Healthier horizons: weight loss in 2024

Issue 77 l Eka’s Weekly Roundup (31 May 2024)

May 31, 2024

1. The context is clear: today’s obesity treatments aren’t reaching everyone who need them, and it’s a big problem

Over 1m people in England qualify for bariatric surgery, but less than 100,000 receive treatment in any one year.

Obesity rates peak in the US at >33%, or 1 in 3 people. The UK is marginally better but by no means well off, with 1 in 4 people being obese.

2. The causes of obesity are complex, and as a result aren’t easily solvable by only one solution

We think a lot about the social determinants of health and their impact on health outcomes. Many underlying factors within obesity and weight are tied to socioeconomic demographics, food environments, and other deeply entrenched factors. For example, stores in high-income neighbourhoods are >3x more likely to stock recommended diet items.

This has to start at the very foundational level of wellbeing, and includes vectors like housing, access to employment, and education.

3. This complex approach may include medication, changing food environments, and other behavioural changes

We really like Nesta’s graphic representation below around how GLP-1s are only one part of the overall strategy to improve our health.

If you take away one thing from this newsletter, it’s definitely this chart below.

There is already evidence of large food producers being forced to shift their strategy. Just last week, Nestle announced its new product range to support GLP-1 users.

Early signs suggest GLP-1 users are swapping out unhealthy foods for healthy foods, though there is still debate on how long this behaviour change can last.

4. GLP-1s are one possible tool in the broader health strategy

12% of US adults have now tried a GLP-1 agonist. The majority of these had diabetes and/or heart disease, but the % of those who are using GLP-1s solely for weight loss is increasing.

Source. There is no comparable data on UK penetration that we have found to date (let us know if this exists!).

The early signs of GLP-1 impact on cardiovascular health are encouraging. In high-risk non-diabetic populations, taking semaglutide (a type of GLP-1) for 30 months correlated with a -20% reduction in major cardiovascular events.

Today, GLP-1s are not cheap… but the problem isn’t cheap either. The WEF called out unsustainable pricing of current GLP-1 medication earlier in 2024.

Medicare spending has gone up over 100x in the last five years on these drugs as the use case has changed.

Source. No similar UK statistics were found when preparing this piece, but let us know if you have estimates of NHS spend on GLP-1s.

Yes, it’s expensive, but the Nesta also models the costs of obesity if left untreated in the system (below)

5. However, there are real & material side effects from these synthetics and GLP-1s and broader behaviour management will need to be considered

These side-effects include pancreatitis, bowel obstruction, and gastroparesis. These risks must be considered by patients who are thinking of using the drugs for weight loss, as the tradeoff might differ from that of those who use them for diabetes.

According to Boots, nausea is another common side effect impacting around 1 in 10 users of GLP-1 medication.

Innovators like Embla and Yazen are piloting new ways of combining GLP-1 with behaviour change. Yazen combines medication with Doctors and psychologists for weight loss.

Similarly, Embla shows an average 15-20% weight loss during its period which combines medication and coaching.

Incumbents are going to have to change in order to keep up. The butterfly effect here can already be seen in early public markets data across consumer discretionary and staples.