from which showed a 16.6% drop in weight at 76 weeks, as compared with 3.2% in placebo controls. These numbers “appear less competitive vs other dual target mechanisms,” such as Lilly’s tirzepatide, BMO said in an April 28 note.

Still, survodutide could set itself apart from the current leaders by offering better quality weight loss, BMO added. Indeed, most of the weight reduction in SYNCHRONIZE-1 was due to fat loss. Lean mass accounted for “only a small proportion” of the total weight that participants lost, Zealand said at the time.

William Blair expects to see more detailed data from SYNCHRONIZE-1 at ADA, particularly “additional color from survodutide’s impact on body composition and liver fat,” according to the firm’s May 4 note. These findings, in turn, could have readthroughs to other indications, such as metabolic dysfunction-associated steatotic liver disease (MASH), which survodutide is also targeting, the analysts continued.

Another potential third-placer is Roche. The pharma in late 2023 invested $2.7 billion to acquire Carmot Therapeutics and its pipeline of GLP-1 therapies, including CT-388, which additionally activates the GIP receptor. Phase 2 data for the asset in January demonstrated a 22.5% placebo-adjusted weight reduction at 48 weeks, with no signs of plateauing.

More detailed data from the trial will be presented at ADA, where William Blair will be keeping an eye out for detailed tolerability data, “given the relatively high doses being evaluated,” analysts said on May 4. So far, Roche has only said that CT-388’s safety is “generally consistent with the incretin class of medicines.”

The firm also believes that investors will also be interested in learning about Roche’s plans to combine CT-388 with Zealand’s amylin therapy petrelintide. Roche signed an up to $5.3 billion partnership in March 2025 with the Danish biotech for the asset.

Also gaining ground on the leaders is Amgen, which according to Hsieh is just a bit behind Boehringer in terms of timing. When it comes to weight-loss numbers, Amgen might “have a better chance of catching up to the duopoly,” he said.

Anchoring Amgen’s weight-loss portfolio is MariTide, a bispecific antibody-peptide that targets both GLP-1 and GIP pathways. In November 2024, the pharma released Phase 2 data showing an up to 20% drop in body weight at 52 weeks—findings analysts found disappointing.

Amgen is nevertheless standing by MariTide. During the company’s earnings call in April, Murdo Gordon, executive vice president of global commercial operations, said MariTide has the potential “to be the best monthly or less frequently dosed agent” in obesity.

In addition to weight loss, Amgen is positioning MariTide as a medicine for adjacent indications, such as heart failure, obstructive sleep apnea and elevated liver fat.

“We see the future of care as increasingly connected across obesity and cardiovascular disease as these conditions commonly coexist and can lead to serious outcomes or death, even though they are treatable,” Chief Medical Officer Paul Burton told BioSpace in an email.

Amgen will be at ADA 2026 but will not be presenting MariTide data.

Don’t discount the little guys

Obesity isn’t just an opportunity for the big guys, of course, as many smaller biotechs are also advancing promising candidates.

Structure Therapeutics is working on the GLP-1 pill aleniglipron, a potential competitor to Lilly’s Foundayo and Novo’s oral Wegovy. In December 2025, Structure released data from the Phase 2b ACCESS II study, showing that a 120-mg dose of aleniglipron resulted in an 11.3% placebo-adjusted weight reduction at 36 weeks—findings that BMO in a Dec. 8 note called “highly competitive.”

Additional data in March showed that at the 44-week follow-up, average weight loss improved even further to 16.3% on a placebo-adjusted basis.

Structure will show up at ADA with a detailed presentation of ACCESS II, as well as data from the dose-ranging ACCESS study. The biotech will also have posters looking at a lower starting dose of aleniglipron and a combination regimen of the candidate paired with an amylin asset.

Viking Therapeutics is similarly looking to play alongside the industry giants with its dual GLP-1/GIP agonist VK2735, which the biotech is advancing both as a subcutaneous injection and as a daily pill. In his email to BioSpace, Hsieh also named VK2735 as one of the obesity hopefuls likely to catch up to Lilly and Novo, with a chance to potentially overtake Boehringer.

At the recently concluded European Congress on Obesity last month, Viking presented data from the Phase 2 VENTURE-Oral study, touting placebo-adjusted weight reduction of up to 10.9% for patients on oral VK2735 at 13 weeks. Meanwhile, the weekly subcutaneous injection hit weight loss of up to 13.1% on a placebo-adjusted basis at the same time point, according to Phase 2 data presented in November 2024.

Viking has pushed subcutaneous VK2735 into late-stage development, while the oral formulation is scheduled to enter Phase 3 studies later this year.

https://www.biospace.com/drug-development/obesity-davids-and-goliaths-face-off-at-ada-2026