26th Mar 2025
Investor attention to obesity and diabetes treatments has grown rapidly, driven by significant breakthroughs in drug development and broader awareness of the healthcare and economic impact of these conditions. Leading pharmaceutical companies such as Eli Lilly and Novo Nordisk continue to report major advances and accelerating revenues, suggesting robust potential for 2025 and beyond.
Expanding Market Projections and Key Drivers
Surging Demand for GLP-1 Analogues
According to a November 2024 GlobeNewswire report, the global market for GLP-1 analogues—medications often prescribed for both type 2 diabetes and obesity—could soar from about USD 56.62 billion in 2025 to USD 322.85 billion by 2034, growing at a 21.3% CAGR. These drugs have been a focal point in the obesity and diabetes space because of their effectiveness in regulating blood sugar, aiding weight management, and even improving certain cardiovascular outcomes in recent clinical trials.
Obesity as a Chronic Disease Requiring Long-Term Care
An IQVIA analysis suggests that obesity is moving toward being recognized and treated as a chronic condition, with potential annual global spending on prescription obesity treatments reaching USD 131 billion by 2028. This shift is underpinned by rising obesity rates worldwide and a deeper understanding of obesity’s link to comorbidities such as cardiovascular disease, obstructive sleep apnea, and more. It is also supported by an increasingly vocal medical consensus that weight-management drugs can produce meaningful, lasting health benefits when properly prescribed and monitored.
Technology-Enabled Diabetes Management
In the diabetes sphere, continuous glucose monitoring (CGM) technologies and integrated insulin delivery solutions are gaining traction. IDTechEx forecasts the global market for diabetes management technologies—covering devices such as insulin pumps, patch pumps, and CGMs—will continue to expand through 2035. Digital monitoring tools, telemedicine platforms, and connected devices are making it easier for patients to control blood glucose levels and, in some cases, lose weight as part of integrated obesity and diabetes management.
Novo Nordisk: Semaglutide Expansion and Higher-Dose Trials
Novo Nordisk has pioneered several GLP-1 analogues, including Ozempic (for type 2 diabetes) and Wegovy (for obesity). In January 2025, Reuters reported that a higher-dose version of Wegovy showed 20.7% average weight reduction in late-stage trials, underscoring the continued innovation of its portfolio. Novo Nordisk also posted a 22% increase in quarterly sales in early 2024, indicating high ongoing demand.
The company’s strategic acquisitions, such as the recent purchase of three fill-finish sites from Novo Holdings A/S, are set to bolster its manufacturing capabilities, ensuring a steady supply of its blockbuster drugs and supporting further market penetration. Additionally, Novo Nordisk’s ongoing FLOW kidney outcomes trial with semaglutide 1.0 mg demonstrates the drug’s potential beyond weight loss, addressing critical kidney-related complications in diabetic patients, thereby expanding its therapeutic applications and market reach.
Eli Lilly: Focus on Tirzepatide and Diversified Pipeline
Eli Lilly’s tirzepatide (marketed under different brand names for diabetes and obesity indications) remains a significant driver of the company’s revenue. For 2025, Lilly has provided revenue guidance of USD 58 billion to USD 61 billion, a notable jump from expected 2024 figures. This substantial growth projection is fueled by the robust sales of tirzepatide, particularly with its flagship products Mounjaro® and Zepbound®, which have shown impressive efficacy in both glycemic control and weight reduction.
In the first quarter of 2024, Mounjaro® sales climbed by about 114% year-over-year, demonstrating strong market acceptance and demand. Analysts consider Lilly’s next-generation obesity and diabetes treatments—along with its robust oncology and immunology pipeline—a reason for rising sales, though the company advises that manufacturing capacity and broader market dynamics may affect quarterly numbers.
Additionally, Eli Lilly is expanding its product offerings with upcoming oral formulations of tirzepatide, which are expected to enhance patient convenience and adherence, potentially capturing a larger market share. The company’s diversified pipeline also includes promising oncology treatments, such as Verzenio®, which generated nearly USD 4 billion in sales in Q3 2024, and ongoing acquisitions like the recent purchase of STX-478 from Scorpion Therapeutics, further solidifying its position in multiple high-growth therapeutic areas.
Competitive Landscape and Market Entries
Estimates from Morningstar suggest that at least 16 new weight-management drugs are set to arrive by 2029, potentially capturing USD 70 billion of the GLP-1 market. In addition, Reuters has reported that upcoming entrants—Amgen, Boehringer Ingelheim, Pfizer, and others—are looking to challenge the incumbents. Increased competition may pressure prices, but it is also likely to expand patient access and drive therapeutic innovation.
