Small-Cap Healthcare: The Biggest Loser

December 12, 2023 | Eddie Arrieta, Associate Research Analyst

This chart description is for illustrative purposes only and its accuracy cannot be guaranteed. Please see full disclosures at end of PDF document in the web post. General description: Three-line chart displaying cumulative returns of Novo Nordisk, Eli Lilly, and the Russell 2000 Healthcare Sector. Chart subtitle: GLP-1 drugs have become a focus of investors this year, which has benefitted large-cap pharmaceutical companies but negatively impacted the small-cap healthcare space. Chart source: Bloomberg as of December 11, 2023. Chart visual description: Y-axis labeled “Cumulative Return” and ranges from -30% to +80%. X-axis is labeled in monthly increments at month end, beginning with 12/31/22 and ending at 11/20/23. Novo Nordisk is plotted in slate line, Eli Lilly is plotted in dark orange, and Russell 2000 Healthcare Sector in light blue. A dotted line at is overlaid in early August and labeled “August earnings calls.” Chart data description: Please contact us for the full dataset. Generally, Novo Nordisk and Eli Lilly have had positive performance this year, with most recent at 42.8% and 59.6% respectively. The Russell 2000 Healthcare Sector has seen less growth, and overall has been negative since early September, with a low point at -18.9% at the end of October and a most recent datapoint at -3.3%. End chart description. See disclosures at end of document.

Innovations in the field of weight loss are nothing new, as the first generation of products designed to provide individuals with slimmer waistlines were first developed nearly 100 years ago. These products primarily consisted of stimulants, such as dinitrophenol and methamphetamine. The healthcare industry has since moved on from such stimulants as other products have come to market in recent time, including Saxenda by Novo Nordisk. Saxenda, which was approved by the U.S. Food and Drug Administration (FDA) in 2014, represents the first GLP-1 product designed for weight loss management. A second Novo Nordisk product, Wegovy, was approved by the FDA in 2021. Indeed, these and other GLP-1s have been on the market for several years now, however, investors took particular note of these products in 2023, which led to notable impacts across the healthcare space in terms of equity performance.

On the positive side, many large-cap pharmaceutical companies, including Novo Nordisk and Eli Lilly, have benefitted from increased investor focus on GLP-1s this year. In August, new guidance related to these drugs was issued during the earnings calls for both businesses, fueling upticks in their respective share prices as shown in this week’s chart. Specifically, Novo Nordisk reported sales growth of 157% for its obesity-related drugs, with North American operations growing sales for these products by a staggering 207%. Elli Lilly also shared positive news on its August earnings call with investors, including robust sales growth of Mounjaro, the company’s diabetes drug. This growth led to investor optimism related to the potential of Elli Lilly’s weight loss management drug Zepbound, which was ultimately approved by the FDA in November. As of the time of this writing, the share prices of Novo Nordisk and Eli Lilly are up roughly 42.8% and 59.6%, respectively, on a year-to-date basis. Negative impacts stemming from increased investor focus on GLP-1s were primarily observed within the small-cap space, specifically the healthcare sector of the Russell 2000 Index. To that point, the weight loss products detailed above caused some investors to question the extent to which other healthcare products and services, including orthopedic surgeries and sleep apnea machines, would be utilized by new and existing patients going forward. This uncertainly led to a decline of the healthcare sector of the Russell 2000 Index of roughly 25% in the three months leading into November, though the space has recovered some of those losses within the last several weeks.

Even though GLP-1 drugs have been available in the market for some time, their adoption for weight loss management remains nascent and has investors excited for the future of the healthcare space. Time will tell how successful and disruptive these products will ultimately prove, and Marquette will continue to monitor the impact of these drugs on equity markets, both broadly and at the sector level.

Print PDF

Eddie Arrieta
Associate Research Analyst

Get to Know Eddie

The opinions expressed herein are those of Marquette Associates, Inc. (“Marquette”), and are subject to change without notice. This material is not financial advice or an offer to purchase or sell any product. Marquette reserves the right to modify its current investment strategies and techniques based on changing market dynamics or client needs.

