We are living through one of the most consequential moments in the history of obesity medicine. GLP-1 drugs work better than almost anything we've had before—producing 15–20% weight loss, treating cardiovascular disease, sleep apnea, kidney disease, and osteoarthritis along the way (did I miss any?). The drugs in the pipeline may be even more impressive.
And yet nearly 85% of patients without diabetes stopped taking GLP-1s within two years. The drugs work but keeping patients on them is a different problem entirely!
Meanwhile, a $177 billion industry has exploded around these medications—telehealth prescribing centers, digital coaching platforms, pharma going direct-to-consumer, compounding pharmacies flooding the market with unregulated copies of Wegovy. Hims & Hers ran a Super Bowl ad for compounded semaglutide, then got referred to the DOJ. 23andMe bought a telehealth company for $400 million and sold it for $10 million eighteen months later. Eli Lilly launched a platform to sell Zepbound directly to employers—cutting out insurers, PBMs, and the prior authorization circus entirely.
I've been tracking this space since I was a baby med student. A lot has changed. I'm sharing my full updated analysis—prevalence projections, the GLP-1 pipeline, coverage gaps across Medicare and Medicaid, digital health business models, and my own take on whether any of this actually moves the needle at a population level.