2025 Outlook: Positive Yet Complex
Continued Growth but Nuanced Market Dynamics
Across diabetes and obesity treatment spaces, forecasts consistently point to sustained growth. A Business Research Company report projects the GLP-1 receptor agonist market may rise from USD 14.22 billion in 2025 to USD 17.72 billion by 2029, growing at a 5.7% compound annual growth rate (CAGR), which represents the annualized rate of return or growth over a specified period, assuming profits are reinvested each year.
However, varied payer coverage, regulatory frameworks, and affordability considerations might influence adoption rates. Some experts see out-of-pocket payment trends driving initial uptake in regions where public or private insurers are less inclined to cover obesity medications, especially when prescribed primarily for weight loss.
Economic and Clinical Value Proposition
Beyond raw revenue projections, the ability of these therapies to address broader healthcare costs—diabetes complications, hospitalization, cardiovascular diseases—is fueling reimbursement arguments. Trials like Novo Nordisk’s SELECT study and ongoing outcomes research on cardiac, renal, and other benefits from improved glycemic control and weight reduction will continue shaping payer stances, which, in turn, impact the commercial potential.
Risks and Research Imperatives
From a cautious perspective, the heightened interest in these therapies calls for diligence. Manufacturing scalability, supply chain reliability, potential side effects, and real-world evidence all require close monitoring. According to IQVIA, real-world data collection on the long-term use of GLP-1 analogues and combination therapies will be critical to understanding the full clinical and economic outcomes.
Ongoing Transformation Offers Opportunities and Responsibilities
The year 2025 stands as a critical juncture for the obesity and diabetes treatment market. Breakthrough GLP-1 medications, emerging oral formulations, and integrated device technologies are driving both financial expansion and meaningful patient outcomes. The positive forecasts from top research firms serve as a guiding light for those assessing this segment—but any investment or strategic move should be grounded in meticulous research, due diligence, and ongoing risk management.
Stay tuned with Defiance ETFs if you are interested in gaining comprehensive insights into the transformative healthcare sector, including companies at the forefront of diabetes and obesity treatment innovation.
Important Disclosures
The funds attempt to provide daily investment results that correspond to two times (200%) the share price performance of an underlying exchange-traded fund (an “Underlying Security”). The Funds are not intended to be used by, and are not appropriate for, investors who do not intend to actively monitor and manage their portfolios. The Funds are very different from most mutual funds and exchange-traded funds.
The Funds’ investment adviser will not attempt to position a Fund’s portfolio to ensure that the Fund does not gain or lose more than a maximum percentage of its net asset value on a given trading day. As a consequence, if an Underlying Security’s share price referenced by a Fund decreases by more than 50% on a given trading day, the corresponding Fund’s investors could lose all of their money.
LLYX and NVOX Disclosure: Defiance ETFs LLC is the ETF sponsor. The Funds’ investment adviser is Tidal Investments, LLC (“Tidal” or the “Adviser”).
The Funds’ investment objectives, risks, charges, and expenses must be considered carefully before investing. The prospectus and summary prospectus contain this and other important information about the investment company. Please read the prospectus and / or summary prospectus carefully before investing. Hard copies can be requested by calling 833.333.9383.
Investing involves risk. Principal loss is possible. As an ETF, the funds may trade at a premium or discount to NAV. Shares of any ETF are bought and sold at market price (not NAV) and are not individually redeemed from the Fund. A portfolio concentrated in a single industry or country, may be subject to a higher degree of risk.
There is no guarantee that the Fund’s investment strategy will be properly implemented, and an investor may lose some or all of its investment.
Total return represents changes to the NAV and accounts for distributions from the fund.
Median 30 Day Spread is a calculation of Fund’s median bid-ask spread, expressed as a percentage rounded to the nearest hundredth, computed by: identifying the Fund’s national best bid and national best offer as of the end of each 10 second interval during each trading day of the last 30 calendar days; dividing the difference between each such bid and offer by the midpoint of the national best bid and national best offer; and identifying the median of those values.
Underlying Security Risk. The underlying security is subject to many risks that can negatively impact the Fund.
Indirect Investment in LLY Risk. LLY is not affiliated with the Trust, the Fund, or the Adviser, or their respective affiliates and is not involved with this offering in any way and has no obligation to consider your Shares in taking any corporate actions that might affect the value of Shares.
LLY Trading Risk. The trading price of LLY may be subject to volatility and could experience wide fluctuations due to various factors. The pharmaceutical industry, including LLY, operates within a market that has historically witnessed significant price and volume fluctuations, sometimes unrelated to the companies’ operating performance. Short sellers may also play a significant role in trading LLY, potentially affecting the supply and demand dynamics and contributing to market price volatility.
LLY Performance Risk. LLY may fail to meet its publicly announced guidelines or other expectations about its business, which could cause the price of LLY to decline. LLY provides guidance regarding its expected financial and business performance, such as projections regarding sales and production, as well as anticipated future revenues, gross margins, profitability and cash flows.