Related Content

Combination column and line chart showing increase in non-renewables and renewables in net installed capacity (GW) in columns and share of new electricity generating capacity by renewables (line) annually since 2005. Renewables ave seen a marked increase in recent years (183.95GW in 2019 to 691.94GW in 2025). Renewable Share was at 86% for 2025. For full dataset, please contact marquettemarketing@marquetteassociates.com.

05.11.2026

A Renewed Focus on Renewables

In addition to the humanitarian toll of the conflict in Iran, the world is currently confronting the impact that trade…

Stacked column chart showing Weight in S&P 500 Index in 1985, 1995, 2005, 2015, and 2025 for top 10 companies at that time, with companies stacked for each year by weight. From 1985-2015, top 10 weight ranged from 17.6% to 21.1%, but 2025's weight was 40.6%. Company makeup changes over time, with no companies from 1985/1995 categories in 2025. For full dataset, please contact marquettemarketing@marquetteassociates.com.

05.04.2026

This Too Shall Reconstitute

Rooted in medieval Persian Sufi thought, the adage “this too shall pass” speaks to the fleeting and impermanent nature of…

Three-line chart comparing cumulative returns for MSCI EM Latin America Index, MSCI EAFE Index, and S&P 500 Index, Jan 1, 2026 through April 24, 2026. Dashed line at February 28 demarcates U.S. strikes on Iran. While all three indices dipped after war began, Latin America Index was higher to begin with and remains high. Most recent data point (4/24) for Latin America is 20.36%, EAFE is 5.7%, and S&P 500 is 5.06%. For full dataset, please email marquettemarketing@marquetteassociates.com.

04.27.2026

Let’s Hear It for Latin America

Latin American equity markets have shown remarkable strength in 2026. After a strong start to the year, the MSCI Emerging…

04.23.2026

We’ve Seen This Before

Diversify. Rebalance. Stay invested. Every one of these letters has concluded with that same advice in some shape or form….

Two-line chart showing unemployment rate for All U.S. Workers and Recent College Graduates (Ages 22–27), 12/31/05 to 12/31/25. Up to 2020 period, Recent College Graduates generally had a lower unemployment rate than all U.S. workers category, but since then, the opposite has been true. Lines begin at ~3% to ~5% range in 2005, rose during Global Financial Crisis of '07-'09 to near 10% for All, ~7% for Grads, then both lines declined fairly steadily up to COVID. Peak for both series was 6/30/20, with All at 12.8% and Grads at 13.4%. Most recent data for 12/31/25 is ~4% for All and ~5.5% for Grads. For full dataset, please email marquettemarketing@marquetteassociates.com.

04.20.2026

The Sorrows of Young Workers

Entry-level jobs have traditionally served as the primary bridge between education and stable employment, offering young workers a foothold from…

Combination column and line chart showing Net Duties Received (columns, left-hand axis, ranging $0 to $35 billion) and Effective Tariff Rate (line, right-hand axis, ranging 0 to 12%) monthly, from April 2024 through February 2025. Up to March 2025, both data series held relatively steady, averaging around $7B for net duties received, and 2% for effective tariff rate, but both series have quadrupled since then. Most recent (Feb-26) is $26B and 8%. Please contact us for the full data set at marquettemarketing@marquetteassociates.com.

04.13.2026

Liberation Day: One Year Later

On April 2, 2025, President Donald Trump announced a sweeping set of tariffs on imports into the United States. Dubbed…

More articles

Subscribe to Research Email Alerts

Research Email Alert Subscription

Research alerts keep you updated on our latest research publications. Simply enter your contact information, choose the research alerts you would like to receive and click Subscribe. Alerts will be sent as research is published.

We respect your privacy. We will never share or sell your information.

Thank You

We appreciate your interest in Marquette Associates.

If you have questions or need further information, please contact us directly and we will respond to your inquiry within 24 hours.

Contact Us >