The Health Care Select Sector SPDR Fund (NYSEARCA:XLV) is the default healthcare allocation for millions of investors, and for good reason. XLV owns the entire S&P 500 healthcare complex in one ticker: insurers, device makers, biotech, and Big Pharma. It has returned 21.61% over the past year and 159.84% over ten years. If the reason for holding XLV is simply broad sector exposure, it does that job well. The reason to look past it is narrower: investors who bought XLV specifically to participate in the GLP-1 obesity boom are getting a heavily diluted version of that trade, and a small thematic fund, the LeaderShares Dr. Bill Grace Global Obesity ETF (NYSEARCA:OZEM) offers a more direct route.
Why XLV Waters Down the Obesity Trade
The GLP-1 franchise is concentrated in two companies: Eli Lilly (NYSE:LLY | LLY Price Prediction) and Novo Nordisk. Lilly’s Q1 2026 results underline the scale. Revenue reached $19.8 billion, up 55.5% year over year, with Mounjaro at $8.66 billion (+125%) and Zepbound at $4.16 billion (+80%). Non-GAAP EPS came in at $8.55. CEO David Ricks said, “2026 is off to a strong start, we delivered 56% revenue growth… raised full-year revenue guidance by $2 billion.” The FDA has since approved Foundayo (orforglipron), the first oral GLP-1 pill with no food or water restrictions.
Lilly’s stock reflects this: shares are up 54.8% over the past year and 433.36% over five years, with a market cap of roughly $1.07 trillion. Yet within XLV, Lilly is the largest single position, accounting for roughly 16% of the fund. While that provides significant exposure, the remaining 84% of the fund is spread across insurers, device makers, and legacy pharma. For investors whose core thesis is specifically the metabolic-disease franchise, the heavy allocation to non-obesity segments can dampen the impact of Lilly’s specific trajectory.”
What OZEM Actually Owns
If you’re looking at the obesity and GLP-1 supply chain, OZEM is the fund that comes up most often. According to its March 31, 2026, NPORT filing, Lilly is its largest holding at 16.10% of net assets, with Novo Nordisk right behind at 13.13%. Put those two together, and the two drugmakers that dominate the category represent 29.23% of the fund. For context, that is a materially higher single-theme weighting than either name individually delivers in XLV
The remainder is a mix of GLP-1 developers and adjacencies: Viking Therapeutics at 5.29%, Zealand Pharma at 3.60%, Structure Therapeutics at 2.38%, plus Chinese biotech exposure through Innovent, Ascletis, and CSPC. Broader pharma names such as Pfizer (7.56%) and Amgen (3.94%) round out the book. The fund also carried a 12.89% cash position at the March filing, which can dampen performance during rapid market rallies, though it provides the manager with the liquidity needed to navigate the extreme volatility typical of small-cap biotech stocks.
The Tradeoffs Are Real
The swap involves real tradeoffs. OZEM returned 32.8% over the past year, better than XLV’s 21.61%, but well behind Lilly’s 54.8%. Novo Nordisk shares fell 25.53% over the same period, and that weighting, combined with the cash drag and small-cap biotech volatility, explains the gap. Year-to-date, OZEM is actually down 1.18% while XLV is up 5.51%
Other considerations: OZEM’s total net assets sit at just $51.4 million, which means wider bid-ask spreads and closure risk if inflows stall. Thematic ETFs also carry higher expense ratios than sector SPDRs, and Lilly itself faces pricing pressure, with realized prices down and Mounjaro added to China’s national reimbursement list. A prospectus review is warranted before committing capital
How to Think About the Swap
PineBridge’s 2026 equity outlook notes that “In 2026, we will see the expansion of obesity treatments to the broader population as lower-cost, easier-to-administer oral pill versions of the current injectable GLP-1s are introduced to the market.” That backdrop supports thematic exposure, but the vehicle matters
For an investor whose XLV position is designed to capture the obesity story, three paths are available. Owning Lilly directly has delivered the cleanest exposure by a wide margin. A partial OZEM sleeve alongside XLV preserves diversification while raising the weighting to GLP-1 developers globally. Keeping XLV as-is remains defensible for anyone who wants the whole sector rather than one theme within it. In a taxable account, trimming XLV to fund the switch would realize gains that should be weighed against the incremental exposure, since XLV itself already owns Lilly. The decision hinges on how narrow the reader wants the bet to be.
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