Indirect Investment in NVO Nordisk Risk. NVO Nordisk is not affiliated with the Trust, the Fund, or the Adviser, or their respective affiliates and is not involved with this offering in any way and has no obligation to consider your Shares in taking any corporate actions that might affect the value of Shares.
NVO Trading Risk. The trading price of the Underlying Security may exhibit volatility and significant fluctuations due to various factors inherent in the pharmaceutical industry. This sector is susceptible to price and volume fluctuations, which may not always correlate with the companies’ operational performance. Short sellers may exert influence on trading dynamics, potentially impacting supply and demand dynamics and contributing to market price volatility.
NVO Performance Risk. NVO may fail to meet its publicly announced guidelines or other expectations about its business, which could cause the price of NVO to decline. NVO provides guidance regarding its expected financial and business performance, such as projections regarding sales and production, as well as anticipated future revenues, gross margins, profitability and cash flows.
Pharmaceutical Industry Risks. Pharmaceutical research and development are very costly and highly uncertain; pharmaceutical companies may not succeed in developing, licensing, or acquiring commercially successful products sufficient in number or value to replace revenues of products that have lost or will lose intellectual property protection or are displaced by competing products or therapies. These companies and their products face intense competition from multinational pharmaceutical companies, biotechnology companies, and lower-cost generic and biosimilar manufacturers, and such competition could have a material adverse effect on their business.
Fixed Income Securities Risk. When the Fund invests in fixed income securities, the value of your investment in the Fund will fluctuate with changes in interest rates. Typically, a rise in interest rates causes a decline in the value of fixed income securities owned by the Fund.
Leverage Risk. Leverage may increase the risk of loss and cause fluctuations in the market value of the Fund’s portfolio to have disproportionately large effects or cause the NAV of the Fund generally to decline faster than it would otherwise.
Derivatives Risk. Derivatives may be more sensitive to changes in market conditions and may amplify risks.
Foreign and Emerging Markets Risks. Investments in foreign securities may involve risks such as social and political instability, market illiquidity, exchange-rate fluctuations, a high level of volatility and limited regulation. Investing in emerging markets involves different and greater risks, as these countries are substantially smaller, less liquid and more volatile than securities markets in more developed markets.
Effects of Compounding and Market Volatility Risk. The Fund has a daily leveraged investment objective and the Fund’s performance for periods greater than a trading day will be the result of each day’s returns compounded over the period, which is very likely to differ from the Fund performance, before fees and expenses.
Single Issuer Risk. Issuer-specific attributes may cause an investment in the Fund to be more volatile than a traditional pooled investment which diversifies risk or the market generally. The value of the Fund, which focuses on an individual security, may be more volatile than a traditional pooled investment or the market as a whole and may perform differently from the value of a traditional pooled investment or the market as a whole.
Swap Agreements. The use of swap transactions is a highly specialized activity, which involves investment techniques and risks different from those associated with ordinary portfolio securities transactions. These risks may prevent the Fund from achieving its leveraged investment objective, even if the Underlying Security later reverses all or a portion of its movement.
Counterparty Risk. The Fund is subject to counterparty risk by virtue of its investments in derivatives which exposes the Fund to the risk that the counterparty will not fulfill its obligation to the Fund.
Non-Diversification Risk. Because the Fund is “non-diversified,” it may invest a greater percentage of its assets in the securities of a single issuer or a smaller number of issuers than if it was a diversified fund. As a result, a decline in the value of an investment in a single issuer or a smaller number of issuers could cause the Fund’s overall value to decline to a greater degree than if the Fund held a more diversified portfolio.
New Fund Risk. As of the date of this prospectus, the Fund has no operating history and currently has fewer assets than larger funds. Like other new funds, large inflows and outflows may impact the Fund’s market exposure for limited periods of time.
Diversification does not ensure a profit nor protect against loss in a declining market.
Brokerage Commissions may be charged on trades.
LLYX and NVOX are distributed by Foreside Fund Services, LLC.
Current Fund Holdings (as of 02/05/2025)
For LLYX:
- Eli Lilly & Co SWAP MAREX – L (147.58%)
- Eli Lilly & Co SWAP Cantor – L (44.59%)
- Eli Lilly & Co (7.87%)
- First American Government Obligations Fund (4.67%)
- Cash & Other (-104.71%)
For NVOX:
- Novo-Nordisk A S ADR SWAP – L (109.79%)
- Novo-Nordisk A/S-Spons ADR NOMURA (23.38%)
- First American Government Obligations Fund (3.60%)
- Novo Nordisk A/S (0.74%)
- Cash & Other (-126.27%)
Holdings are subject to change. For current fund holdings, please visit:
- LLYX Holdings: www.defianceetfs.com/llyx/holdings
- NVOX Holdings: www.defianceetfs.com/nvox/holdings
Current holdings as of 02/05/2025. Visit the fund website for the most current holdings information.
